Search

The diagnostic and staging approach for the mediastinal lymphadenopathies, with or whithout pulmonary lesions endoscopically visible, is based on transbronchial needle aspiration (TBNA) during fiberoptic bronchoscopy and on mediastinoscopy. One important factor impacting on TBNA sensitivity is the rapid on site cytological examination (ROSE).The aim of this study was to evaluate the economic impact of TBNA and TBNA + ROSE, in the diagnosis of these lesions.120 patients, affected by mediastinal lymphadenopathies suspected for lung cancer, underwent TBNA during fiberoptic bronchoscopy: 60 patients without ROSE (group A) and other 60 with ROSE (group B). Whenever needle aspirations failed to provide diagnosis, the patient underwent mediastinoscopy. The economic impact of the diagnostic process was performed.In group A, 39 patients (65%) obtained a diagnosis with TBNA while 21 patients (35%) required mediastinoscopy. In group B, 48 patients (80%) obtained a diagnosis with TBNA + ROSE, while 12 patients (20%) required mediastinoscopy. With regards to the costs of the procedures performed in the diagnostic process, the use of TBNA with ROSE as first diagnostic approach has saved a considerable amount of euros (19,413) compared to the use of TBNA without ROSE and the combined procedure increased (p0.02; chi square test) the sensitivity of TBNA by 15%.ROSE significantly impacts on the diagnostic yield, as well as on the overall management costs of patients with mediastinal lymphadenopathy, suspected for lung cancer.

Inadequate cervical sampling is the most frequent cause of misdiagnosis in cervical cancer screening. The aim of this study was to test the ability of PapCone® versus the conventional sampling method (Ayre's spatula plus cytobrush) to collect ectocervical and glandular cells.In 18 healthy women, two ecto-endocervical samples, obtained by two different methods, were obtained at a three-month interval. Qualitative and quantitative parameters were evaluated. Ultrastructure features of sampling devices were analyzed by scanning electron microscopy (SEM) before and after sampling.The χ(2) test revealed a statistically significant difference between the two methods: PapCone® caused less cell overlap and sampled less white blood cells (p0.05) and more metaplastic cells (p0.01). SEM evaluation highlighted the porous and spongy structure of PapCone® that was responsible for the large number of glandular cells on its surface.Cervical smears performed by PapCone® were adequate and generally easier to screen than conventionally performed ones.

The results of a recent study have shown the superiority of treatment with gefitinib or erlotinib in lung tumors positive for epidermal growth factor receptor (EGFR) mutation. As a consequence, the complete diagnosis of lung cancer cannot be limited to histotype classification, but should include a series of molecular biology analyses. In most cases, the diagnosis of lung cancer is performed on cytological specimens; therefore, there is a need to obtain a complete and reliable molecular diagnosis on cytologic specimens. Brushing, transbronchial needle aspiration (TBNA) and broncho alveolar lavage during fibro-bronchoscopy allow the sampling of the lung and the mediastinal lymph node. The aim of this study was to demonstrate that direct sequencing of exons 19 and 21 of EGFR in lung tumors, carried out on the cytological samples obtained through fibro-bronchoscopy, is as reliable as the same analysis carried out on a histological surgical sample obtained from the same individual. We considered 50 patients with a histological diagnosis of lung adenocarcinoma whose cytological samples, obtained by fibro-bronchoscopy and histological samples, obtained by surgical resection were available. A comparison of the sensitivity and reliability of the molecular biology analyses carried out on histological and cytological samples of the same patient was carried out. The combined mutation percentage of exons 19 and 21 of EGFR was 10%. The results of the analyses carried out on cytological samples matched those obtained from the histological samples. The feasibility of EGFR analysis on cytological samples has already been demonstrated in previous studies, however these studies referred to the method of fluorescence in situ hybridization, or did not perform any comparison between histological samples from the same patient; our work, on the other hand, shows that direct sequencing of exons 19 and 21 of the EGFR gene is feasible on fibro-bronchoscopy cytological samples with the same reliability offered by the histological samples obtained from the same patient.

Background and Aims The prognosis of patients with gastric cancer is poor, even following curative resection, and is related primarily to the extent of disease at presentation. In locally advanced gastric tumors, peritoneal lavage cytology (PLC) is a relevant prognostic factor. The Authors present their results of peritoneal washing cytology, evaluating the prognostic value of this technique, and discussing the clinical impact. Patients and Methods From July 2003 to May 2008, results of PLC in 64 patients with histologically proven primary gastric adenocarcinomas were analyzed. At laparotomy the abdomen was irrigated with 200 ml of normal saline, and ≥50 ml were aspirated and examined by means of cytology and immunocytopathology. Results PLC was positive in 7 cases (11%). Overall, 86% of patients with a positive PLC had a pT3/pT4 tumor and 100% with a positive PLC had an N-positive tumor ( p p = 0.001). At a median follow-up of 32 months, the cumulative 5-year survival was 28%. The median survival of patients presenting positive PLC (19 months) was significantly lower than that of patients with negative peritoneal cytology (38 months) ( p = 0.0001). Multivariate analysis identified cytology as a significant predictor of outcome ( p = 0.018). Conclusions Results in the present series demonstrated that patients with a positive peritoneal cytology had advanced disease and poor prognosis, thus indicating that patients with locally advanced gastric cancer should undergo staging laparoscopy and PLC examination in order to select those requiring more aggressive treatment. Future therapeutic strategies should include PLC examination in preoperative staging, in order to select patients for more aggressive treatment.

The aim of this study was to determine whether modulation of expression of cell adhesion molecules may occur in neoplastic transformation of endometrial epithelium.E-Cadherin and α-catenin protein expression were evaluated by immunohistochemistry in 124 biopsies representative of normal, hyperplastic and neoplastic endometrium.In normal endometrium (proliferative, secretive and atrophic endometrium) strong homogeneous, E-cadherin and α-catenin reactivity was found; 58.3% and 66.6% of biopsies representative of simple hyperplastic endometrium were homogeneously positive for E-cadherin and α-catenin, respectively, whereas no samples representative of atypical hyperplasia showed evidence of homogeneous E-cadherin or α-catenin expression. No expression of homogeneous E-cadherin was seen in endometrial adenocarcinomas; α-catenin homogeneous immunostaining was observed in 2 G1 and 2 G2 out of 22 adenocarcinoma samples (18.2%). A homogeneous co-expression of both molecules was seen only in normal (70%) and simple hyperplastic (46%) endometrium.These results suggest that E-cadherin and α-catenin down-regulation might be associated with neoplastic transformation of endometrial tissues.

To evaluate the existence of an association between cervicovaginal infections and precancerous lesions of the uterine cervix, through determination of prevalent cervicovaginal micro-organisms, alone and in association with human papillomavirus (HPV), in patients with abnormal and normal vaginal cytology.Patients with abnormal vaginal cytology were divided into three study groups according to cytological findings: ASC-US, L-SIL and H-SIL. All patients underwent colposcopic examination and exoendocervical and vaginal sampling for microbiological and molecular analysis for detection of HPV-DNA, Ureaplasma urealyticum, Chlamydia trachomatis, Trichomonas vaginalis, mycetes and common bacteria. Results were compared with the patient group asymptomatic for cervicovaginal inflammation with negative vaginal cytology and colposcopy.A high association between Ureaplasma urealyticum infection and the grade of cytological cervical lesion (27% for ASC-US, 35% for L-SIL and 45% for H-SIL) was found. Furthermore, 19% of the control group samplings were positive for Ureaplasma urealyticum, significantly less than that observed in the positive cytology groups. An interesting association of HPV with Ureaplasma urealyticum in patients with H-SIL vaginal cytology (83%), much higher than that observed in patients with slightly abnormal or normal vaginal cytology (56% for ASC-US, 49% for L-SIL, 40% for normal cytology) was also identified. In contrast, the association between Papillomavirus and multiple microorganisms seemed to decrease with the level of cellular dysplasia in 30% of controls, 33% of ASC-US, 32% of L-SIL and 17% of H-SIL.The presence of a high Ureaplasma urealyticum level seems to be a cofactor of HPV infection, a necessary cause of precancerous lesions of the uterine cervix. The presence of Ureaplasma urealyticum may play a role both in initiating viral cellular anomalies and in viral persistence. It can be hypothesized that these initial processes are helped by a state of cervical inflammation, also supported by multiple microorganisms. It would, thus, be suggested for all patients who present with an abnormal PAP test to undergo a cervicovaginal microbiological examination to detect potentially pathogenic microbes for correct diagnosis and treatment, as well as a more complete follow-up of cervical cytological lesions.

Microtubules are involved in cell growth and division, motility, signalling and in the development and maintenance of cell shape. Consequently, the non-equilibrium dynamics of these microtubules can be crucial to cellular function, including cancer development. Although the involvement of tubulins in human development has been well investigated, the role of alpha- and beta-tubulins in human tumorigenesis still remains controversial. The aim of this study was to investigate alpha- and beta-tubulin protein expression in rectal cancer development.By immuno-histochemistry, using alpha- and beta-tubulin monoclonal antibodies, 66 patients were examined, 32 of whom (22 male, 10 female; range 31-60 years, mean age 49.5 years) had preneoplastic lesions discovered during endoscopic surveillance, which were classified as mild, moderate and severe dysplastic polyps of the rectum, and 34 had invasive adenocarcinomas (24 male, 10 female; range 39-60 years, mean 52 years) of the rectum, with no local or distant metastases at the time of surgical resection.In preneoplastic lesions, no statistically significant relationship was found among alpha- and beta-tubulin protein expression, grade of dysplasia, or other clinical data. Statistical association among alpha- and beta-tubulin immunoreactivity and Dukes' stages B and C was found with p = 0.017 and p = 0.009, respectively. No statistical relationship was found between alpha- and beta-tubulin protein expression among different grades of dysplasia. On the contrary, a significant relationship was detected among tubulins in different stages of cancer.In this preliminary study a significant difference of alpha- and beta-tubulin protein expressions was found in polyps and invasive cancer of the rectum, indicating a possible role of tubulins in invasive, but not in preinvasive cancer development. This preliminary data suggest the possibility of performing alpha- and beta-tubulin protein expression in order to identify B stage versus C stage rectal cancer, before surgical treatment.

Purpose: This paper reports a prospective study designed to measure the accuracy of mammography, ultrasonography, fine needle aspiration cytology and one of the most recently introduced techniques, vacuum biopsy, in the diagnosis of breast cancer. Experimental Design: A sample of 146 breast lesions on 135 patients were examined at our Breast Centre. The lesions had been examined previously at different outpatient centres, without any definite conclusion being reached. The design of the study made it possible to compare MRx, US, FNAC and VB directly, because it excluded several confounding variables. The histological diagnosis on surgical specimen, when available (45 cases), was considered as the gold standard. In the other 101 cases the biopsy results complemented by the negative clinical results of the follow-up were taken to be the true outcome. Statistical indicators (sensitivity, specificity, predictive values PPV and NPV, FN and FP rates, suspicious plus indeterminate rate and likelihood ratios) have been calculated. Results: The NPV of MRx and US are remarkably high (92.4% and 97.9% respectively), confirming previous reports. Complete sensitivity of FNAC turns out to be 80%, while specificity and LR of positive test were 99.1% and 88.8 %. The combined score of FNAC, US and MRx results in a good increase in complete sensitivity (97.1%), if compared with the results of the single diagnostic tests evaluated separately. Absolute sensitivity of VB is 97.1% and specificity is 100%. Conclusions: Considered together, MRx, Us and FNAC appear to be reliable diagnostic procedures and when they are all negative the possibility of a cancer is extremely low (NPV = 0.988 in our sample of women) although it cannot be completely ruled out. The VB test, obviously, has the highest absolute sensitivity among all methods compared and is significantly more sensitive than the Combined Score. Therefore, this technique could be considered conclusive in diagnostic doubtful cases, avoiding open surgical biopsy. 1. Introduction Breast cancer accounts for one-third of cancer diagnoses (more than 192,200 new cancer cases in 2001) and 15% of cancer deaths in U.S. women1,2 and is believed to be the most common cause of malignancy for women in most other Western countries too. In Europe breast cancer accounts for 34% of all prevalent cancers in females and in Italy over 33000 new breast cancer cases are expected in 20023. Over the last 25 years the diagnostic approaches and therapeutic strategies for breast cancer have changed dramatically and mortality rates have fallen by 21% as a result of earlier detection and improved treatment. The diagnostic tools have gradually become more diversified and sophisticated, with a consequent improvement in their resolution limits and accuracy, the tools referred to being digital mammography, ultrasound (US associated with Colour Doppler, Power Doppler, Contrast Agents), magnetic resonance, fine needle aspiration biopsy (FNAC), Core Biopsy (CB), Vacuum Biopsy (VB) and advanced breast biopsy instrument (ABBI). A crucial role has been played by the introduction of national screening programmes4. At present, according to the European Quality Assurance Guidelines in Mammography screening5 the “Triple Approach” is recommended: combined physical examination, mammography (MRx) and FNAC. By introducing mammography screening programmes, however, the size of detected breast lesions has become smaller and the diagnostic problems greater6 so that it seems necessary to redefine the conditions and indications in the use of the new diagnostic tools recently developed. The aim of this paper is to describe a prospective study carried out in a well defined clinical and experimental setting in order to report the accuracy of certain well-established techniques, such as MRx, US and FNAC in our sample of women, and to measure the accuracy of a recently introduced one, VB, in the diagnosis of breast cancer.

The "biologically effective dose markers", DNA and protein adducts, are a direct index of carcinogen induced cell damage and an indirect one of genetic susceptibility. This study aimed to examine the dose-response relationship for 4-Aminobiphenyl-DNA adducts in oral cells of smokers and non smokers.An immunoperoxidase method with the monoclonal 3C8 antibody, which recognizes 4-Aminobiphenyl-DNA, has been used for detecting DNA damage in oral cells of 12 smokers and 12 non smokers.Higher staining for 4-Aminobiphenyl-DNA was detected in the cells of smokers (187 +/- 42) vs. non smokers (135 +/- 35) (p = 0.004), with a twofold range in relative staining for both groups, suggesting individual differences relevance in metabolizing carcinogens and/or repairing DNA damage.This non invasive method requiring small cell amounts is a tool for monitoring large groups of subjects at risk in primary prevention programs.

The pathological changes and the risk of developing cancer in the ileal pouch mucosa of patients who received restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) were studied. The presence or absence of remaining rectal mucosa below the IPAA in both patients with stapled and handsewn IPAA was also examined.Endoscopy of the ileal pouch was performed on 38 patients at 4, 12, 18 and 36 months after restorative proctocolectomy with ileal pouch. Mucosal biopsy specimens were taken from the ileal reservoir in order to assess the histological incidence of inflammation. In 23 patients, biopsies were taken to perform cytometric DNA analysis. Clinical symptoms of pouchitis (over six evacuations in 24 hours, night-time evacuations, leakage of feces, bloody diarrhea, abdominal pain and fever) were recorded and correlated with the histological findings. Biopsies were also sampled below the ileo-anal anastomosis (IPAA) in order to identify residual rectal mucosa.Results of histological assessment showed various degrees of chronic inflammation increasing over time (from 42 to 60%) while the presence of both acute and chronic inflammation of the reservoir was less frequent (from 18 to 30%). Villous atrophy was present in 39-68% of patients and the grade of villous atrophy was correlated to the grade of inflammation. Clinical pouchitis was present in 3 to 8% of cases at the different controls and it was always associated with the highest grade of histological inflammation and severe villous atrophy. No significant alteration of the DNA cellular content was observed. Very low incidence of aneuploidy (0.7-1% Ex.R.) has been reported in three cases. However, we found dysplasia in only one patient who underwent surgical treatment for familial polyposis coli. IPAA evaluation showed no residual rectal mucosa in 40% of cases with stapled IPAA; in the remaining 60%, we found a small amount of rectal mucosa (maximum 1 cm). We did not find rectal mucosa after handsewn IPAA with mucosectomy.Patients treated with restorative proctocolectomy with IPAA showed a higher and increased incidence of inflammation during follow-up. No significant alteration of DNA cellular content nor dysplasia of the pouch mucosa were observed. In this study the chance of leaving rectal mucosa after stapled IPAA was about 60%.