John A. Maksem

Group Consensus Reports from the Consensus Conference on Focal Treatment of Prostatic Carcinoma, Celebration, Florida, February 24, 2006

( EPORT OF CONSENSUS GROUP 1: ATHOBIOLOGY OF PROSTATE CANCER: MPLICATIONS FOR FOCAL THERAPY ocal ablative therapy may be reasonable for some atients with prostate cancer; selection factors include variety of clinical and pathologic factors in combiation with informed patient choice. Our group evalated 4 specific pathologic features that may influence his treatment decision. We reviewed the published iterature for applicable studies regarding the natural istory of prostate cancer, multifocality, cancer volme, and accuracy of cancer detection by current ethods. Results were as follows:

PROSTATITIS AND ASPIRATION BIOPSY CYTOLOGY OF PROSTATE

Aspiration biopsy of the prostate is contraindicated when active prostatitis is present. However, we have found prostatitis in 45.2 percent of 250 consecutive aspiration biopsy specimens, confirming that urologists have difficulty in distinguishing prostatitis from carcinoma on a clinical basis. The epithelial changes accompanying prostatitis also may be confused with carcinoma. We review the microscopic features which distinguish prostatitis from carcinoma. Because 14.1 percent of the patients with prostatitis in this study also had carcinoma, repeat follow-up biopsy is necessary if suspicion of carcinoma persists after adequate therapy for prostatitis.

Liquid fixation of endometrial brush cytology ensures a well-preserved, representative cell sample with frequent tissue correlation.

Endometrium was obtained by brushing 656 hysterectomy specimens with a MedScand cytobrush (Hollywood, FL) in order to evaluate linking an easy‐to‐use liquid fixative with brush‐sampling of the endometrium, and to determine the fixatives operating characteristics when applied to brush‐sampling the endometrium. Liquid‐fixed brush‐samples yielded 4 to 6 slides per case, and any one slide accurately represented the case diagnosis. Tissue fragments were incidentally collected by the brush in 524 cases (79.9%), were least often obtained from senile and weakly proliferative endometria, and were always obtained from high‐grade endometrial hyperplasias and carcinomas. With tissue fragments obtained by brush‐sampling, the diagnosis matched that of the hysterectomy endometrium. Cytology alone separated benign endometrium from high‐grade atypical hyperplasia and carcinoma, showing that clinical decision‐making can be based on endometrial brush cytology collected into a liquid fixative. Furthermore, the addition of tissue‐fragment histology increased the diagnostic accuracy of the endometrial brushing procedure to 92.5% overall and 100% for high‐grade atypical hyperplasias and carcinomas. At this juncture, we advocate endometrial brushing as a sensitive and generally specific case‐finding technique; and perhaps as experience teaches us to distinguish low‐grade nontypical hyperplasias from purely physiological changes of the endometrium, it may become accepted as a definitive diagnostic method. The advantages of examining a liquid‐fixed suspension are that 1) because these preparations are homogeneous from slide to slide, with any one slide affording the same diagnosis as any other slide from the same case, the number of slides examined may be greatly reduced, and 2) tissue fragments can be used to quality‐control the cytology diagnosis in the majority of cases, especially in cases of endometrial hyperplasia and carcinoma. Diagn Cytopathol 1996;14:367–373.

Liquid-based cervical-cell collection with brushes and wooden spatulas: A comparison of 100 conventional smears from high-risk women to liquid-fixed cytocentrifuge slides, demonstrating a cost-effective, alternative monolayer slide preparation method

Our purpose was to demonstrate that 17.5‐mm liquid‐based cytocentrifuge circle‐slides made using a Hettich (Andreas Hettich Co., Tuttlingen, Germany) cytocentrifuge are at least as efficacious as conventional smears for detecting cervical abnormalities. One hundred conventional smears were collected with cytobrushes and wooden spatulas from high‐risk women. Both devices were then placed into CytoRich Red (AutoCyte, Inc., Burlington, NC). Cells were concentrated from CytoRich Red by centrifugation and suspended in CytoRich Yellow. Two 17.5‐mm circle‐slides were produced, compared to each other in order to test reproducibility of diagnoses between slides, and compared to conventional slides. Sixty‐five normals, three ASCUS, three LSIL, and two HSIL matched. Overall, cytocentrifugation yielded 27 additional findings among 25 cases. Also, it downgraded one conventional ASCUS to normal (immature metaplasia and chronic inflammation) and one conventional HSIL to normal (transitional cell metaplasia). Cytocentrifugation of 14 conventional normals afforded four ASCUS and 10 LSIL. Cytocentrifugation of 11 conventional ASCUS afforded nine LSIL and two HSIL (one with AIS). One HSIL + AIS was found with a conventional HSIL. Cytobrushes and wooden spatulas can be used to collect material for liquid‐based cervico‐vaginal cytology if they are placed into CytoRich Red. Hettich cytocentrifuge slides were more reliable than conventional smears in presenting well‐dispersed, sharply imaged cells, affording greater diagnostic sensitivity and certainty. Compared to previous split‐sample studies, three different outcomes were noted: 1) the endocervical component was consistently well‐represented; 2) AIS was seen more often in liquid‐based slides; and 3) the liquid‐based slide did not underdiagnose its conventional companion. The liquid‐based preparations downgraded one ASCUS to normal and one conventional HSIL to transitional‐cell metaplasia. Histology correlation of these two cases agreed with the liquid‐based cytology diagnoses, which validates their specificity. These improvements are ascribed to differences in fixation and processing. The low cost, ease of operation, and reusable chambers of the Hettich cytocentrifuge make it a cost‐effective liquid‐based cytology instrument, especially for small to intermediate‐size laboratories. The claims that this paper makes must be proven by additional studies, and test implementation needs to be scrutinized by appropriate regulatory agencies whose standards may vary from country to country. Diagn. Cytopathol. 2000;22:86–91.

Rare epithelial sheets with “cancer-like” nuclei presenting against a background of cytologically normal-appearing endometrial epithelium in endometrial brush samplings: Establishing a differential diagnosis

Liquid‐fixed Tao brush samples showing small quantities (less than 10%) of endometrial epithelial sheets with cancer‐like nuclei that are admixed with benign endometrium raise a concern about false‐positive cytology interpretations. This paper details 7 cases along with the outcomes of three prior papers that touch on the differential diagnosis of “small amounts of atypical epithelium with cancer‐like nuclei.” Liquid‐fixed, cytocentrifuge‐processed Tao brush endometrial samples from 7 women showing “small amounts of atypical epithelium with cancer‐like nuclei” were followed up by hysterectomy. Clinical presentations, diagnostic tests, surgical procedures, and tissue outcomes are detailed. Four women had hyperplastic polyps (three with focal atypical complex hyperplasia, and one with focal atypical simple hyperplasia). One had endometrial microcarcinoma. One had p53‐positive endometrial intraepithelial carcinoma (EIC). One had endometrial intraepithelial neoplasia (EIN). The differential diagnosis of the index cytological finding, “small quantities of endometrial epithelial sheets with cancer‐like nuclei admixed with benign endometrium,” includes hyperplastic polyp, EIC, microcarcinoma/EIN, and carcinoma metastatic to the endometrium. Combining endometrial brushing, endovaginal sonography/sonohysterography, and selective immunostaining may be useful for both detecting and sorting out these lesions. Diagn. Cytopathol. 1999;21:378–386.