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Article
Fine needle aspiration cytology of breast lesions:Diagnostic values

Author: Nada S. Al-Rubai'ee
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2006 Volume: 48 Issue: 4 Pages: 413-415
Publisher: Baghdad University جامعة بغداد

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Abstract

Back ground:Fine needle aspiration (FNA) is indicated in the exploration of superficial and deep masses. The accuracy of this procedure differs in various studies, and according to the organ explored. Palpable mammary masses of concern to the patient or clinician should be aspirated, regardless of imaging findings.
Objective: The present study aimed at evaluation of cytological results of FNA of different palpable
breast lesions, using histopathological diagnosis as the gold standard for final diagnosis.
Patients & Methods: This prospective study includes 289 females with palpable breast lesions. FNA aspiration was conducted in a private out patient clinic during the period of 1994-2004. The cytological results of aspirated masses are compared with the histopathological result of biopsies or surgical specimens. Estimation and evaluation of the validity parameters of cytology and histopathology were performed.
Results: Out of seventy one (71)cases of malignant neoplasms diagnosed in histopathological; sixty three (63) showed malignant cellular aspirates, four (4) showed atypical cellular changes and four (4) were negative for significant cellular findings on FNA. On the other hand out of (217) benign lesions diagnosed by histopathology; 15 showed atypical epithelial changes on cytological aspirates while the rest showed benign cellular aspirates. Twenty (20) cases out of the whole sample showed epithelial cellular atypia on FNA; four of them proved to be malignant, one case revelead atypical epithelial hyperplasia or epithelioisis, and the other 15 proved to be benign lesions by histopathology. The validity parameters of FNA were as follows; sensitivity= 88.7%, specificity= 100%, False negative results= 11.3% and accuracy= 96.1%.
Conclusion: F. N. A. is a quick, inexpensive, relatively painless safe procedure from which results can be obtained in a short time with the other supportive investigations. Adequacy determination must be based not only on the cytological findings but also on their correlation with the clinical, mamrnographic, and ultrasonic findings to avoid false negative results. Atypical epithelial changes on cytological smears indicate the need for immediate excional biopsy.

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Article
Soft Tissue Sarcomas: A review of 40 cases

Author: Nada S. Al-Rubai’ee
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2006 Volume: 5 Issue: 1 Pages: 87-93
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Soft tissue sarcoma (STS) represents a heterogeneous group of rare malignant tumors. Many diagnostic problems and difficulties are often encountered in the differential diagnosis of these tumors. The variety of appearance gives a wide range of tumor types and subtypes with a high discrepancy rate in tumor typing among pathologists. METHODS: This study was conducted at the Military Medical Academy (EGYPT) during the period from (1989-1990). The study aimed to reexamine a routinely processed H and E stained slides of cases previously diagnosed as STS by a group of pathologist and match the old and new diagnoses, with the application of some special stains; histochemical and immunohistochemical, then evaluate the results. Forty cases previously diagnosed as STS were reexamined and classified according to the criteria of Enzinger and Weiss. A descriptive or morphological classification was also used; as spindle, round, myxoid and pleomorphic STS. The results were compared to, and matched with the previous diagnoses. Histochemical stains used are, Picro Sirius red (PSR), Masson trichrome (MT), and Periodic-acid schiff stain (PAS). Myoglobin was used as immunohistochemical marker for the detection of cross-striated muscle cell differentiation by peroxidase antiperoxidase method (PAP). RESULTS: Agreement in diagnosis between the previous and the recent diagnosed STS was found to be 47.5%. For spindle cell malignant tumors the agreement was 58.8%, while for round cell malignant tumors was 33.3%. Agreement in diagnosis in mixed malignant soft tissue tumors was 62.5%. PSR and MT demonstrate the amount and distribution of collagen. MT also demonstrates muscle fibers. Using Myoglobin immunohistochemical marker in the previously diagnosed STS: one out of four cases diagnosed as Rhabdomyosarcomas gave a positive result, while two cases from the unsuspected group gave positive results. In the recently diagnosed tumors: all cases diagnosed as Rhabdomyosarcoma gave positive results, while from the unsuspected group one gave positive result. CONCLUSION: While the ordinary H and E stain will suffice to permit recognition of many of STS, it will not do so for all. Limitation of diagnosis of these tumors, especially the rare ones, to specialized centers or highly qualified pathologists is recommended. Histochemical stains are supportive rather than exclusive for the diagnosis of STS. Myoglobin immunohistochemical marker could be used to aid in the diagnosis of rhabdomyosarcomas. Definite diagnosis of many STS needs further special stains and/or electron microscopy and other sophisticated procedures


Article
Diagnostic Value of Cytology and Colposcopy in Patients withAbnormal Cervical Pap Smears

Authors: Nada A Alwan --- Raji H Al-Hadithi --- Nada S Al-Rubai’ee
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2006 Volume: 3 Issue: 1 Pages: 56-62
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: An optimal cancer detection system
for preclinical cervical lesions should combine a
cytological examination with a colposcopic follow-up
examination. Detection at early pre-invasive stage
provides an opportunity for treatment to prevent
progression to invasive cancer.
Objective: The present study aimed at evaluation
of cytology, colposcopy, and combined cytology and
colposcopy in predicting histopathological diagnosis
of cervical intraepithelial neoplasia/squamous
intraepithelial lesion (CIN/SIL) or other neoplastic
changes in patients with abnormal cervical
cytological findings.
Methods: This prospective study was conducted in
the Cyto-colposcopy Unit of Teaching Laboratories
and Outpatient Department of Medical City Teaching
Hospital over a period of one year (Sep. 2001- Sep.
2002). Eighty-one married females were included in
the study. A cervical smear was taken followed by a
colposcopic examination of the cervix and then a
punch biopsy was taken from the suspected lesions
for histopathological study. Estimation and evaluation
of the validity parameters of cytology, colposcopy,
and combined cytology and colposcopy were
performed using different cutoff points by special
statistical analysis.
Results: Sensitivity, specificity and accuracy of
cytology in the diagnosis of CIN/SIL were 73%,
93.2% and 84.0% respectively.
The False–negative rate was 27%. Sensitivity,
specificity and accuracy of colposcopy in the
diagnosis of CIN were 83.3%, 58.5% and 70.1%
respectively choosing doubtful findings as a cut-off
point. The combination of cytology and colposcopy
gave the following results: sensitivity, specificity and
accuracy were 94.6%, 61.4% and 76.5% respectively;
the negative predictive value (NPV) was 93.1%.
When suspicious colposcopic findings were chosen as
the cut-off point, the specificity and the positive
predictive value (PPV) were higher at the expense of
sensitivity and NPV
Conclusion: The conventional Pap smear, a
valuable tool in the evaluation of patients with
abnormal cervical cytology, was found to be of
relatively low sensitivity in predicting CIN/SIL.
Colposcopy is a valuable tool too. However, the
validity parameters showed variable figures
depending on the different cut-off points applied for
the diagnosis of CIN/SIL. The ideal cut-off point was
when doubtful and higher-grade colposcopic lesions
are considered positive. The combination of cytology
and colposcopy resulted in an increased sensitivity
and NPV. The specificity could be further increased
or improved when the threshold was set to distinguish
higher-grade lesions (suspicious lesions) from lesser
abnormalities.
Key words: Colposcopy, Abnormal Pap smears,
Biopsy


Article
applications of the bethesda system for cervical cytological reporting

Authors: nada S.AL-Rubai'ee --- nada A.ALwan ندى عبدالصاحب العلوان
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: PISSN: 00419419 / EISSN: 24108057 Year: 2006 Volume: 48 Issue: 1 Pages: 41-47
Publisher: Baghdad University جامعة بغداد

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