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We have assessed the effectiveness and accuracy of reporting fine needle aspirates of the breast (FNAB) using a liquid-based cytology (LBC) system (the Cytospin) method) in the pressure situation of a rapid access clinic (RAC). We have reviewed every case from the RAC from June 1997 to February 2001 inclusive. There were 1322 cases, which accounted for 26% of the total FNAB received in our department over the period. There were 323 cancers and 999 benign cases in the group. The inadequate/nondiagnostic rate (C1) was 18%. The absolute sensitivity, including C1 cases, was 73% with the complete sensitivity being 90%. The groups of 'atypical, probably benign' (C3) and 'suspicious, probably malignant' (C4) accounted for a total of 6.2%. There were 28 false negative cases and 1 false positive case (a borderline phyllodes tumour). Comparing our results with the standards recommended by the NHSBSP has shown that the diagnosis of FNAB using this LBC method is feasible, accurate and reliable even in the pressure situation of a RAC.

This case is believed to be the first reported recurrent intracranial ganglioglioma with purely neuroblastomatous malignant transformation. A complete macroscopic resection of a right frontal lobe tumor in an 18-year-old woman revealed differentiated ganglioglioma. Seven years later a large, well-demarcated recurrent tumor was again macroscopically totally resected in the same patient. Histological analysis showed malignant transformation in only the neuronal component of the original tumor. A review of the literature on recurrent gangliogliomas and their malignant transformation is included.

SUMMARYA new technique of treating incompetent perforating ueins using a shearing instrument is described, and the results in 24 patients are reported.AT the present time the main therapeutic approach to the treatment of incompetent perforating veins consists of either a direct surgical ligation technique as described by Dodd and Cockett (1956) or the injection/ compression technique popularized by Fegan (1963).The operation described by Dodd and Cockett (1956) necessitates a longitudinal incision, often through unhealthy skin and fat, to approach directly the incompetent perforating veins. Not infrequently such incisions do not heal rapidly and the resultant scars are painful. The technique of injection/compression, apart from being unreliable, also has a definite morbidity.A new approach to the problem of perforating vein incompetence has been devised, with the development of a new instrument. The technique has proved effective and to date has had no complications. Shearing instrument or phlebotomeThe instrument has been termed as such in recognition of the physical action involved in the technique. It is depicted in Fig. 1, and consists essentially of an 'end knife'. The cutting edge is curved and bevelled and measures 2.5 cm. The sides of the blade are blunt. The instrument, made of stainless steel, forms a U-loop shape with a spring temper in the curve of the loop. The design was by the author and it is manufactured by Macarthys. t TechniqueThe patient with incompetent perforating veins, often associated with varicose veins of the long saphenous system, is prepared in the usual way for surgery.Under general anaesthesia, via a skin crease groin incision the saphenous vein is ligated flush with the femoral vein; the various tributaries are also ligated. The technique follows the traditional pattern. A stripping operation of the main long saphenous vein is then performed to below the knee using a Nabatoff stripper with detachable heads. The vein stripper is introduced from above and passed downwards to just below the knee.A transverse incision is made over the medial aspect of the lower leg just below the knee. The stripper end is identified, isolated and delivered into the wound. The head of the stripper is then attached and drawn upwards into the wound. The lower incision is deepened through the deep fascia, avoiding the saphenous nerve, and the shearing instrument is then introduced under the fascia. With the leg elevated, the phlebotome is passed downwards on the deep surface of the fascia along the line of the perforating vein position, viz. one finger's breadth behind the medial subcutaneous border of the tibia (Fig. 2). The cutting edge of the instrument is felt to engage these veins which are then sheared off level with the deep fascia. The phlebotome is passed downwards to the level of the medial malleolus and the manmuvre is repeated two or three times to ensure that the veins are divided.The phlebotome is withdrawn, followed usually by a trickle of blood from the wound. The limb is then bandaged with...

Borderline nuclear change; can a subgroup be identified which is suspicious of high-grade cervical intraepithelial neoplasia, i.e. CIN 2 or worse? Only 10% of first borderline smears are associated with a histological high-grade (HG) abnormality, i.e. CIN 2,3, invasive malignancy or glandular neoplasia on subsequent investigation. The advantages of highlighting this subgroup are obvious but is this possible? From 1996 and 1997, 242 borderline smears with histological follow-up were examined by two independent experienced observers (observer 1 and 2) without prior knowledge of further investigation results. For each smear a profile of nuclear details was produced, also noting the type of cell mainly affected by the process; then the observers were asked to assess the degree of worry of HG disease for each smear i.e. whether the smear fell into group 1 borderline changes indicative of low-grade (normal, inflammatory, CIN1/HPV) disease (BL/LG) or group 2 difficult borderline smear, HG disease (CIN 2,3, invasive neoplasia or glandular neoplasia) cannot be excluded (BL/HG). Observer 1 selected a group of BL/HG with a PPV for HG disease of 38%, with observer 2 having a PPV of 50%; this compared with the overall laboratory HG disease PPV for borderline smears of 14%. Both observers found the most useful criterion to be the increase in nuclear:cytoplasmic ratio. Our results show that it is possible to separate a small group of borderline smears which should be classified as 'borderline/high grade lesion difficult to exclude' (BL/HG). Both observers had some success in arriving at this classification although their method of selecting out this group was quite different.