Cytology and Cytopathology

Question 1

Define cytology

Answer 1

Study of cells under light microscopy

Question 2

Give some examples of methods of acquiring cells
(3)

Answer 2

Cells can be exfoliated, scraped (brushing) or aspirated

Fine needle aspiration -> cells from a solid legion e.g. a benign or malignant legion

Brushing e.g. for cervical cells

Question 3

What is cytopathology

Answer 3

Microscopic examination of cells from the body for the diagnosis of disease

A branch of pathology that deals with manifestations of disease at the cellular level

Two divisions: cervical and diagnostic

Question 4

What are the two divisions of cytopathology
(2)

Answer 4

Cervical (gynae)
- cervical smears

Diagnostic (non-gynae)
- everything other than cervical smears
- can get ovarian cyst fluid which is technically still gynae so ‘diagnostic’ is used instead

Question 5

Write about the history of cytology - cervical
(6)

Answer 5

George Papanicolaou carried out research on hormonal cycle in rats and then extended this on the human menstrual cycle

He looked at hormonal changes in cervical cancer

He identified cell changes that were pre-clinical i.e. asymptomatic

Identified morphology of cervical carcinoma

Used immediate fixation to retain cellular detail

Developed the Papanicolaou staining procedure for cervical and diagnostic cytology

Question 6

Write about Papanicolau’s publications

Answer 6

Used drawing of cells as pictures weren’t taken
Didn’t know what he was drawing or what was causing it e.g. tadpole cells
He was ahead of his time
Republished in the 1950s
Precursor to the cervical screening program

Question 7

What is Liquid Based Cytology and why was it introduced?

Answer 7

Implementation of LBC for cervical screening allowed for residual sample to be used for research

Clinician used to swab cervix with wooden spatula and then smear cells

The spatula was thrown in the bin and the slide was fixed

Most of the cells were lost in the bin

The slide often had artefact as it wasn’t fixed correctly

Now we use LBC and a brush to get the cells and transfer them straight to liquid broth

We can get the cells out of the brush in the lab so we don’t waste any

We also have a more controlled, cleaner preparation of cells

Question 8

What are the benefits of liquid based cytology
(5)

Answer 8

Further understanding of HPV associated with cervical cancer

Development of HPV testing

Implementation of primary HPV testing for cervical cancer screening programme

No artefacts in sample e.g. blood

Correct fixation - no air drying

Question 9

Who was the first to use FNA?
(4)

Answer 9

First used in the Karolinska Institute (1940 to 1970’s)
Lost favour in US but continued in EU
Now widely accepted as a diagnostic tool
No complications of biopsy or surgery

Question 10

What is diagnostic cytology
(3)

Answer 10

A diagnostic tool
Not screening
Allows diagnosis to be made based on cellular features

Question 11

Give some examples of extra-cellular features which can be used in a diagnosis in diagnostic cytology

Answer 11

Nuclear
Cytoplasmic
Architectural
Extra-cellular
- Colloid
- Amyloid
- Lympho-glandular bodies

Question 12

Give three methods of staining used in diagnostic cytology

Answer 12

Routine staining methods

Histochemistry

Immunohistochemistry

Question 13

What are the two routine staining methods in diagnostic cytology

Answer 13

Pap stain

May-Grunwald Giemsa

Question 14

What are the three histochemistry stains used in diagnostic cytology

Answer 14

Grocott’s silver
Congo Red
D/PAS

Question 15

What is the most common sample in the diagnostic cytology lab?

Answer 15

Exfoliated cells

Question 16

Where can cells be exfoliated from?
(4)

Answer 16

Cyst fluid
Body cavity fluids
Sputum
Urine

Question 17

What three methods allow access to deeper lesions in diagnostic cytology

Answer 17

Endoscopy
FNA
Endoscopic ultrasound

Question 18

What specimens can be achieved from an endoscopy

Answer 18

Bronchoscopy specimens
e.g. bronchiole brushings or saline wash

Question 19

What specimens can be achieved from a FNA

Answer 19

Cells from a solid lesion
e.g. trans bronchiole FNA -> through bronchus into the legion in the wall

Question 20

How can endoscopic ultrasound be used in diagnostic cytology

Answer 20

CT guided FNA
Lymph nodes
Pancreas

Question 21

Where is FNA very commonly used?

Answer 21

Veterinary practices

Question 22

how can FNA be used with CT guidance?

Answer 22

Place in the guide wire
Check CT to see if guide wire is in the legion
Proceed with needle

Question 23

What is FNA?

Answer 23

Cells are aspirated from a solid lesion using a fine needle under negative pressure (vacuum) and processed for microscopic examination

Question 24

What is cytopathology?

Answer 24

First-line diagnosis

Question 25

What is involved in first-line diagnosis?
(7)

Answer 25

Reactive
Inflammation
Infection
Neoplasia
- Benign
- Malignant
- Metastatic

Question 26

Why are ancillary techniques important

Answer 26

They have an extended role in diagnostics, prognostics and therapeutics

Question 27

Give four examples of applications of ancillary tehcniques

Answer 27

Cell blocks
Immuncyto/histochemistry: Her2 histochemistry
Flow cytometry
Molecular: ISH/DNA/RNA analysis

Question 28

What is ISH

Answer 28

In-situ hybridisation

Question 29

What is the diagnostic algorithm in diagnostic cytology
(4)

Answer 29

Routine stain -> what disease process is going on

Immunohistochemistry -> Primary or secondary? is it benign or malignant? Panels if malignant

Grading and staging if malignant

IHC (for therapeutic markers) and/or molecular

Question 30

What should be done if immunohistochemistry indicates a secondary tumour?
(2)

Answer 30

Need to find the primary site to identify the tumour

Is the tumour well differentiated e.g. does it clearly look like breast. If undifferentiated need to carry out a larger panel to ID the tumour type

Question 31

What is meant by cancer staging
(2)

Answer 31

Low stage means a primary cancer i.e. tumour found in tissue where it is usually found e.g. cancer of the lung involving lung tissue

High stage e.g. carcinoma in lymph node -> indicates metastasis

Question 32

Who reports cytopathology

Answer 32

Cytopathologist
Sometimes histopathologise

Question 33

What training programmes are currently under way for medical scientists in the UK
(2)

Answer 33

Training for medical scientist to report

But there is some resistance from pathologists here in Ireland but this is being done in the UK

Question 34

What are the advantages of cytology
(5)

Answer 34

Less invasive sampling e.g. FNA vs biopsy
Faster turn around times -> no formalin fixation overnight
Ancillary techniques
Metastatic disease -> FNA, fluid cytology
Patient management

Question 35

What are three limitations of cytology

Answer 35

Sample size/cell yield
Experience/expertise
Assessment of invasion