Patten Sf

Uterine sarcomas: natural history, treatment and prognosis.

Seventy‐three documented cases of uterine sarcoma were treated at the University of Rochester Strong Memorial Hospital from 1955 to 1975. Thirty‐three patients (45%) were treated with surgery only [S], 31 (43%) with surgery and radiation [S + R], and 9 (12%) with radiation alone [R]. A review of the literature with over 900 cases was also performed. Several important issues regarding these rare tumors are addressed, such as the prognosis of the several histologic variants, the role of radiation therapy in their management and what perhaps may constitute a comprehensive therapeutic approach. These tumors are characterized by local aggressiveness and early widespread dissemination. There are three main histologic varieties: mixed mesodermal sarcoma (MMS), leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS). Of the three, MMS was the most common, seen in 60% of the cases; LMS occurred in younger patients and tended to be localized to the uterine corpus (Stage I) in 80% of the instances. Tumor extent at diagnosis was the main prognosticator for survival in uterine sarcomas; patients with Stage I tumors had a significantly lower incidence of recurrences, as well as a better survival than patients with more advanced tumors. Stage‐by‐stage, there were no significant differences in survival among the pathologic variants. To ensure adequate staging, a surgical procedure is recommended first whenever possible. Adjuvant radiation therapy significantly improved disease controlability in the pelvis, although it may not have dramatically affected the final outcome. In addition to pelvic irradiation, some form of systemic therapy should be administered to decrease distant metastases.

Uterine sarcomas. Analysis of failures with special emphasis on the use of adjuvant radiation therapy

There were 47 failures among 73 verified cases of uterine sarcoma reported at the University of Rochester Tumor Registry from 1955 to 1975; they constitute the subject of this report. Of 33 patients initially treated with surgery only [S], 19 patients (58%) failed; 20 of 31 patients (65%) treated with surgery and radiation [S + R] failed; 8 of 9 patients (89%) treated by radiation alone [R] failed. According to pathology, failures occurred in 33 of 44 patients (75%) with mixed mesodermal sarcomas (MMS), 7 of 20 patients (35%) with leiomyosarcoma (LMS), 4 of 6 patients with endometrial stromal sarcomas (ESS), and 3 of 3 patients with other types of sarcoma. Once corrected by stage, there were no significant differences in failure rates, spread patterns or survival among these main histologic variants. Twenty of 41 patients (56%) with Stage I tumors failed with an average failure time of 32 months. Twenty‐seven of 32 patients (84%) with Stages II, III, and IV tumor failed; their average failure time was only 9 months. The mean failure time for both the patients treated with [S] and [S + R] was 22 months; for patients treated by [R] it was 3 months. Isolated pelvic failures constituted only 4% of all failures, failures both in the pelvis and in distant sites, 49%, and distant metastases, 47%. There was a marked decrease in pelvic failures in patients treated with [S + R] when compared to those who received [S]. Adjuvant radiation proved to increase tumor control in the pelvis but did not influence the final outcome because over 90% of all failures developed distant spread outside the pelvis. The most common distant failures were in the upper abdomen (mainly omentum and peritoneum) and in the lungs. Lung metastases alone was the only site of failure in 16% of the instances. A comprehensive treatment approach based on the spread and failure patterns will be proposed.

The AutoPap 300 QC system multicenter clinical trials for use in quality control rescreening of cervical smears

The AutoPap 300 QC System is an automated device for the analysis of conventionally prepared cervical cytology slides. The AutoPap System selects an enriched population of cases for human quality control (QC) review. The device assigns a score based on the likelihood that a slide is abnormal. Cases are selected for QC rescreening that have scores exceeding a preset threshold corresponding to approximately the top 10% (or greater) of scores.

Enhancing the Performance of the AutoPap 300 QC System with Optimal Staining and Presentation of Cervical Smears

OBJECTIVE To optimize the staining and presentation of slides for the AutoPap 300 QC System, an automated cytology screening system which examines conventionally prepared cervical smears, and to assess subsequent scanning and scoring rates and compare them to those of laboratories not adopting these changes. STUDY DESIGN In this study, procedures were developed for optimal presentation and staining of slides for the AutoPap System in response to observations made in preclinical trials. Three thousand eight hundred fifty-five slides were then submitted to the device for analysis in a prospective, blind, clinical evaluation study. The scanning and scoring rates were compared to those of a cohort of 12,525 slides that were analyzed in other laboratories which had not adopted these procedures. RESULTS Two hundred forty (6.2%) slides failed scanning due to physical defects. An additional 70 slides (2.0% of scanned slides) did not complete scoring due to staining limitations. The laboratories in the clinical trials that had not adopted these preanalytic method changes had higher scanning failure rates due to physical limitations (15.0%) and incomplete scoring rates due to staining limitations (6.2%). CONCLUSION The present study demonstrated that the performance of the AutoPap 300 is enhanced by meticulous attention to preanalytic staining and presentation procedures.

PROSPECTS FOR AUTOMATED CYTOLOGY

Rescreening of Pap smears using automated devices offers the ability to re-examine Paps initially interpreted as within normal limits and to use cell-sorting technology to increase the detection of missed abnormal smears. Only recently has the development of high-resolution imaging techniques and advances in computer sciences and cell classifiers enabled investigators to achieve sensitivity and specificity levels in automated screening and quality control devices.