We compared the performance of the ThinPrep (TP) Imaging System (TIS) with manual reading of TP slides (TPM) and with manual reading of the paired conventional Pap smear (PS) in terms of sensitivity for and positive predictive value (PPV) of high-grade disease and productivity. The study consisted of 11,416 routine PS and paired TP slides as well as 103 confirmed abnormal TP slides. In terms of sensitivity for the detection of biopsy-confirmed high-grade disease, overall there was no statistically significant difference between TIS-screened TP (TPI) and TPM (81.1% vs. 86.8%). For the routine cases, TPI was significantly more sensitive than PS (73.4% vs. 57.8%). In terms of PPVs for the cytologic prediction of high-grade disease, there was no statistically, significant difference among TPI, TPM, and PS (75.6%, 73.9%, and 84.6%). For cytologic reports of possible high-grade disease, the PPVs were equivalent for TPI (45.0%) and TPM (37.0%) and there was no significant difference in PPVs between TPI and PS (61.3%). For TP slides, TIS screening showed a 27% productivity gain when compared with manual screening and a 54% productivity gain when compared with manual screening of PS slides. Use of TIS showed productivity benefits when compared with TPM and both productivity and sensitivity benefits over use of PS.

This is a case of granulocytic sarcoma presenting as bilateral breast masses in a 40‐yr‐old woman with concurrent unsuspected chronic myeloid leukemia diagnosed by fine‐needle aspiration. The granulocytic differentiation was recognized on Diff‐Quik‐stained cytology smears and confirmed rapidly on flow cytometry on the same day. The breast has been reported to be an uncommon site for granulocytic sarcoma. We found that 38.8% of granulocytic sarcomas diagnosed by fine‐needle aspiration in the English‐language literature occurred in the breast. In the absence of clinical history or hematological abnormality, granulocytic sarcoma may be misdiagnosed, depending on the degree of myeloid differentiation present within the tumor. The differential diagnosis includes large‐cell non‐Hodgkin's lymphoma, lobular carcinoma of the breast, undifferentiated carcinoma, malignant melanoma, extramedullary hemopoeisis and inflammation. The key morphological features and useful ancillary tests are discussed. Diagn. Cytopathol. 2001;24:53–57. © 2001 Wiley‐Liss, Inc.

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SummaryThe relationship between expression of receptors for oestrogen and progesterone (ER and PR) and disease progression in breast cancer was investigated by comparing immunocytochemical determinations of ER and PR in fine needle aspirates from primary and secondary breast tumours. Rates of receptor expression were significantly higher in primary than in secondary lesions: for ER 63.3% (n = 689) compared with 45.3% (n = 223), and for PR 53.7% (n = 443) compared with 33.1% (n = 121). The effect of menopausal status was examined by subdividing the patient cohort into those over or under the age of 50 years. In both instances, ER expression in secondary tumours was relatively low; however, only postmenopausal patients had significantly lower rates of PR expression in secondary tumours. Consistent with this, an increase in the ER+PR-profile in secondary tumours compared with primary cases from postmenopausal patients was seen, and in a multivariate analysis, a specific absence of PR expression in secondary tumours was revealed. Comparison of ER and PR expression in simultaneously sampled primary tumours and lymph node metastases from the same patient showed that receptor expression was stable with progression to a metastatic site as results were concordant for ER in 92% (n = 88) and PR in 93.8% of cases (n = 65). These results suggest that absence of PR expression in primary breast cancer is associated with disease progression and may be a marker of an aggressive tumour phenotype. Keywords: breast cancer; metastatic; receptors -oestrogen -progesterone 1564British Journal of Cancer (1999) 79(9/10), 1564-1571 © 1999 Cancer Research Campaign Article no. bjoc.1998 Received 14 April 1998 Revised 2 September 1998 Accepted 18 September 1998 Correspondence to: R Balleine numbers examined are small. Nevertheless, it appears that in matched cases the receptor phenotype of the primary cancer is likely to be maintained in the recurrent tumour in the majority of cases (Kamby et al, 1989;Muller-Holzner et al, 1993;Kuukasjarvi et al, 1996). The more general question of whether certain receptor phenotypes are associated with greater likelihood of progression to metastasis is, therefore, important.The purpose of this study was to determine, using immunocytochemical methods in a large cohort of primary and secondary breast cancers sampled by fine needle aspiration, the combined ER and PR phenotypes, to ask whether secondary lesions are more likely to be receptor-positive than negative and to determine whether a particular ER/PR phenotype predominated in secondary lesions. The profile of receptor expression in primary and secondary tumours in pre-and postmenopausal women is not known and has also been examined in this study. METHODS PatientsPatients were women who presented for diagnostic fine needle aspiration biopsies of breast tumours to the Department of Tissue Pathology at Westmead Hospital between 1986 and 1993. 'Primary' tumours were aspirates of lesions in the breast diagnosed as 'adenocarcinoma' or 'colloid carcinoma'....