How often is dysplasia diagnosed by biopsy or smear examination? Application of a maximum likelihood based method to the assessment of detection rates in the nasal mucosa of nickel workers.
In view of the known increased risk of nasal carcinoma and the high prevalence of dysplastic lesions of the nasal mucosa among nickel workers, regular screening for the existence of possibly precancerous dysplastic lesions is offered to workers in a Norwegian nickel refinery. Unfortunately, available sampling techniques do not allow the identification of all subjects in whom dysplastic changes are present. Independent histological and cytological (brush cytology) diagnoses, obtained for each of a group of 90 workers, have been used to estimate, by a maximum likelihood method, the probabilities that existing dysplastic lesions will be detected by each of these two screening methods. In the group studied, cytology performed rather less well than histology in unambiguously detecting dysplasia. However, when cytological specimens showing irregular (possibly dysplastic) epithelial cells were grouped with those showing clear dysplastic changes, detection probabilities were estimated at 0.52 by histology and 0.57 by cytology. Detection probabilities were estimated to be higher among subjects with a previously known history of dysplasia, particularly by histology (P < 0.01), probably due to larger dysplastic areas. In view of both its greater facility and speed of sampling, and its greater acceptability, brush cytology may be preferable to biopsy sampling for the screening of large numbers of workers at risk.
Downs
A M
AM
Laboratoire de Microscopie Quantitative en Histopathologie, Université Paris 7, France.
Boysen
M
M
Voss
R
R
Reichborn-Kjennerud
S
S
Abeler
V
V
Rigaut
J P
JP
Reith
A
A
D001706:Biopsy; D002277:Carcinoma / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D008403:Mass Screening; D009297:Nasal Mucosa / Q000187:drug effects* / Q000473:pathology; D009532:Nickel / Q000633:toxicity*; D009664:Norway; D009669:Nose Neoplasms / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D009784:Occupational Diseases / Q000139:chemically induced / Q000517:prevention & control*; D011230:Precancerous Conditions / Q000139:chemically induced / Q000473:pathology; D013223:Statistics as Topic
D009532:Nickel