1. Health care is a human right. 2. The care of the individual is at the center of health care, but the whole system needs to work to improve the health of populations. 3. The health care system must treat illness, alleviate suffering and disability, and promote health. 4. Cooperation with each other, those served, and those in other sectors is essential for all who work in health care. 5. All who provide health care must work to improve it. 6. Do no harm.

https://www.journalacs.org/article/S1072-7515(00)00768-7/pdf

Is this a practical approach

Head and neck squamous-cell carcinoma (HNSCC) is the sixth most common cancer worldwide and, disappointingly, survival rates are not improving. Moreover, HNSCC has a severe impact on the quality of life of patients and survivors, and the significant morbidity subsequent to treatment often mandates long-term multidisciplinary care, which places significant financial pressures on the treating institution. Therefore, prevention and early diagnosis of high-risk pre-malignant lesions are high priorities for reducing deaths due to head and neck cancer. Recent advances have begun to elucidate the different aetiologies of HNSCCs in relation to previous pre-malignancies and to identify which pre-malignant lesions are likely to progress to malignancy.

Profiling early head and neck cancer.

Diagnostic cytology and its histopathologic Bases

After almost a year's absence from the book stores, Koss's Diagnostic Cytology is back again in its second edition. This is probably the most complete book on cytology available, correlating the exfoliated cell with its parent healthy or diseased organ. As is the trend of modern texts, the new book is almost 300 pages longer than the original. Among its new features are a greatly expanded discussion of basic cellular structures with abundant photographs of electron microscopy. There also are several new chapters by Miles on the chromosome. Coverage of normal female genital-tract cytology has been increased by more illustrations of excellent quality. However, the second edition still describes what are probably metaplastic cells as parabasal cells with intercellular bridges. Another error has been corrected. In the new volume a special variety of multinucleated cells which previously had been called "trophoblastic syncitial cells" now is correctly identified as a cell

Diagnostic Cytology and Its Histopathologic Bases

PCR detection of human papillomavirus of the mucosa: comparison between MY09/11 and GP5+/6+ primer sets.

Objective. The aim of this prospective study was to report on the diagnostic accuracy of conventional oral exfoliative cytology taken from white‐spotted, ulcerated or other suspicious oral lesions in our clinic. In addition we checked DNA‐image cytometry as an adjuvant diagnostic tool. Our hypothesis is that DNA‐aneuploidy is a sensitive and specific marker for the early identification of tumor cells in oral brushings. Study design. 251 cytological diagnoses obtained from exfoliative smears of 181 patients from macroscopically suspicious lesions of the oral mucosa and from clinically seemingly benign oral lesions which were exisiced for establishing histological diagnoses were compared with histological and/or clinical follow‐ups of the respective patients. Additionally nuclear DNA‐contents were measured after Feulgen restaining using a TV image analysis system. Results. Sensitivity of our cytological diagnosis on oral smears for the detection of cancer cells was 94.6%, specificity 99.5%, positive predictive value 98.1% and negative predictive value 98.5%. DNA‐aneuploidy was assumed if abnormal DNA‐stemlines or cells with DNA‐content greater 9c were observed. On this basis the prevalence of DNA‐aneuploidy in smears of oral squamous cell carcinomas in situ or invasive carcinomas was 96.4%. Sensitivity of DNA‐aneuploidy in oral smears for the detection of cancer cells was 96.4%, specificity 100%, positive predictive value 100% and negative 99.0%. The combination of both techniques increased the sensivity to 98.2%, specificity to 100%, positive predictive value to 100% and negative to 99.5%. Conclusions. Brush cytology of all visible oral lesions, if they are clinically considered as suspicious for cancer, are an easily practicable, cheap, non‐invasive, painless, safe and accurate screening method for detection of oral precancerous lesions, carcinoma in situ or invasive squamous cell carcinoma in all stages. We conclude that DNA‐image cytometry is a very sensitive, highly specific and objective adjuvant tool for the early identification of neoplastic epithelial cells in oral smears.

/pdf/cytologic-and-dna-cytometric-early-diagnosis-of-oral-cancer-4jvfdbuax9.pdf

Cytologic and DNA-Cytometric Early Diagnosis of Oral Cancer

To determine the prevalence of immunocytochemical positivities for a panel of antibodies in benign and malignant cells in effusions with known follow‐up in order to use these as diagnostic markers. Besides their ability to identify malignant epithelial cells their contribution to the differential diagnosis between carcinomatoses and mesotheliomas was investigated. 101 tumour cell positive and 53 negative effusions were stained with 12 different antibodies. Results were scored semiquantitatively per cell type. Furthermore, DNA‐image cytometry was performed. While prevalence of Ber‐EP4 positivity was 95.4% in metastatic carcinoma cells, it was 0% in those from mesotheliomas. No cell type reacted with this marker in benign effusions (0%). Ber‐EP4 correctly differentiated between metastatic carcinoma and mesothelioma in 98.0%. Prevalence of DNA‐aneuploidy was 95.4% in metastatic carcinomas, 57.1% in mesotheliomas and 0% in reactive effusions. Combining immunocytochemistry (Ber‐EP4 positivity) and DNA‐image cytometry (aneuploidy) results in a 100% detection of metastatic carcinomatoses and 57.1% of mesotheliomas. Both markers furthermore allowed a correct differentiation of these entities in 98%.

/pdf/immunocytochemistry-and-dna-image-cytometry-in-diagnostic-39shugphyq.pdf

Immunocytochemistry and DNA-image cytometry in diagnostic effusion cytology I. Prevalence of markers in tumour cell positive and negative smears.

In the present study, the aim has been to investigate the interobserver reproducibility of DNA‐image‐cytometry (DNA‐ICM) applied to routine Pap smears classified as Atypical Squamous Cells of Undetermined Significance (ASCUS) or higher lesions (ASCUS+). 202 Pap smears diagnosed as ASCUS or higher were included in the study. After cytological assessment, smears underwent restaining according to Feulgen. First measurements were performed as routine workup. The second measurements were blinded to the result of the first and consecutively performed. DNA‐ICM met the consensus statements of the European Society of Analytical Cellular Pathology (ESACP). Interobserver agreement was assessed by calculating Kappa statistics. The diagnosis of DNA‐aneuploidy in the first measurements was confirmed in all cases. Second measurement detected 12 additional cases with aneuploidy. Nine out of these cases were classified as aneuploidy by detection of 9c Exceeding Events (9cEE). In three cases stemline‐aneuploidy was disclosed. The overall proportion of observed agreement was 94.1%, κ=0.87, 95% CI=0.74–0.99. Our study shows a good interobserver reproducibility of DNA‐ICM performed on cervical smears with ASCUS or higher lesions. DNA‐ICM thus represents a highly reproducible diagnostic procedure.

/pdf/interobserver-reproducibility-of-dna-image-cytometry-in-4zfqymyksx.pdf

Interobserver reproducibility of DNA-image-cytometry in ASCUS or higher cervical cytology

To determine sensitivity and specificity of different antibodies for the immunocytochemical detection of malignant cells in diagnostically equivocal effusions in comparison with those achieved by DNA‐image cytometry. 65 cytologically doubtful effusions of the serous cavities were stained with twelve antibodies. Furthermore, DNA‐image cytometry was performed. Data were correlated with patient follow‐up. Sensitivity of cellular staining of Ber‐EP4 for the identification of malignant cells was 77.8%, specificity of absent staining for benign cells was 100%. Positive predictive value for the identification of malignant cells was 100%, negative value 65.5%. Sensitivity of DNA‐aneuploidy for the identification of malignancy was 82.9%, specificity of DNA‐non‐aneuploidy for benignity 94.7%. The positive predictive value of DNA‐aneuploidy for the occurrence of malignant cells was 96.7%. Negative predictive value of DNA‐non‐aneuploidy was 72.0%. Combining immunocytochemistry applying Ber‐EP4 only and DNA‐cytometry in equivocal effusions resulted in a sensitivity of 88.9% for the identification of malignant cells associated with a 95.0% specificity. Positive predictive value was 97.7%, the negative one 79.2%.

/pdf/immunocytochemistry-and-dna-image-cytometry-in-diagnostic-3rndfih0v5.pdf

Immunocytochemistry and DNA-image Cytometry in Diagnostic Effusion Cytology. II. Diagnostic Accuracy in Equivocal Smears

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Cytologic and DNA-Cytometric Early Diagnosis of Oral Cancer

Immunocytochemistry and DNA-image cytometry in diagnostic effusion cytology I. Prevalence of markers in tumour cell positive and negative smears.

Interobserver reproducibility of DNA-image-cytometry in ASCUS or higher cervical cytology

Immunocytochemistry and DNA-image Cytometry in Diagnostic Effusion Cytology. II. Diagnostic Accuracy in Equivocal Smears