- Email: [email protected]
CYTOLOGICAL METHOD FOR ASSESSING THE TOPOGRAPHY OF NEOPLASTIC CELLS ON THE ECTOCERVIX
972
standpoint is predominantly clinical. The author has a sensible approach to pulmonary function tests, but the section on principles of management is a rather weak compromise. The principles are briefly stated but are then obscured by long lists of measures which, although physiologically sound, lack clinical perspective. The volume is well produced and reasonably priced. It can be recommended as good background reading to all concerned with chest disease and respiratory failure, but a really useful book on respiratory failure has not yet been
logical purposes, a working knowledge of t and X2 tests, analysis of variance, and regression will suffice and Campbell goes into these in some detail, with clear and fully worked examples. In a fairly short book it must be difficult to know what to do about the multitude of other tests. By mentioning them only briefly, Dr. Campbell leaves the reader unsure of their limitations and of the situations to which they are best suited.
written.
New Editions
Statistics for Biologists R. C. CAMPBELL, university lecturer in the School of Agriculture, Cambridge. London: Cambridge University Press. 1967. Pp. 242. 40s. (cloth), 15s. (paperback). FEW authors of books on statistics stick to their promise to eschew mathematical gymnastics: sooner or later the essence of the subject breaks through. Dr. Campbell largely avoids temptation until his final chapters on analysis of variance and correlation (and even here the thread of his description gains little from algebraic interruption). This book should not be as a manual for those who wish to analyse their own results. All too often published statistical analyses end abruptly with a value for P, the reader being left to draw his own conclusions: Campbell’s chapter on decision-taking will provide most valuable help. For most medical and bio-
regarded merely
Community as Doctor: New Perspectives on a Therapeutic Community.-2nd ed. By Robert N. Rapoport, with the collaboration of Rhona Rapoport, and Irving Rosow. London: Tavistock Publications. 1967. Pp. 325. 25s. (paperback); 45s. (hardback). The Diabetic ABC: A Practical Book for Patients and Nurses.14th ed. By R. D. Lawrence. London: H. K. Lewis. 1967. Pp. 91. 7s. The Technique of Psychotherapy: Parts I and II.-2nd ed. By Lewis R. Wolberg. London: Heinemann Medical Books. New Stratton. 1967. Pp. 1411. £ 11 4s.;$29.75. York: Grune &
Surgery of the Ear.-2nd ed. By George E. Shambaugh, Jr. London Philadlephia: W. B. Saunders. 1967. Pp. 722. E10 10s.;$30.
and
Designing for the Disabled.-2nd ed. By Selwyn Goldsmith. London: Royal Institute of British Architects. 1967. Pp. 207. 70s.
Methods and Devices CYTOLOGICAL METHOD FOR ASSESSING THE TOPOGRAPHY OF NEOPLASTIC CELLS ON THE ECTOCERVIX EXFOLIATIVE cytology entails the examination of desquamated cells whose relation to each other has been disturbed. Microscopy of stained smears enables the cells to be identified, but does not give much information concerning their in-vivo
topography.
Tenovus membrane
The purpose of the technique described here is to assess the distribution of neoplastic cells on the ectocervical surface, by applying a membrane to which the superficial cells of the cervix adhere. The original surface arrangement of the cells of the ectocervix is thus preserved. The only reference found to a comparable technique, traced after the present method had been developed, is that of Nyklicek1 who used a glass slide instead of a plastic membrane. THE DEVICE
The membrane, a nylonMillipore ’ filter (N.s.w.p. 4700), is applied to the cervical surface by means of a Tenovus membrane applicator-essentially a metal cylinder with one end cut obliquely. The membrane is placed over this end, and is held in place by a metal ring slightly larger in diameter than the cylinder (see accompanying figure). Close and uniform application of the membrane to the cervical surface is obtained by means of an obturator padded with replaceable foam nylon. The obturator fits into the cylinder like a piston, its flat end with an obliquity corresponding to that of the membrane on the end of the cylinder. This correspondence of obliquity is attained by slots at the free end of the applicator, into which projections on the handle of the obturator slide. Only gentle pressure is required on the obturator to cause the superficial cervical cells to adhere to the membrane. THE METHOD
in the dorsal position and the cervix of a speculum. The applicator is then introduced, usually with the longest part in the posterior fornix, but sometimes it has to be rotated slightly in order to obtain the closest contiguity between the membrane and the surface of the cervix. After gentle pressure has been applied to the The
patient by
is exposed
is
placed
means
1.
Nyklíček, O.
Acta
cytol. 1960, 4,227.
applicator, exploded.
obturator, the applicator is withdrawn, the membrane is removed, fixed without delay by an aerosol fixative, and placed in a dry container. The portion of the membrane corresponding to the anterior margin of the cervix is marked at the time of collection. By touching the external os with a silver nitrate stick immediately before applying the membrane the site of the os is imprinted the membrane. The distribution of carcinoma cells on the membrane is determined by microscopic examination of the filter after staining with haematoxylin and eosin, the position of the groups of abnormal cells being indicated by ink marks on the coverslip. This method of examination is now being used in patients in whom the standard cervical-smear technique reveals carcinoma cells. By giving information concerning the extent of carcinoma in situ on the ectocervix, the method provides a guide whether the usual cone-biopsy procedure will remove the lesion completely. The topography of the neoplastic lesion on the cervix is represented by the pattern of ink marks on the membrane coverslip, enabling its relation to the marked site of the external os to be displayed. The total outline of the area of cervix in contact with the membrane is also clearly delineated. The correlation of cytological topography with the histological localisation of in-situ carcinoma on the ectocervix provided by serial section of cone-biopsy specimens will be discussed in a more detailed report.
on
I wish to thank Mr. D. Griffiths for making the Tenovus applicator; Mr. P. Ponsford and Mrs. J. McCormack for their technical assistance ; Dr. Jane Jones for clinical cooperation; and Tenovus for their support in this project. Tenovus Institute for Cancer Research, The Heath, Cardiff
D. M. D. EVANS M.D.
Lond.,
M.R.C.P., M.C.PATH.
standpoint is predominantly clinical. The author has a sensible approach to pulmonary function tests, but the section on principles of management is a rather weak compromise. The principles are briefly stated but are then obscured by long lists of measures which, although physiologically sound, lack clinical perspective. The volume is well produced and reasonably priced. It can be recommended as good background reading to all concerned with chest disease and respiratory failure, but a really useful book on respiratory failure has not yet been
logical purposes, a working knowledge of t and X2 tests, analysis of variance, and regression will suffice and Campbell goes into these in some detail, with clear and fully worked examples. In a fairly short book it must be difficult to know what to do about the multitude of other tests. By mentioning them only briefly, Dr. Campbell leaves the reader unsure of their limitations and of the situations to which they are best suited.
written.
New Editions
Statistics for Biologists R. C. CAMPBELL, university lecturer in the School of Agriculture, Cambridge. London: Cambridge University Press. 1967. Pp. 242. 40s. (cloth), 15s. (paperback). FEW authors of books on statistics stick to their promise to eschew mathematical gymnastics: sooner or later the essence of the subject breaks through. Dr. Campbell largely avoids temptation until his final chapters on analysis of variance and correlation (and even here the thread of his description gains little from algebraic interruption). This book should not be as a manual for those who wish to analyse their own results. All too often published statistical analyses end abruptly with a value for P, the reader being left to draw his own conclusions: Campbell’s chapter on decision-taking will provide most valuable help. For most medical and bio-
regarded merely
Community as Doctor: New Perspectives on a Therapeutic Community.-2nd ed. By Robert N. Rapoport, with the collaboration of Rhona Rapoport, and Irving Rosow. London: Tavistock Publications. 1967. Pp. 325. 25s. (paperback); 45s. (hardback). The Diabetic ABC: A Practical Book for Patients and Nurses.14th ed. By R. D. Lawrence. London: H. K. Lewis. 1967. Pp. 91. 7s. The Technique of Psychotherapy: Parts I and II.-2nd ed. By Lewis R. Wolberg. London: Heinemann Medical Books. New Stratton. 1967. Pp. 1411. £ 11 4s.;$29.75. York: Grune &
Surgery of the Ear.-2nd ed. By George E. Shambaugh, Jr. London Philadlephia: W. B. Saunders. 1967. Pp. 722. E10 10s.;$30.
and
Designing for the Disabled.-2nd ed. By Selwyn Goldsmith. London: Royal Institute of British Architects. 1967. Pp. 207. 70s.
Methods and Devices CYTOLOGICAL METHOD FOR ASSESSING THE TOPOGRAPHY OF NEOPLASTIC CELLS ON THE ECTOCERVIX EXFOLIATIVE cytology entails the examination of desquamated cells whose relation to each other has been disturbed. Microscopy of stained smears enables the cells to be identified, but does not give much information concerning their in-vivo
topography.
Tenovus membrane
The purpose of the technique described here is to assess the distribution of neoplastic cells on the ectocervical surface, by applying a membrane to which the superficial cells of the cervix adhere. The original surface arrangement of the cells of the ectocervix is thus preserved. The only reference found to a comparable technique, traced after the present method had been developed, is that of Nyklicek1 who used a glass slide instead of a plastic membrane. THE DEVICE
The membrane, a nylonMillipore ’ filter (N.s.w.p. 4700), is applied to the cervical surface by means of a Tenovus membrane applicator-essentially a metal cylinder with one end cut obliquely. The membrane is placed over this end, and is held in place by a metal ring slightly larger in diameter than the cylinder (see accompanying figure). Close and uniform application of the membrane to the cervical surface is obtained by means of an obturator padded with replaceable foam nylon. The obturator fits into the cylinder like a piston, its flat end with an obliquity corresponding to that of the membrane on the end of the cylinder. This correspondence of obliquity is attained by slots at the free end of the applicator, into which projections on the handle of the obturator slide. Only gentle pressure is required on the obturator to cause the superficial cervical cells to adhere to the membrane. THE METHOD
in the dorsal position and the cervix of a speculum. The applicator is then introduced, usually with the longest part in the posterior fornix, but sometimes it has to be rotated slightly in order to obtain the closest contiguity between the membrane and the surface of the cervix. After gentle pressure has been applied to the The
patient by
is exposed
is
placed
means
1.
Nyklíček, O.
Acta
cytol. 1960, 4,227.
applicator, exploded.
obturator, the applicator is withdrawn, the membrane is removed, fixed without delay by an aerosol fixative, and placed in a dry container. The portion of the membrane corresponding to the anterior margin of the cervix is marked at the time of collection. By touching the external os with a silver nitrate stick immediately before applying the membrane the site of the os is imprinted the membrane. The distribution of carcinoma cells on the membrane is determined by microscopic examination of the filter after staining with haematoxylin and eosin, the position of the groups of abnormal cells being indicated by ink marks on the coverslip. This method of examination is now being used in patients in whom the standard cervical-smear technique reveals carcinoma cells. By giving information concerning the extent of carcinoma in situ on the ectocervix, the method provides a guide whether the usual cone-biopsy procedure will remove the lesion completely. The topography of the neoplastic lesion on the cervix is represented by the pattern of ink marks on the membrane coverslip, enabling its relation to the marked site of the external os to be displayed. The total outline of the area of cervix in contact with the membrane is also clearly delineated. The correlation of cytological topography with the histological localisation of in-situ carcinoma on the ectocervix provided by serial section of cone-biopsy specimens will be discussed in a more detailed report.
on
I wish to thank Mr. D. Griffiths for making the Tenovus applicator; Mr. P. Ponsford and Mrs. J. McCormack for their technical assistance ; Dr. Jane Jones for clinical cooperation; and Tenovus for their support in this project. Tenovus Institute for Cancer Research, The Heath, Cardiff
D. M. D. EVANS M.D.
Lond.,
M.R.C.P., M.C.PATH.