Objective To explore the diagnostic accuracy of urine liquid-based cytology(LBC)for diagnosis of urothelial carcinoma(UC).Methods A total of 603 cases in our department from January 2005 to July 2007 were subject to urine liquid-based cytology test(LBC)and followed by histological examination.Using the histological appearance as the gold standard,the accuracy of LBC test was evaluated.Results A total of 436 cases with histological diagnoses were selected.There were 274 cases of UC and 61 cases of other malignant tumors of urinary system.The sensitivity,specificity and accuracy of urine LBC test for malignant tumors were 61.5%,86.5% and 67.1%,respectively.The positive predictive value and negative predictive value were 94.1% and 39.2%,respectively.The sensitivity of urine LBC test for UC and non-urothelial malignant tumors were 68.6% and 29.5%,respectively.The sensitivity for UC Was significantly higher than that for non-urothelial malignant tumors.The diagnostic sensitivity of urine LBC test for UC G1,G1-2;G2,G2-3 and G3 was 53.3%,74.5% and 90.6%,respectively.The diagnostic sensitivity of urine LBC was increased with the increacment of histological grade of UC.Conclusions The sensitivity of urine LBC test for high grade UC is high and has a good clinical value.However,for the diagnosis of low grade UC,the sensitivity of LBC test is low and adjuvant test is needed to improve it.

OBJECTIVETo investigate the value of the liquid-based cytology (LBC) of brushing specimens obtained via fiberoptic bronchoscopy for clinical diagnosis of lung cancer.

METHODSWe retrospectively analyzed the LBC cases in our hospital from January 2011 to May 2012, and evaluate its role in the diagnosis of lung cancer.

RESULTSThe clinical data of a total of 4 380 cases were reviewed and 3 763 of them had histopathological or clinical follow-up results (including 3 306 lung cancer cases and 457 benign lesion cases). The sensitivity, specificity, and accuracy of LBC diagnosis for lung cancer were 72.4% (2 392/3 306), 99.3% (454/457) and 75.6% (2 846/3 763), respectively. Of the 1 992 lung cancer cases diagnosed by brushing LBC, 528 cases (26.5%) were failed to take forceps biopsy and 113 cases (5.7%) showed negative forceps biopsy results. The accurate rate of subtyping of LBC for non-small cell carcinoma and small cell carcinoma was 99.0% (1 487/1 502) (P < 0.001). Take the resection histopathology as gold standard, the accurate rates of subtyping squamous cell carcinoma, adenocarcinoma and small cell carcinoma by LBC were 95.6% (351/367), 95.6% (351/367) and 100% (367/367), respectively, (P < 0.001). The accurate rates of subtyping of squamous cell carcinoma, adenocarcinoma and small cell carcinoma by forceps biopsy were 97.0% (293/302), 97.4% (294/302) and 99.7% (301/302), respectively, (Kappa = 0.895, P < 0.001). There was no significant difference in subtyping respectively between forceps biopsy and brushing LBC (P > 0.05).

CONCLUSIONSFiberoptic bronchoscopic brushing liquid-based cytology can significantly improve the detection rate of lung cancer, and have a high specificity and accurate rate of subtyping. It is an effective tool for the diagnosis and subtyping of lung cancer.

Adenocarcinoma ; pathology ; Biopsy ; instrumentation ; methods ; Bronchi ; Bronchoscopy ; methods ; Carcinoma, Non-Small-Cell Lung ; pathology ; Carcinoma, Small Cell ; pathology ; Carcinoma, Squamous Cell ; pathology ; Humans ; Lung Neoplasms ; pathology ; Retrospective Studies ; Sensitivity and Specificity ; Small Cell Lung Carcinoma ; pathology ; Surgical Instruments

OBJECTIVETo evaluate the prognosis of cervical intraepithelial neoplasia grade 1 (CIN1) at different follow-up time points in Chinese women and the relationship with high-risk human papillomavirus (HR-HPV) infection.

METHODSBiopsy-confirmed CIN1 women were followed up from cervical cancer screening cohorts established during 1999 to 2008 in Xiangyuan county, Yangcheng county, Qinxian county and Wuxiang county, Shanxi Province.In each follow-up visit, participants were examined by visual inspection with acetic acid, liquid-based cytology and HR-HPV DNA testing. Those with any positive results received colposcope and biopsies. The cumulative incidence rates of CIN grade 2 or worse (CIN2+) and CIN grade 3 or worse (CIN3+), regression rates and persistent rates were calculated using pathological findings as a gold standard. The risks of progression related with HR-HPV were evaluated stratified by baseline and follow-up HR-HPV status.

RESULTSA total of 228, 224, 261 and 105 CIN1 women received the 1-year, 2-year, 6-year and 11-year follow-up exams, respectively. The cumulative incidence rate of CIN2+ among baseline HR-HPV positive women was 4.8% (6/126), 10.7% (16/150), 16.9% (29/172) and 35% (19/55) in the above follow-up visits, respectively, and their risk of progression was 2.7(95%CI:0.3-22.0), 2.9 (95%CI:0.7-12.1), 12.0 (95%CI:1.7-86.2) and 30.6 (95%CI:1.9-493.5) times higher than baseline HR-HPV negative women. Moreover, the cumulative incidence of CIN2+ among women with positive HR-HPV both at baseline and follow-up visit was 11% (6/55), 14% (6/42), 17% (10/60) and 50% (13/26) in the above follow-up visits, respectively.No new CIN2+ cases were found among those with negative HR-HPV both at baseline and follow-up visits.

CONCLUSIONGiven that CIN1 progression is related to HR-HPV infection, different follow-up intervals and strategies for CIN1 should be taken according to HR-HPV infection status.

Aged ; Biopsy ; Cervical Intraepithelial Neoplasia ; Disease Progression ; Female ; Humans ; Papillomavirus Infections ; Prognosis ; Prospective Studies ; Uterine Cervical Neoplasms

OBJECTIVETo evaluate the clinical value of domestically manufactured digital colposcope system (SLC-2000) in the detection of early cervical lesions.

METHODSDuring a follow-up study of patients in Xiangyuan county, Shanxi, a high risk area for cervical cancer, a digital colposcope and an optical colposcope were randomly used for diagnosis, with pathology as the gold standard.

RESULTSIn 163 cervical biopsy specimens, 103 were diagnosed as chronic inflammation by histologic examination. Among 60 specimens which gave abnormal pathology, there were papilloma 1, cervical intra-epithelial neoplasia (CIN) I 37, CIN II 18 and CIN III 4. In 33 endocervical curettage specimens, 3 were pathologically positive. Comparing the digital and optical colposcope in diagnosing the positive lesions of > or = CIN I, the sensitivity of the former and latter were 83.3% and 95.0%, the difference without being statistically significant (P = 0.075). The specificity, positive predictive value, and accuracy of these two instruments were 61.2%, 21.4%, 55.6% and 41.3%, 69.3% 48.5%, with significant difference (P = 0.000, P = 0.035, and P = 0.000). In diagnosing > or = CIN II cervical lesions, these three results of the two instruments did not show any significant difference either. The negative predictive value of the digital and optical colposcope were 86.3% and 88.0%, also showing no significant difference (P = 0.075).

CONCLUSIONThe specificity, positive predictive value, and accuracy of the digital colposcope in diagnosing cervical lesions > or = CIN I are all superior to those of the traditional optical colposcope, even though the sensitivity of the latter is higher. There is no difference between the two instruments in diagnosing lesions > or = CIN II. Not only is domestic digital colposcope (SLC-2000) effective, but feasible and practical in the diagnosis, research and follow-up of cervical lesions.

Colposcopes ; Female ; Humans ; Predictive Value of Tests ; Sensitivity and Specificity ; Uterine Cervical Diseases ; diagnosis ; Uterine Cervical Neoplasms ; diagnosis ; Uterine Cervicitis ; diagnosis

OBJECTIVETo evaluate the value of colposcopical 4-quadrant biopsies for detecting precancerous lesion in cervical cancer screening.

METHODSWe used the data of a cross-sectional screening study in 1999, in which 1,997 women received cervical cancer screening in Xiang Yuan County, Shanxi province. The sensitivity, specificity and accuracy of both 4-quadrant biopsy and colposcopy directed biopsy to detect high-grade or more severe squamous intraepithelial lesions (HSIL+) were calculated.

RESULTS1,784(89.3%) women who received 4-quadrant biopsies and endocervical curettage were negative. 127(6.4%) women were diagnosed as LSIL, 74(3.7%) women as HSIL and 12(0.6%) cases of squamous cell carcinoma. 1,478(74.0%) women who received biopsies in the sites of abnormal lesions were negative, 463(23.2%) cases of LSIL, 41(2.1%) cases of HSIL, 15(0.8%) cases of squamous cell carcinoma. The positive rate was 26.0%(519/1,997) for colposcopy, and the coincidence rate was 73.7% with pathological diagnosis. Sensitivity and specificity were 81.4% and 76.5% of colposcopy for HSIL+. In total of 519 women were found to be with any abnormal colposcopic appearance. The consistency rate between 4-quadrant biopsies and suspicious lesion-directed biopsies was 96.3%. By suspicious lesion-directed biopsy alone, 14.8% cervical lesions were miss-diagnosed, of which 8.6%(5/58) cases of total HSIL and 24.1%(14/58) cases of all LSIL.

CONCLUSIONS4-quadrant biopsy can detect more HSIL+ lesions and is more accurate than suspicious lesion biopsy alone. As an important triage technique to detect cervical precancerous lesions, it can improve the detection rate of HSIL+ lesions in cervical cancer screening.

Biopsy ; Carcinoma, Squamous Cell ; pathology ; Cervix Uteri ; pathology ; Colposcopy ; Cross-Sectional Studies ; Early Detection of Cancer ; Female ; Humans ; Hysterectomy ; Precancerous Conditions ; pathology ; Pregnancy ; Sensitivity and Specificity ; Uterine Cervical Neoplasms ; pathology

Objective: To evaluate and compare the screening performance of primary high-risk HPV(HR-HPV) screening and HR-HPV screening plus liquid-based cytology (LBC) cotesting in diagnosis of cervical cancer and precancerous lesions (CIN2+). Methods: We pooled 17 population-based cross-sectional studies which were conducted across China from 1999 to 2008. After obtaining informed consent, all women received liquid-based cytology(LBC)testing, HR-HPV DNA testing. Totally 28 777 women with complete LBC, HPV and biopsy results were included in the final analysis. Screening performance of primary HR-HPV DNA screening and HPV screening plus LBC co-testing in diagnosis of CIN2+ were calculated and compared among different age groups. Results: Among the whole population, the detection rates of primary HR-HPV screening and HR-HPV screening plus LBC co-testing are 3.05% (879 CIN2+) and 3.13%(900 CIN2+), respectively. The sensitivity were 96.4% and 98.7% (χ²=19.00, P<0.001), and the specificity were 86.2% and 78.8% (χ²=2 067.00, P<0.001), respectively. Areas under the receiver operating characteristic (ROC) curve (AUC) showed that the primary HR-HPV screening performed better than co-testing (AUC were 0.913 and 0.888; Z=6.16, P<0.001). Compared with primary HR-HPV screening, co-testing showed significantly higher colposcopy referral rates (16.5% and 23.6%, respectively, χ²=132.00, P<0.001) and the number of colposcopy examination for detecting per CIN2+ (5.4 and 7.6, respectively).In the group aged 25-29, the colposcopy referral rates was 8.7 (10.9%(199 cases) vs 1.3%(23 cases)) times as much as the detection rate of primary HR-HPV screening in diagnosis of CIN2+, and was 12.5 (15.7%(288 cases) vs 1.3%(23 cases)) times as much as the detection rate of HR-HPV screening plus cytology contesting. Conclusion Compared with primary HR-HPV screening, HR-HPV screening plus cytology co-testing does not show better results in the screening performance for CIN2+ detection, and the cost-effectiveness is not good enough, especially in younger age group.

Objective: To explore the role of HPV viral loads in random biopsy under normal colposcopy. Methods: 908 atypical squamous cells of undetermined significance (ASC-US) and HPV positive women, recruited in cluster sampling in 9 provinces including 5 urban areas and 9 rural areas in China from 1999 to 2008 and meeting the inclusion and exclusion criteria were included in this analysis. According to relative light units/cutoff (RLU/CO) value, subjects were stratified as low (286 cases), intermediate (311 cases) and high (311 cases) viral load groups. Risks of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among different viral load groups were compared with linear trend Chi-square test. Results: Detection rate of CIN3+ in low, intermediate and high viral load groups were 2.1% (6 cases), 2.6% (8 cases) and 6.8% (21 cases) (Chi-square test for trend χ²=8.91, P=0.003) and were 60.3, 74.0 and 201.3 times higher than ASC-US and HPV negative women, respectively. Among 908 subjects, 27.0% (245 cases) were abnormal under colposcopy and 68.6% (623 cases) diagnosed as normal. Under normal colposcopy, detection rate of CIN3+ in low, intermediate and high viral load groups were 0.9% (2 cases), 0.9% (2 cases) and 3.8% (7 cases) (χ²=6.42, P=0.040). Conclusion HPV viral loads display satisfactory risk stratification ability among ASC-US and HPV positive women under normal colposcopy. Women with high HPV viral loads show a significantly increased detection rate of existing CIN3+ and could be recommended to perform random biopsy for histologic diagnosis.

Objective To analyze the type-specific prevalence of human papillomavirus(HPV) among women aged 18-45 years from the general population in Liuzhou,Guangxi Zhuang Autonomous Region.Methods Totally,2 300 women aged 18-45 years old were enrolled in Liuzhou,from March to July,2013.Cervical exfoliated cells were collected for liquid based cytological and HPV DNA tests.Women were referred to colposcopy exam,based on the clinical practice guideline.Results Overall,the prevalence rates of any HPV or oncogenic HPV appeared as 22.7％ (95％CI:21.0％-24.4％) and 17.3％ (95％CI:16.0％-19.1％),respectively in this population under study.The high-risk HPV prevalence peaked at the age groups of 18-25 and 41-45,increasing along with the severity through cytological and histological tests.Statistically significant differences between the prevalence of CIN2 + (Cervical intraepithelial neoplasia 2 +) in women older than 26 years (1.7％,95％CI:1.0％-2.4％) and 18-25 years (1.2％,95％CI:0.5％-1.9％) of age,were not observed.Among samples diagnosed as CIN2+,positivity of HPV bivalent (16/18) and nine-valent (6/ 11/16/18/31/33/45/52/58) vaccine,related high risks on the types of HPV types appeared as 44.1％ and 97.1％.Conclusions The age-specific HPV prevalence rates in the general women aged 18-45 in Liuzhou presented as having bimodal distribution,suggesting that the disease burden of cervical diseases in women aged 26-45 years should not be ignored.Nine-valent HPV vaccine might provide more effective prevention outcomes on cervical cancer in China.

Objective: To evaluate the diagnostic value of fluorescence in situ hybridization (FISH) combined with bronchial brushing cytology for detecting lung cancer. Methods: Centromeric enumeration probes (CEPs) for chromosomes 7, 8 and 17 were used in FISH assay. The combination of FISH and cytology was analyzed in 69 bronchial brushing specimens. Results: The positive rates of CEP7, CEP8 and CEP17 in malignant cases diagnosed by cytology were 50.0%, 80.8% and 65.4%, respectively. CEP8 probe showed significantly higher positive rate than CEP7 (P=0.015). In the samples of suspicious of malignancy, the positive rates of CEP7, CEP8 and CEP17 were 46.6%, 66.7% and 58.8%, respectively. While in atypical cases, the positive rates of these three probes were 20.0%, 33.3% and 25.0%, respectively. There was no statistical difference between suspicious of malignancy and atypical cases (P>0.05) as well as between malignant and suspicious of malignancy (P>0.05). No chromosome aberrations were found in normal cases diagnosed by cytology. The positive rates of these three probes in adenocarcinoma (ADC) were slightly higher than those in squamous cell carcinoma and small cell lung cancer. However, only CEP8 probe showed statistically difference between ADC and small cell lung cancer (P=0.044). The combination of cytology and FISH using any one of the three-probe set (CEP7, CEP8 and CEP17) showed the sensitivity and specificity of 80.3% and 100.0%, while those of cytology were 54.1% and 100.0%, respectively. Conclusions FISH combined with cytomorphology assisted the cytology diagnosis of suspicious of malignancy and atypical cases. Therefore, it significantly improved the diagnostic sensitivity for lung cancer without sacrificing specificity.

OBJECTIVETo explore the feasibility of testing HER-2 expression and gene amplification in fine needle aspiration specimens of advanced breast cancers, and to benefit the patients receiving targeted drug therapy.

METHODSLiquid-based cytology specimens by fine needle aspiration of 49 breast cancer cases were used in this study. The expression of HER-2 protein was detected by immunocytochemistry (ICC) and the gene amplification was assessed by fluorescence in situ hybridization (FISH). All the 49 cases had overexpression of HER-2 protein marked as ++ or +++ in immunohistochemistry (IHC), and had corresponding FISH results in formalin-fixed, paraffin-embedded (FFPE) tissue samples.

RESULTSFNA samples in all the 49 cases were tested by FISH, and showed a complete agreement with the FISH results in the histological specimens (kappa = 1.0). Of the 49 cases, 33 had HER-2 gene amplification in FFPE samples. So do that in FNA samples. Both had an amplification rate of 67.3%. Among the 33 cases with HER-2 gene amplification, 26 had an ICC score of +++ (78.8%). The conformity rate was 78.8%. Of the 33 cases, 29 had an IHC score of +++ (87.9%). Its conformity rate was 87.9%. The difference between the ICC and IHC results was statistically not significant (P = 0.322). Among the 16 cases with negative gene amplification by both ICC and IHC, 15 cases showed HER-2 protein expression as 0/+, and another one case was not counted because there was not enough cells. Of the 16 cases, 15 had an IHC score of ++ and one of +++ . To take the FISH results as gold standard, ICC results had a high sensitivity (87.9%) and specificity (100.0%).

CONCLUSIONSFISH in FNA samples can be used in the clinic to test HER-2 gene amplification and overexpression in breast cancers, with a high sensitivity and specificity in ICC. Our data support the use of FISH and ICC analysis to determine HER-2 status on FNA specimens in patients with advanced breast cancer and recurrence or metastatic tumors. When ICC score is +++ , it indicates that there is a HER-2 gene amplification by FISH.

Adult ; Aged ; Biopsy, Fine-Needle ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Carcinoma, Ductal, Breast ; genetics ; metabolism ; pathology ; Female ; Gene Amplification ; Humans ; Immunohistochemistry ; In Situ Hybridization, Fluorescence ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Paraffin Embedding ; Receptor, ErbB-2 ; genetics ; metabolism ; Sensitivity and Specificity