Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Background:
Sputum is a non-invasive, economic investigation whereby bronchogenic carcinoma
can be identified. Manual cytological screening is labour intensive, time-consuming
and requires a continuous high level of alertness. Automation has recently been
successfully introduced in gynaecological cytology. Since sputum samples are similar
to cervical smears, the question arises as to whether they are also suitable for
automated screening.
Objective:
This study presented with various objectives: 1) To test automated sputum screening
using the BD FocalPoint™ Slide Profiler (FP) and compare with manual sputum
screening. 2) To determine the sensitivity and specificity of sputum in identification of
bronchogenic carcinoma. 3) To ascertain if any clinical, radiological or bronchoscopy
findings would be predictors for bronchogenic carcinoma. 4) To determine the
significance of adequacy.
Method: Sputum samples were collected prospectively from patients attending the Division of
Pulmonology at Tygerberg hospital for a transbronchial fine needle aspiration biopsy
(TBNA) or a transthoracic fine needle aspiration biopsy (TTNA) for the period from
2010 to 2012. A pre-bronchoscopy sputum was collected and submitted for
processing. Stained slides were put through the FP for automated screening. After
slides were qualified, sputum slides were put back in the routine screening pool.
Correlation was done using the TBNA/TTNA result as the standard to evaluate the
sputum results. Results:
108 sputum samples were included in this study. Of the 84.3% malignant (n=91) and
15.7% benign (n=17) cases confirmed with a diagnostic procedure, sputum cytology
had a sensitivity of 38.5% (35/91 malignant cases), and a specificity of 100% (17/17
benign cases). Automated screening had a better sensitivity of 94.3% (33/35 positive
sputum cases), while manual screening showed a sensitivity of 74.3% (26/35 positive
sputum cases) when compared to the final sputum result.
Individual parameters with a significant association with positive sputum included the
presence of an endobronchial tumour, partial airway obstruction / stenosis, round
mass, spiculated mass (negative association), loss of weight (negative association)
and squamous cell carcinoma as the histological subtype. Adequacy was not as
significant as hypothesised since 85.3% of true positive sputum, but also 65.5% of
false negative sputum, had large numbers of alveolar macrophages present.
Conclusion:
Sputum cytology remains an important part of the screening programme for
bronchogenic carcinoma in the public health sector of South Africa. Results confirm
that sputum cytology is very specific, and automated screening improves sensitivity.
Automated screening proved to be more time efficient, resulting in 83.1% reduction
(p<0.0001) in the screening time spent per case by a cytotechnologist.
Results confirm that the quantity of alveolar macrophages is not directly proprtional to
pathology representation. Positive sputum results did however improve with sputum
adequacy, but had no significant association.
Recommendations from this study include adopting automated sputum screening. / AFRIKAANSE OPSOMMING: Agtergrond:
Die verkryging van ‘n sputummonster is ‘n nie-indringende, ekonomiese ondersoek
waardeur bronguskarsinoom identifiseer kan word. Nie-geoutomatiseerde sitologiese
ondersoek is arbeidsintensief, tydrowend en vereis ‘n deurlopende hoë vlak van
konsentrasie en fokus. Outomatisering is onlangs suksesvol geïmplementeer in
ginekologiese sitologie-ondersoeke. Aangesien sputummonsters soortgelyk aan
servikale monsters is, het die vraag ontstaan of sputummonsters ook geskik sou
wees vir geoutomatiseerde sifting.
Doelwit:
Hierdie studie het verskeie doelwitte gehad: 1) Om geoutomatiseerde sifting van
sputummonsters te toets deur gebruik te maak van BD Focal Point ™ Slide Profiler
(FP), en te vergelyk met nie-geoutomatiseerde sputum sifting. 2) Om die sensitiwiteit
en spesifisiteit van sputum in die identifikasie van bronguskarsinoom te bepaal. 3)
Om vas te stel of enige kliniese, radiologiese of brongoskopiese bevindings
bronguskarsinoom sou kon voorspel. 4) Om die belang van ‘n verteenwoordigende
monster te bepaal.
Metode:
‘n Prospektiewe studie van die pasiënte wat die Divisie van Pulmonologie by
Tygerberg Hospitaal vir transbrongiale nodale aspirasie (TBNA) of ‘n transtorakale
aspirasie (TTNA) vanaf Julie 2010 tot Mei 2012 bygewoon het, is gedoen. ‘n Prebrongoskopiese
sputum is geneem en gestuur vir prosessering. Die gekleurde
skuifies is deur die FP gestuur vir geoutomatiseerde ondersoek. Indien die
sputumskuifies gekwalifiseer het vir geoutomatiseerde sifting, is hulle in die groep vir
ondersoek ingesluit. ‘n Korrelasiestudie, om die sputumresultate te evalueer, is
uitgevoer deur die TBNA/TTNA bevindings as standaard te gebruik. Resultate:
Vir hierdie studie is 108 sputummonsters ingesluit. Vanuit die 84.3% maligne (n=91)
en 15.7% benigne (n=17) gevalle, bevestig deur ‘n diagnostiese prosedure, het
sputumsitologie ‘n sensitiwiteit van 38.5% (35/91 maligne gevalle) en ‘n spesifisiteit
van 100.0% (17/17 benigne gevalle), getoon. Geoutomatiseerde sifting het ‘n beter
sensitiwiteit met 94.3% (33/35 maligne gevalle), terwyl nie-geoutomatiseerde
(ondersoek) ‘n sensitiwiteit van 74.3% (26/35 maligne gevalle) wanneer met die finale
resultaat vergelyk, gevind.
Individuele parameters met ‘n betekenisvolle assosiasie het die teenwoordigheid van
‘n endobrongiale tumor, gedeeltelike lugwegobstruksie / stenose, ronde massa, ‘n
spekuleerde massa (negatiewe assosiasie), gewigsverlies (negatiewe assosiasie) en
plaveiselkarsinoom as die histologiese subtipe, ingesluit. Geskiktheid van die
monster was nie so betekenisvol as wat in die hipotese gestel is nie: aangesien
85.3% van ware positief gediagnoseerde sputummonsters, maar ook 65.5% van die
vals negatiewe sputummonsters, groot hoeveelhede alveolêre makrofae ingesluit het.
Gevolgtrekking:
Sputumsitologie bly steeds ‘n belangrike deel van die siftingsprogram vir
bronguskarsinoom in die openbare gesondheidssektor in Suid-Afrika. Resultate van
hierdie studie bevestig dat sputumsitologie baie spesifiek is en dat geoutomatiseerde
sifting die sensitiwiteit verbeter. Ge-outomatiseerde sifting het bewys dat dit meer
tydsbesparend is, met ‘n 83.1% vermindering (p<0.0001) in die siftingstyd wat deur
een sitotegnoloog per geval bestee word.
Resultate het bevestig dat die hoeveelheid alveolêre makrofae nie direk
proporsioneel verwant is tot die patologie nie. Hoe meer verteenwoordigend die
sputummonster was, hoe groter was die kanse om ‘n akkurate positiewe diagnose te
maak. Die assosiasie van die geskiktheid van die sputummonster en die positiewe
resultate het egter nie ‘n statisties betekenisvolle resultaat getoon nie.
Aanbevelings vir hierdie studie sluit in die aanwending van geoutomatiseerde
sputumondersoeke.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/86677 |
| Date | 04 1900 |
| Creators | Neethling, Greta Sophie |
| Contributors | Schubert, P. T., Koegelenberg, C. F. N., Diacon, A. H., Wright, C. A., Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology, Division of Anatomical Pathology. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | xx, 164 p. : col. ill. |
| Rights | Stellenbosch University |
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