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ANALYSIS OF FALSE POSITIVE AND FALSE NEGATIVE FINE NEEDLE ‎ASPIRATION CYTOLOGY OF BREAST LUMP : A PERSONAL ‎EXPERIENCE

Author: Sawsan S, Al-Haroon ‎
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2004 Volume: 10 Issue: 2 Pages: 30-37
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to determine the reasons for sampling and interpretative errors in false ‎negative and false positive diagnoses of breast carcinoma on fine-needle aspiration ‎cytology (FNAC) material. The study design is that a totally 912 cases of breast FNAC were ‎performed between 2000 and 2004, and 126 cases of them were diagnosed as breast ‎carcinoma. Only those cases with cytohistological discrepancies were cytologically reviewed, ‎in which the cytological material was abnormal and to some extent misinterpreted or both. ‎There were 8 false negative diagnoses (false negative rate 6.3%) and 3 false positive ‎diagnoses (false positive rate 2.3%). The results of this study showed that among 8 false ‎negative cases, 5 showed hypocellular smears with minimal nuclear pleomorphism of the ‎cells. Histology revealed 3 infiltrating ductal carcinomas of scirrhous subtype and 2 ‎infiltrating lobular carcinomas. The smears of other 2 false negative cases, which ‎histologically verified as well-differentiated infiltrating ductal and pure intraductal carcinomas, ‎were hypercellular and composed predominantly of groups of cohesive, small, and uniform ‎cells simulating fibroadenoma or fibrocystic changes. Smear of the last false negative case ‎‎(histologically verified as infiltrating ductal carcinoma with extensive cystic degeneration) ‎revealed large sheets of macrophages and degenerated epithelial cells on inflammatory ‎background. In 3 false positive cases, 2 were histologically proved as fibroadenoma and 1 ‎fibrocystic changes. Smears of the 2 false positive fibroadenomas showed very high ‎cellularity, overlapped clusters, and frequent stripped bipolar nuclei. The fibrocystic case ‎showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that ‎were over interpreted. The conclusion of this study is that hypocellularity and relatively ‎nuclear monomorphism are the reasons for failure to diagnose breast carcinoma. Careful ‎attention should be paid to extreme nuclear monomorphism and absence of naked bipolar ‎nuclei. So awareness of smear cellularity and subtle cytological features will aid in the correct ‎preoperative diagnosis of lobular; scirrhous; and intraductal carcinomas, and false negative ‎diagnoses can be minimized. A cytologically atypical or suspicious diagnosis together with ‎positive mammographical and clinical findings should suggest a diagnosis of malignancy. ‎Hypercellular smears with overlapped clusters should be carefully assessed for uniformity of ‎the cells and detailed nuclear features. If the full-blown malignant cytomorphological features ‎are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section ‎Created by Wameed Al-Hashimy intraoperative imprint cytology is recommended before ‎surgery.‎

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5- EVALUATION OF ENDOSCOPY BASED METHODS (HISTOPATHOLOGY, CYTOLOGY AND UREASE TEST) FOR THE DETECTION OF HELICOBACTER PYLORI

Authors: Sawsan S Al-Haroon --- Sarkis K Strak --- Rafid Adil Abood
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 21-24
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to assess the accuracy of histopathology, brush cytology, andurease test in the diagnosis of Helicobacter pylori and to evaluate the effect of testduration on the sensitivity and specificity of positive urease test for the detection of H.pylori.Fifty patients [25 patients with gastritis group A and 25 patients with duodenal ulcergroup B] selected from those attending endoscopy unit for dyspeptic symptoms, wereenrolled in the study. Four endoscopic biopsies were taken from each patient. Onebiopsy from each of antrum and body were obtained for urease test (Urease test wasread at 30 min, 1, 4 and 24 hour after biopsy insertion into the reagent), and onebiopsy from each of antrum and body were used for histopathological examination.Antral brush cytology was taken also from each patient. The patients were consideredH. pylori positive when minimum concordances of 2 out of 3 tests (Histopathology,brush cytology, and urease test) were positive.Fourteen patients were positive for H. pylori in group A, in comparison to seventeenpatients in group B. The sensitivities of the histopathological examination, brushcytology, and urease test at 24 hours in group (A) were 58%, 79%, and 93%respectively. Corresponding figures for the specificity were 100%, 91%, and 46%respectively. While in group (B) the sensitivities were 82%, 82%, and 100% and thespecificities were 100%, 100%, and 88% respectively.It is concluded that among the invasive methods, the association of the urease testwith brush cytology constituted the best choice for confirming the diagnosis of H.pylori, due to the high sensitivity of the urease test and high specificity of brushcytology.

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