A task force of experts in the field of diagnostic DNA image cytometry, invited by the ESACP, and further scientists or physicians revealing experience in that diagnostic procedure (names are given in Addendum A), agreed upon the following 4th updated Consensus Report on Standardised Diagnostic DNA Image Cytometry during the 7th International Congress of that society in Caen, 2001. This report is based on the three preceding ones [6,14,17]. It deals with the following items: – Critical review and update of the definitions given in the 1997 Consensus Update; – Review and detailed description of basic terms, principles and algorithms for diagnostic interpretation; – Recommendations concerning diagnostic or prognostic applications in specific fields of tumour pathology. This update is not aimed to substitute the 1997 consensus, but to make necessary addenda and give more detailed descriptions of those items not unequivocally to interpret by potential users of the methodology.

EUS-FNA-based cytology is safe and has only limited value for the differential diagnosis of submucosal tumors, mainly because insufficient material is harvested. Better tissue acquisition techniques are necessary for better differential diagnosis.

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.

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In the fight against cervical malignancy and its precursors, several adjuvant diag- In patients with borderline lesions (mild and moderate dysplasias) of the uterine cervix, cytomorphology alone often is not sufficient for the early and definite cytologic detection of malignancy. Cervical dysplasia describes squamous cells or tissues that potentially may lead to malignancy but do not exhibit sufficient evidence for a definite assumption. Resulting from weakness of morphologic criteria to identify malignant transformation in epithelial cells early and unequivocally, dysplasias are not a disease entity. The widely accepted assumption is that the higher the grade of dysplasia is, the higher the probability of progression to carcinoma is.1 However, as a result of insufficient morphologic criteria, neither histologic nor cytologic evaluation can predict whether a lesion will progress to cancer in an individual patient.2 Rates of regression and progression of cervical dysplasia (positive and negative predictive values) are quite different from one study to another. 1 Insufficient interobserver reproducibility in diagnostic cytology and histology represents another dilemma in the microscopic diagnosis of precancerous cervical intraepithelial lesions.Because the diagnosis of cervical squamous intraepithelial lesions (SILs) is not only poorly reproducible but also of limited biologic meaning for the individual patient, the number of resulting control procedures usually is high. These range from repeated cytologic smears and biopsies to unnecessary operations (conizations). Missed early diagnoses of cancers may result from cytomorphologic uncertainties. This also results in unnecessary costs and avoidable anxiety for the patients.In the late 1970s, zur Hausen suggested that there may be an association between human papillomavirus (HPV) and cervical carcinoma.3 Large numbers of subsequent epidemiologic, clinicopathologic, and molecular studies have linked the presence of specific types of HPV to the development of anogenital carcinoma and its precursors. A recent study estimated the worldwide HPV prevalence in cervical carcinomas at 99.7%. 4 Today, it is widely accepted that HPVs play a critical role in the pathogenesis of most cervical carcinomas and their precursor lesions. The infection of cervical epithelial cells with HPV itself is necessary but still insufficient for neoplastic progression. Other factors, especially genetic alterations, are needed to enter into the process of neoplastic transformation. 5Several adjuvant diagnostic methods currently are proposed to increase the diagnostic accuracy and reproducibility of cytology and histology. These range from clinical procedures, like colposcopy, to laboratory methods, like assays for the detection of HPV DNA and HPV typing 6 or DNA image cytometry (DNA-ICM). 1,7,8 In the current review, we focus on the technical performance and application of DNA-ICM in diagnosis and prognosis of cervical SILs and invasive cervical carcinoma. Biologic BackgroundChromosomal aneuploi...

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A task force of invited experts in the field of diagnostic DNA image cytometry, especially consisting of participants from the PRESS (Prototype Reference Standard Slides) and EUROPATH (European Pathology Assisted by Telematics for Healthcare) projects, but open to any other scientist or physician revealing experience in that new diagnostic procedure (names are given in the Annex A) agreed upon the following updated consensus report during the 5th International Congress of the ESACP 1997 in Oslo. This report is based on the preceeding one [9] and on results of the above mentioned European research projects. It deals with the following items: – Biological background and aims of DNA image cytometry,– Principles of the method,– Basic performance standards,– Diagnostic interpretation of DNA measurements,– Recommendations for practical use.

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