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Summary and conclusionsNeedle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports.Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps. IntroductionIn a newly established breast clinic preliminary use of aspiration cytologyl-3 gave an unacceptably high incidence of false-negative reports and unsatisfactory preparations. These were apparently due to poor aspiration technique and faulty preparation of slides.4 Accordingly it was arranged that a cytologist should prepare slides at the clinic. Now, using the Diff Quik rapid staining method, a provisional report is given within five minutes of aspiration. If the preparation is found to be unsatisfactory aspiration is immediately repeated.Results obtained during the first year of this procedure have been analysed, with particular emphasis on finding reasons for false-negative and unsatisfactory reports. The value of aspiration cytology in patient management, the usefulness of which was recently questioned,5 has been assessed prospectively.

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SUMMARY Cervical smears from 30 women were examined. Fifteen of these had actinomycetes visible by direct smear examination and the organisms were isolated in 13. Of the remainder, all had negative smears and culture was similarly negative in 12, whilst in 3, the cultures were either positive (1) or suspicious (2).During the last ten years actinomycetes have increasingly been recognised in cervical smears of women using intrauterine contraceptive devices (IUCD). The identification of these actinomycetes has mainly been based on morphological findings.1-3 However, Bhagavan and Gupta4 isolated four strains of actinomycetes from 11 cases (36-3 %) taken from a series of 36 women diagnosed by Papanicolaou stain. Two of these isolates were identified as Actinomyces israeli using fluorescein-labelled antisera; the other two isolates were not ascribed to a species.It is well documented that actinomycetes are difficult to obtain from a mixed culture5-7 and that there are at least six different strains of actinomycetes which can produce actinomycotic infections.8 Therefore a cultural method which improves the isolation rate would be of benefit in diagnosis and an aid towards precise identification which in turn would assist the investigation of cervical infection.In a previous retrospective study we showed that actinomycetes were present in 42 of 293 (14 %) IUCD users and that most of these women were using all-plastic devices.9 In a continuing study, women found to have organisms suggestive of actinomycetes in routine cervical smears are being recalled to a special clinic. As part of this study attempts are made to culture the organisms from cervical swabs and from removed devices. Patients and methodsThirty women in two groups (A and B) were examined at a special clinic. In group A cases, referral was because actinomyces-like-organisms (ALOs) had been seen or suspected in cervical smears stained by Papanicolaou's method at a previous examination, Accepted for publication 14 January 1981 whilst group B women were randomly selected from those attending a family planning clinic. Two of group B were shown on first examination to have cervical smears positive for ALOs and these were transferred thereafter to group A. In group A cases, the second examination was within a 2-5 month period of the first and all women still had an IUCD in situ. Cervical smears and swabs were taken from the external os in these women and in six cases, the IUCD was removed, and studied bacteriologically.The cervical smears were Gram-stained and examined for leucocytes, ALOs and microcolonies of actinomycetes. Within two hours of sampling, bacteriological examination was made on the swabs and selected beads of pus from the device. CULTURE METHODA primary inoculum was made by soaking the swabs or emulsifying selected beads of pus from the device in 5 ml thioglycollate broth (BBL). From this primary inoculum a series of tenfold dilutions was made in thioglycollate broth (10-1 to 10-4). 0*1 ml of each dilution was inoculated in duplicate on two 10 %...