The detailed history was elicited from each case with respect to high risk factors for cervical cancer. This was followed by meticulous general and systematic examination including gynaecological examination. Care was taken to perform per speculum examination and take PAP-Test before bi-manual examination. It was ensured that the PAP-test was not performed if patient gave history of taking vaginal medication within seven days .PAP smear was taken for all the patients with unhealthy cervices using Ayres spatula after exposing cervix with Cusco’s speculum. Samples smeared on two glass slides were sent in Coplin’s jar containing fixative (95% ethyl alcohol or equal parts of 95% ethyl alcohol and ether) to pathology department. The cytological interpretation of the smears was made according to the Bethesda system.
Proper evaluation of women with postcoital bleeding is necessary to rule out cervical cancer. Conventional papsmear has its own limitations like inadequancy of smear, non-inclusion of endocervical cells, air drying of slide and fixation problems. Colposcopy is an excellent means of evaluating abnormal cervicalcytology. Ultimately, HPE of cervix is necessary to establish the definitive diagnosis. In present study, we carefully evaluated women with postcoital bleeding by clinical features, papsmear, colposcopy and guided biopsy.
After cytological diagnosis, patients with LSILs were followed up for 6~12 months. During the follow-up, if HSILs appeared, they were referred for colposcopy and biopsy screening. All the 26 patients with LSILs took part in the first round review at the end of 6 months, the results showed that 12 patients have regressed to nor- mal, accounting for 46.15% (12/26); The other 14 patients had different degrees of pathologi- cal changes (1 case was ASC-US, 10 remain LSILs, 3 developed into HSILs). 3 HSILs cases were referred for colposcopy and biopsy, one case showed no pathological changes, the biopsy of other two proved to be high level intraepithelial neoplasia (CIN 2/3), then the two were operated on cervix conization (the follow- up were made separately). For the second round follow-up at the end of the 12 months, 22 cases were obtained, 4 cases were lost to follow-up (2 cases with HSILs, 1 with LSILs, 1 was negative at the first round follow-up). Of the 22 followed-up cases, 7 showed different degree of lesions (2 with ASC-US, 3 with LSILs, and 2 with HSILs), the other 15 cases were neg- ative cytologically. For 3 cases with HSILs, col- poscopy and biopsy showed progressive lesions, confirmed as severe dysplasia, and these 3 cases were operated on the conization of cervix (the follow-up were made separately). Of the 12 cases with LSILs who were identified negative at the first follow-up, 2 cases (16.67%) showed EGFR gene amplification with 1 trisomy and 1 polysomy. Of the 14 cases with LSILs Table 1. EGFR gene amplification in different
smear, clarity of background and increased specificity for detection of LSIL and HSIL lesions. On the other hand, colposcopic assessment is a critical step in the diagnosis of preinvasive cervicallesions, as the detection of abnormal cervicalcytology is dependent on precise visual localization of micropathological changes and precise biopsy of such tissue for subsequent histopathological diagnosis. Therefore, use of single visit approach in which cytology, colposcopy and biopsy are all done in one sitting and treated accordingly will help us to detect a significant number of cases in premalignant state which may otherwise be missed if the above-mentioned screening methods are used individually.
Integrating screening into primary care services for women should increase the likelihood that precancer is detected, as is seen in high-income countries, where effective screening averts progression to cervical cancer The present study is an endeavor to perform a comparative study of performance of colposcopy and Pap smear for mass screening of premalignant and malignant lesions of the cervix. Study aims to critically evaluate the sensitivity and specificity of Colposcopy versus Pap smear in the early detection of dysplasias. Its secondary objective being, to correlate the findings in the evaluation of unhealthy cervix by cytology, colposcopy and colposcopy guided biopsy.
The microscopic appearance of cells from the vagina was illustrated by observers Donne and Beale. In 1847, a Frenchman, F.A. Pouchet , published a book dedicated to the microscopic study of vaginal secretions during the menstrual cycle. In the closing years of the 19 th century, illustrations of cancer cells derived from cancer of the uterine cervix were published. In 1927, C. Daniel, reported that cervical smears, obtained by means of a bacteriologic loop, fixed with methanol and stained with Giemsa, were an accurate and reliable method of diagnosing cancer of the uterine cervix. In 1928, Babes published an extensive beautifully illustrated article on his subject in the French publication, Presse Medicale 29 . He introduced cytological sampling of the uterine cervix for the diagnosis of cancer.
Thyroid nodule size is routinely measured, although its impact on thyroid cancer risk is unclear. In this study: all malignant lesions were more than 2 cm.However, it differs from the studies ofTai et al (12) revealed that there was no great significance between nodule size larger than 4 cm and nodule size less than 4 cm (P = 0.5) and in Kamranet al (11) revealed that, below 1 cmIncreasing thyroid nodule size impacts cancer risk in a nonlinear fashion but threshold is detected at 2.0 cm, beyond which cancer risk is unchanged.
In the present study , disease finding in screening colposcopy group (2%) was significantly less than Diagnostic group (4%). Consideration of significantly more unsatisfactory colposcopy reports in screening group in comparison to diagnostic group (72.1% versus 42.2%, P<0.001) in explication of this difference is necessary. In the other hand diagnostic group were selected among referral oncology patients with probably more positive cases.
lymphoma and conversely low grade NHL resemble reactive lymphnode hyperplasia. In cytology low grade NHL can’t be distinguished from benign lymphonode. 90% of high grade NHL are identified correctly. In Hodgkins lymphoma diagnosis can be made but sub typing may not be feasible by FNAC but can be made to some extent by Imprint. RS cells are makers. In lymphocyte predominant type typical RS cells are infrequent. In nodular sclerosis cell yield is poor. When Imprint is combined with Immunohistochemisty the exact typing of lymphoma and metastatic disease can be diagnosed more accurately.
This is to certify that the dissertation entitled “COMPARATIVE ANALYSIS OF COLPOSCOPIC VIA, VILI, LIQUIPREP TM AND CONVENTIONAL PAP SMEAR WITH HISTOPATHOLOGY AS GOLD STANDARD” AT ISO-KGH is a bonafide work done by Dr.K.SABARI. in the Institute of Social Obstetrics, Govt. Kasturba Gandhi hospital(Madras Medical College) Triplicane , Chennai in partial fulfillment of the university rules and regulations for award of MD degree in Obstetrics and Gynecology under my guidance and supervision during the academic year 2010-2013.
Immediate treatment was proposed based on the extended and lesion situa- tion compared to the cervical canal. Epi-info software was used for data analysis, statistical tests of sensitivity, specificity, predictive values, positive and negative were computed directly and compared among all participants.
The present study included patients of all age group with a mean age 43.5 years. Patients who had benign and non-neoplastic lesions were relatively younger than malignant cases. More than 70% of the malignant cases were in seventh decade. Lipoma was the most common lesion diagnosed which coincided with the study done by Enzinger et al (1995) and Layfield LJ et al 6 . Nodular
Funding for the original data collection in Zimbabwe was through a United States Agency for International Development (USAID) cooperative agree- ment with JHPIEGO (Number CCP-3069-A-00-3020-00). Funding for this analysis and manuscript write up was provided in part by the Bill and Melinda Gates Foundation through the Alliance for Cervical Cancer Pre- vention (ACCP). SD Walter contributed to the conception of this analysis and the rationale supporting LCA as an analysis option in this situation with a potential imperfect gold standard. Credit also goes to Saifuddin Ahmed for his contribution to the study. Finally, the authors are grateful to all con- tributors to the initial studies upon which this analysis was based and the women of Zimbabwe who took time to investigate their health and gener- ously allowed these data to be used for furthering cervical cancer preven- tion worldwide. MA received financial support for his time from 1) the European Commission (Directorate of SANCO, Luxembourg, Grand- Duché du Luxembourg) through the European Cancer Network; 2) the DWTC/SSTC (Federal Services for Scientific, Cultural and Technical Affairs of the Federal Government, Belgium) and 3) the Gynaecological Cancer Cochrane Review Collaboration (Bath, UK).
Congenital and developmental anomalies: On both USG and CT, fat-fluid levels and calcification are pathognomonic of orbital dermoids; additionally, scalloped bony orbit and globe contour abnormality being observed in CT (Smirniotopoulos, 1995; Chawada, 1999). The differentiation between orbital dermoids (Figure-1) and epidermoids was not possible on USG and or CT in our study; specificity of USG found to be 80%.Congenital cystic eye, a relatively rare diagnosis was also seen in one case with no identifiable ocular structure and rudimentary EOMs. Optic nerve glioma or orbital plexiformneurofibromafrequently are associated with bony orbital deformity; later associated with orbital-bone changes in four patterns (Jacquemin et al., 2003). In our cases of neurofibromatosis, bony defect, bilateral optic nerve glioma, plexiformneurofibroma and pulsatile exopthalmos with hernia ion brain parenchyma were noted. Among theencephalocele cases, defect in frontal bones bilaterally and in yet another, unilateral sphenoid bone was observed. Another case of Crouzon’s disease presented with bilateral exorbitism; USG was normal but CT was diagnostic.
All these patients were asked to come for follow up, but only 9 of them have come back for follow up. CIN 1 cases were advised follow up every 3-6 months for periodic pap smear and repeat biopsy if the smear is abnormal. CIN 2 & 3 cases were advised repeat biopsy and if repeat biopsy confirmed the diagnosis, were advised locally destructive procedures like Cautery and/or Cryo. If the family is completed, they were advised hysterectomy depending upon the needs of the patient and availability of resources.The patients with microinvasive or invasive carcinoma were advised hysterectomy or referred for radiotherapy.
An accurate cytologic diagnosis can avoid unwarranted surgery. Familiarity with the cytological features of rare lesions and morpho- logical variations of the commoner lesions is necessary to avoid misinterpretation. Cystic lesions remain a problematic area for correct diagnosis on cytology with high diagnostic sensitivity, specificity, accuracy present study reaffirms that FNAC of the salivary glands neoplasms, being a quick, safe, and affordable procedure offers an invaluable and highly accurate initial diagnostic approach for the management of patients, whether it is local excision for a benign neoplasm, radical surgery for a malignant neoplasm or alternate treatment. However, there still remain few cases that may be inaccurately diagnosed on cytology due to overlapping features and in these cases histopathology is the only modality for final diagnosis.
effusion refers to the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion often present as a common diagnostic dilemma to the et al., 1976) as the y indicate the presence of pleural, pulmonary, or extra pulmonary disease, as the no cause can be found in many cases in spite of care full evaluation It is important to establish an accurate be treated in the most appropriate and rationale manner. A better knowledge of spectrum of clinical history and clinical signs of pleural effusion along with radiological, biochemical, and etiological evaluation of pleural fluid helps in narrowing the diagnostic dilemma faced by physicians and helps better. The present study is contemplated the comparative utility of pleural biopsy, cytological and biochemical analysis in the diagnosis of pleural effusion, as patients admitted in the pulmonary medicine ward.
Countering these changes are mechanisms to metabolise carcinogens, repair DNA damage, control growth, and defend against cancer. Cancer is a consequence of an interaction of these many factors. Diagnosis is increasingly aided by detection of cellular and now molecular changes. Treatment is increasingly looking towards chemotherapy and now gene therapy. However, there is no doubt that prevention is the most important aspect, particularly patient education and the reduction of lifestyle risk habits and environmental factors.The risk of developing oral cancer increases with advancing age, most cases occuring in people aged 50 years or over (10) .
Breast cancer is the commonest malignancy in women worldwide and the preoperative evaluation of breast lumps is an essential part of the management of breast lesions. [5,6] A palpable breast lump is a common diagnostic problem to both general practitioners and surgeons. Excisional biopsy was accepted practice in the past, but presently needle biopsy makes it possible to reduce surgical excision of benign breast lesions to a minimum. The main purpose of fine needle aspiration cytology (FNAC) of breast lumps is to confirm cancer pre-operatively and to avoid surgery in specific benign conditions.
Mistakes in cervical histological findings on bioptic specimens, have also been documented, [4, 5] and histo- logical CIN diagnoses are not entirely reproducible [6, 7]. Indeed, similarly to cytological interpretation, histological assessment of cervical dysplasia is complicated by inter- observer variability . The strongest source of disagree- ment was the threshold between normal and CIN 1. Agreement was higher for CIN 3 than for CIN 2 . Moreover, the proportion of false-positive diagnoses of CIN 2 or worse varied according to cytologic and HPV test results .