Showing papers by "Stephen S. Raab published in 1994"

Low Grade Transitional Cell Carcinoma of the Bladder Cytologic Diagnosis by Key Features as Identified by Logistic Regression Analysis

Abstract: Background. Bladder cytology is being used increasingly to detect and monitor early stage bladder cancer. Because of the lack of significant cytomorphologic atypia in low grade transitional cell carcinomas (TCCs), there often is great difficulty in separating these neoplastic cells from benign urothelial cells. Methods. In an attempt to increase diagnostic sensitivity, 82 bladder wash specimens, which included 33 low grade TCCs and 49 nonneoplastic lesions, were reviewed retrospectively. With a stepwise logistic regression analysis, three key cytomorphologic criteria useful in the separation of low grade TCC from benign urothelium were identified. Results. The key cytologic criteria were increased nuclear/cytoplasmic ratios, irregular nuclear borders, and cytoplasmic homogeneity. By using contingency tables, these three criteria combined had a sensitivity of 45% and a specificity of 98% in the diagnosis of low grade transitional cell carcinoma. If any two of the criteria were present, there was a sensitivity of 85% and a specificity of 96%. Conclusions. By using these three criteria, the diagnosis of TCC can be made with a high degree of accuracy in bladder wash specimens.

Diagnostic accuracy in cytopathology

Abstract: Cytopathologic diagnoses play an important role in clinical decision making. As a result, the tests that produce material for cytopathologic interpretation must be evaluated critically and carefully. One way to evaluate these tests is by the assessment of diagnostic accuracy. The commonly used sensitivity and specificity format dichotomizes the data set and often loses or misinterprets important diagnostic information, especially the data which is semiquantitative. In addition, sensitivity and specificity do not allow the clinician to revise the probability of disease depending upon the test result. The LR and ROC analysis are two methods that systematically measure the diagnostic accuracy of tests, including those that produce semiquantitative data. LR and ROC measurements incorporate the concepts of sensitivity and specificity, but, in addition, provide a way to assess the clinical utility of a test by estimating the post-test probability of disease. These methods are related to other techniques in medical decision making such as decision analysis and information theory, and are straightforward and easily utilized by clinicians and pathologists.

Fine-needle aspiration biopsy of salivary gland mycoses

Abstract: This report details the fine-needle aspiration biopsy (FNAB) cytomorphologic features of two cases of salivary gland mycosis. Both patients had acquired immunodeficiency syndrome (AIDS) and presented with parotid gland masses. The first patient had Histoplasmosis with secondary infection by Candida. Cytopathologically, the FNAB smears showed classic features of a deep-seated mycosis characterized by necrosis and scattered fungal forms. The second patient had a colonizing sialadenitis caused by either Asperigillus or Fusarium. Cytopathologically, the findings were similar to those seen in aspergillomas of the lung orparanasal sinuses with numerous hyphal forms and an absence of an inflammatory response. Because mycotic disease can induce a wide spectrum of pathogenic change, other benign or malignant, solid or cystic lesions enter into the differential diagnosis. Diagn Cytopathol 1994; 11:286–290. © 1994 Wiley-Liss, Inc.

Technology assessment in anatomic pathology: an illustration of test evaluation using fine-needle aspiration biopsy

Abstract: Although anatomic pathology diagnoses are the standard on which treatments often are based, many facets of anatomic pathology have not been rigorously examined. These areas include the evaluation of a procedure's technical and diagnostic characteristics, clinical utility, and cost. Technology assessment is the disciplined scientific and systematic evaluation of a test or procedure, and it can be used to evaluate these areas in anatomic pathology. To illustrate and promote the use of technology assessment in anatomic pathology, we show examples in fine-needle aspiration biopsy, which is a subspecialty of cytopathology. We discuss some of the more commonly encountered problems and misconceptions of test evaluation and also the need for further fine-needle aspiration biopsy evaluation. We conclude that technology assessment is a powerful but underutilized tool for test evaluation in fine-needle aspiration biopsy and in anatomic pathology.