Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
Tab. I. distribution of urine cytology diagnosis for the years 2008 and 2011.
CYTOLOGICAL DIAGNOSIS
results for repeated samples. Out of 171 cases of inadequate resulting
in 2011, only in one of them inadequacy was due to the
presence of abundant artifact material, the remaining 170 cases
did not show transitional cells.
Among these 85 cases, corresponding to 50%, repeated the test
during the year and resulted negative. So when a cytology examination
of urine is inadequate with the simultaneous filtration
of three samples, we have reasonable certainty that the sample is
actually negative.
In the “negative” group are doubled papillary hyperplasia, increased
from 2 to 4% in 2011, while among the “positive” group
the papillary hyperplasia with atypia reached 5% in 2011 compared
to previous 2%.
The positive predictive value (PPV) for atypical papillary hyperplasia
was particularly powerful (0.75); while lowest, as expected,
the VPP of hyperplasia without atypia (0.38).
Conclusion. The introduction of the new system for the collection
of urine material with fixative alcohol and the change in
assembly method (completely and together filtration of the three
samples), made it possible to increase the number of performance
per year of 67%, also the good preservation of cellular elements,
due to the presence of fixative to the time of sampling, has allowed
to improve the morphological detail and to better identify
the cases to send for more detailed diagnosis.
references
Rosenthal D, Raab SS. Cytologic Detection of Urothelial Lesions.
Springer 2005.
Eble JN, Sauter G, Epstein JI, et al., eds. W.H.O. Classification of Tumours.
Pathology and Genetics of Tumours of the Urinary System and
Male Genital Organs. Lyon: IARC Press 2004.
Planz B, Jochims E, Deix T, et al. The role of urinary cytology for detection
of bladder cancer. Eur J Surg Oncol 2005:31:304-8.
Rapezzi R, Bondi A. Streamlining the urinary oncology cytological service
in the metropolitan area. Pathologica 2010:04:153-4.
2008 2011
iNaDEQUatE 50 1% 1% 171 2% 2%
NEgatiVE (no inflammation) 2961 62% 4229 59%
NEgatiVE acute inflammation 485 10% 273 4%
NEGatiVE chronic inflammation 567 12% 1441 20%
hYPERPlaSia 207 4% 123 1%
PaPillaRY hYPERPlaSia 95 2% 4315 90% 270 4% 6336 89%
HYpERplaSia WitH atYpia 203 2% 349 5%
SUSPEct 37 2% 14 1%
PoSitiVE 185 4% 425 8.8% 239 3% 602 8,50%
UrInE SAMPLE TOTAL 4790 21318
PATIEnT TOTAL 1597 7106
Tab. II. Cyto/histological comparison of histology panels of papillary
hyperplasia and papillary hyperplasia with dysplasia.
Papillary
hyperplasia 13
Papillary
hyperplasia
with atipa 20
HISTOLOGY CYTOLOGY
Negative Dysplasia/
Cancer
8 5 PPV 0,38
PNV
0,61
5 15 PPV 0,75
PNV
0,25
293
Diagnostic reproducibility on a digital evaluation
system slide in cytology and histology in
oncologic screening
A. Bondi, S. Lega, P. Crucitti, P. Pierotti, R. Rapezzi, P. Sassoli
de’ Bianchi1 , C. Naldoni1 Anatomia Patologica Ospedale Maggiore, Azienda USL di Bologna,
Italia; 1 Direzione Generale Sanità e Politiche Sociali, Regione Emilia-
Romagna, Italia
Background. Diagnostic reproducibility and accuracy in cytology
and histology are the main issues in Oncologic Screening of cervix,
breast and colorectal cancer: it can be achieved by programs
for quality assurance (QA). The slides set standard represents the
most used method to compare diagnostic proficiency, the chance
of interpreting microscopic digital photographs provided an interesting
alternative to read conventional microscope slides.
The whole digital slide observed in a computer screen is a third,
interesting, option to reach the goal. In fact all the information on
conventional samples are transferred into a file, easily archived,
catalogued, duplicated or advice for quality control, but is especially
available at distance and from multiple locations simultaneously
with drastic reduction of time needed to achieve proficiency
test reproducibility 1 .
The production of digital slides with modern scanners is relatively
simple and quick. All suppliers offer services into private
or public networks server in the literature 2 and software able to
track scanned cases stored in comprehensive database to build
large casistic archives online 3 Tools are already available for
a teleconference discussion of cases with vision of cytological
preparations on line 4 5 , educational programs with integrated digital
slides are poorly developed or proficiency tests for continuing
education and professional updating are easily accessible.
A project on Virtual Microscopy and Digital Pathology has been
conducted in Emilia-Romagna Region (Italy) with the goal to
promote quality in diagnostic cytology and histology in Screening
programs by testing a different system involving pathologists
and cytologists using digital slides, with a faster and reproducible
program easier to manage than standard diagnostic sets and by
distance for retraining of patrhologists with a final consensus
meeting.
The aim has been reached with the realization of a management
system for cytological and histological whole-slides digital images
and related clinical data and the building of a picture archive
and communication system (PACS) among pathologists of our
(and probably other) region. This must be backed by software
for the realization of network slide seminars to perform periodic
diagnostic reproducibility and proficiency test. The cases, col-