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Cell Pathology > L.13 Diagnostic Cytology > Flashcards

L.13 Diagnostic Cytology Flashcards

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1
Q

What is diagnostic cytology?

A

The microscopic examination of cells to assist in the diagnosis of disease.

It is performed in hospital laboratories and is used for diagnosis rather than screening.

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2
Q

Is diagnostic cytology a screening test?

A

No, it is not a screening test.

Unlike cervical smears used for population screening.

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3
Q

What are the key characteristics of diagnostic cytology?

A

Morphological evaluation of individual cells or small clusters to:
* Confirm a diagnosis
* Establish differential diagnoses
* Guide treatment and management

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4
Q

What are the primary applications of cytology?

A
  1. Diagnostic Use in Pathology
  2. Research and Non-Clinical Applications
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5
Q

What does diagnostic use in pathology determine?

A

It determines:
* Benign vs malignant nature of lesions
* Primary vs metastatic tumours
* Site of origin

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6
Q

How does cytology support patient management?

A

It supports:
* Therapeutic planning
* Patient management
* Prognostic assessment

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7
Q

What are some research and non-clinical applications of cytology?

A

Used in:
* Cell culture
* Morphological and structural analysis
* Molecular biology techniques
* Drug testing and pharmacological research
* Biochemical and immunological assays

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8
Q

List common anatomical sites for cytology.

A
  1. Body Cavities
  2. Respiratory Tract
  3. Organ Systems
  4. Lymphoid Tissue
  5. Head and Neck
  6. Genitourinary System
  7. Neurological
  8. Gastrointestinal (GI) Tract
  9. Soft Tissue & Bone
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9
Q

What body cavities are commonly examined in diagnostic cytology?

A

Pleural, peritoneal, and pericardial fluids.

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10
Q

What samples are taken from the respiratory tract for cytology?

A

Bronchial brushings, washings, sputum, transbronchial FNAs.

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11
Q

Which organ systems are commonly analyzed in cytology?

A

Thyroid, breast, liver, pancreas, kidney, prostate.

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12
Q

What is the role of lymphoid tissue in diagnostic cytology?

A

Lymph node FNAs are used for lymphoma and metastatic spread.

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13
Q

What samples are collected from the head and neck for cytology?

A

Thyroid, salivary glands, cervical lymph nodes.

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14
Q

What fluids are analyzed from the genitourinary system?

A

Urine, prostatic fluid, seminal vesicles.

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15
Q

What is analyzed from the neurological system in cytology?

A

Cerebrospinal fluid (CSF).

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16
Q

What samples are taken from the gastrointestinal tract for cytology?

A

Brushings, fluid samples, FNAs of lesions.

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17
Q

What is analyzed from soft tissue and bone in diagnostic cytology?

A

Accessible lesions after demineralisation in bone.

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18
Q

What are the various types of specimens that can be collected for cytological examination?

A
  • Fluids (e.g., pleural, peritoneal, pericardial)
  • Aspirates (FNAs from solid lesions)
  • Brushings (e.g., bronchial or GI tract)
  • Washings (e.g., peritoneal, bladder)
  • Urine (especially for urothelial malignancies)
  • CSF (neurological diseases and malignancies)
  • Smears/Scrapings (superficial lesions, cervix)
  • Faeces (occasionally used in some parasitology or GI pathology)
  • Imprints (e.g., from biopsied tissue)

Each specimen type serves specific diagnostic purposes in cytology.

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19
Q

What is the principle of Fine Needle Aspiration Cytology (FNAC)?

A

Involves using a fine needle to aspirate cells from a solid lesion using negative pressure (vacuum)

The collected cells are processed and examined microscopically.

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20
Q

What are the indications for using FNAC?

A
  • Any solid lesion that is accessible by needle (with or without imaging guidance)
  • Minimally invasive
  • Rapid
  • Cost-effective

FNAC is used for quick assessment of lesions.

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21
Q

List common FNAC sites.

A
  • Thyroid
  • Breast
  • Lymph nodes
  • Salivary glands
  • Lung
  • Liver
  • Kidney
  • Pancreas
  • Prostate
  • Soft tissue, subcutaneous lesions
  • Bone

Each site has specific contexts for FNAC application.

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22
Q

What is the context of FNAC in the thyroid?

A

Assess nodules; differentiate benign from malignant

FNAC is crucial for thyroid nodule evaluation.

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23
Q

What role does cytology play in diagnostics?

A

Often used as a first-line investigation when imaging reveals a lesion

It enables rapid decision-making between benign vs malignant and primary vs secondary tumours.

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24
Q

True or False: FNAC can be used for both benign and malignant lesions.

A

True

FNAC is a diagnostic tool applicable to various lesions.

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25
Fill in the blank: FNAC is often performed under _______ guidance for deep organ sampling.
[CT/US] ## Footnote Imaging guidance enhances accuracy in FNAC procedures.
26
What is the importance of differentiating between benign and malignant lesions in cytology?
Critical in triaging for surgery or conservative management ## Footnote This differentiation impacts treatment planning.
27
What does FNAC help to determine in lymph nodes?
Differentiate between reactive, primary, or metastatic lesions ## Footnote FNAC aids in staging and treatment decisions.
28
What is the common use of FNAC?
Influences surgical decisions and monitoring in case of benign lesions ## Footnote Fine Needle Aspiration Cytology (FNAC) is often used to assess thyroid nodules and other lesions.
29
What can affect the interpretation of thyroid cytology?
Blood-stained samples ## Footnote Blood contamination can lead to misinterpretation of cytological findings.
30
What does the presence of colloid suggest in thyroid cytology?
Benign nodules (e.g., colloid goitre) ## Footnote Colloid is a gel-like substance that can indicate benign conditions in thyroid evaluations.
31
What types of body fluids are examined in cytology?
Body cavity fluids and cyst fluids ## Footnote Body cavity fluids include pericardial, pleural, and peritoneal fluids, while cyst fluids are typically from organs like the breast and ovary.
32
What is an example of a primary malignancy identified in body fluids?
Mesothelioma ## Footnote Mesothelioma is a type of cancer that forms in the lining of the lungs, abdomen, or heart.
33
What are some ancillary studies that may be required for diagnosis?
* Immunocytochemistry (ICC) * Molecular studies * Flow cytometry ## Footnote These studies help in further characterizing the cells and understanding the disease.
34
What are the specimen types in respiratory cytology?
* Spontaneous samples (sputum) * Procedure-based samples (bronchial washings, aspirates, BAL, bronchial brushings) * Fine Needle Aspirates (FNA) ## Footnote These samples are collected for the evaluation of respiratory conditions.
35
What does bronchoscopy allow for in respiratory diagnostics?
Direct visualization of airways and collection of samples ## Footnote Bronchoscopy is a key procedure for diagnosing respiratory diseases.
36
What does EBUS stand for?
Endobronchial Ultrasound ## Footnote EBUS combines ultrasound imaging with bronchoscopy to enhance diagnostic capabilities.
37
What is the purpose of ROSE during FNA?
* Assess specimen adequacy * Guide further sampling * Enable early preparation for ancillary testing ## Footnote Rapid On-Site Evaluation (ROSE) helps ensure that the sample collected is sufficient for diagnosis.
38
Fill in the blank: The fluid collected from the joints is called _______.
Synovial fluid ## Footnote Synovial fluid lubricates joints and can be analyzed for various conditions.
39
What are the key points in handling respiratory specimens?
Histology samples and cytology samples require careful handling, with specific attention to biological hazards and adequate sampling. ## Footnote Histology samples include biopsies, which can be small fragments for assessing invasion or large resections needing proper fixation.
40
What are the types of lung cancer?
The main types of lung cancer are: * Non-Small Cell Lung Cancer (NSCLC) * Small Cell Lung Cancer (SCLC) * NOS/Other types ## Footnote NSCLC accounts for approximately 65% of cases, SCLC for about 15%, and NOS/Other types for around 20%.
41
What are the subtypes of Non-Small Cell Lung Cancer (NSCLC)?
The subtypes of NSCLC include: * Squamous cell carcinoma * Adenocarcinoma * Large cell carcinoma ## Footnote Squamous cell carcinoma is often linked to smoking.
42
What immunohistochemical (IHC) markers are associated with squamous cell carcinoma?
The IHC markers for squamous cell carcinoma are: * p63 * CK5/6 ## Footnote These markers help in identifying the subtype and can guide treatment options.
43
What therapies are used for squamous cell carcinoma?
Therapeutics for squamous cell carcinoma include: * PD-L1 for immunotherapy * Chemotherapy (cisplatin/gemcitabine) ## Footnote These treatments target the specific characteristics of squamous cell carcinoma.
44
What IHC markers are associated with adenocarcinoma?
The IHC markers for adenocarcinoma are: * TTF-1 * Napsin A ## Footnote These markers are crucial for the diagnosis and treatment of adenocarcinoma.
45
What are the oncogenic drivers in adenocarcinoma?
The oncogenic drivers in adenocarcinoma include: * EGFR * KRAS * ALK * MET * BRAF ## Footnote These drivers are essential for understanding the biology of the cancer and potential treatment options.
46
What are the EGFR inhibitors used in adenocarcinoma treatment?
The EGFR inhibitors include: * Erlotinib * Gefitinib ## Footnote These medications target specific mutations in the EGFR gene.
47
What is a common treatment for Small Cell Lung Cancer (SCLC)?
Common treatments for SCLC include: * Cisplatin + Etoposide * Prophylactic cranial irradiation if the primary site responds ## Footnote SCLC is known for its aggressive nature and early metastasis.
48
What is the 5-year survival rate for Small Cell Lung Cancer (SCLC)?
<7% ## Footnote The low survival rate highlights the aggressive nature of this cancer type.
49
What biological hazards are associated with unfixed samples?
Unfixed samples pose a biological hazard and require caution during handling. ## Footnote This is particularly important in both histology and cytology samples.
50
Fill in the blank: Adequate representative sampling is crucial for _______.
cytology samples ## Footnote Inadequate sampling can lead to low cell yield and misdiagnosis.
51
What factors contribute to resistance in adenocarcinoma treatments?
Resistance may develop within 6–24 months due to various biological mechanisms. ## Footnote Understanding these factors is essential for optimizing treatment strategies.
52
What is the most common cause of cancer death in Ireland?
Lung cancer ## Footnote Lung cancer has the highest mortality rate among cancer types in Ireland.
53
What is the annual incidence of lung cancer cases in Ireland?
Approximately 2668 cases/year ## Footnote This statistic reflects the number of new lung cancer diagnoses annually.
54
What is the annual mortality rate for lung cancer in Ireland?
Approximately 1916 deaths/year ## Footnote This figure indicates the number of deaths attributed to lung cancer each year.
55
How does the lung cancer mortality rate in women compare to men in Ireland?
Higher rates in women than men ## Footnote This trend is opposite to what is observed in the EU.
56
What is the 1-year survival rate for lung cancer patients?
55% ## Footnote This is significantly lower than breast (98%) and prostate (97%) cancer survival rates.
57
What is the long-term survival rate for lung cancer, depending on stage?
Approximately 25% ## Footnote Survival rates can vary significantly based on the stage at diagnosis.
58
What trend is observed in female lung cancer incidence and mortality?
Increasing ## Footnote This indicates a rising concern for lung cancer among women.
59
What trend is observed in male lung cancer incidence?
Decreasing ## Footnote This suggests a potential improvement in risk factors or early detection in men.
60
What is the primary aetiological factor responsible for lung cancer cases?
Smoking ## Footnote Smoking is linked to up to 90% of lung cancer cases.
61
Name three environmental exposures associated with lung cancer.
* Radon * Asbestos * Air pollutants ## Footnote These factors contribute to the development of lung cancer in non-smokers.
62
What chronic condition is a risk factor for lung cancer?
Chronic lung disease ## Footnote Conditions such as COPD can increase lung cancer risk.
63
List two genetic and molecular pathways involved in lung cancer.
* Carcinogen metabolism (P450, GST) * DNA repair and apoptosis dysregulation (bcl-bax) ## Footnote These pathways can influence cancer development and progression.
64
What is a key tumour suppressor gene associated with lung cancer?
p53 ## Footnote Mutations in p53 are common in various cancers, including lung cancer.
65
What is a notable oncogene linked to lung cancer?
KRAS ## Footnote KRAS mutations are frequently observed in lung adenocarcinomas.
66
What laboratory technique is used for histology and immunohistochemistry in lung cancer diagnosis?
Histology + Immunohistochemistry (IHC) ## Footnote These techniques help in tumor classification and subtype identification.
67
What are some lineage-specific markers used in tumour sub-classification?
* CK5/6 * CK7/CK20 * TTF-1 * p63 ## Footnote These markers are crucial for identifying different types of lung cancer.
68
What is the purpose of therapy prediction markers in lung cancer?
* EGFR * ALK * PD-L1 * BRAF ## Footnote These markers can guide treatment decisions for lung cancer patients.
69
What does immunocytochemistry (ICC) help with in lung cancer diagnostics?
* Cell identification * Tumour classification * Prognostic/therapeutic markers ## Footnote ICC is performed on cytology smears or cell blocks for detailed analysis.
70
List some common markers used in immunocytochemistry for lung cancer.
* Cytokeratins (CK7, CK20) * BerEP4 * MUC1 * TTF-1 * Napsin A * p63 * PD-L1 ## Footnote These markers provide essential information for diagnosis and treatment.
71
What are CD markers used for in lung cancer?
Lymphoma classification ## Footnote CD markers such as CD45, CD3, and CD20 help identify lymphoma types.
72
What ancillary technique is useful in lymphoproliferative disorders?
Flow cytometry ## Footnote This technique aids in diagnosing blood cancers.
73
What is the limited use of histochemistry in lung cancer?
Certain tumour types ## Footnote While not widely used, histochemistry can still provide valuable insights for specific cancers.
74
What is the focus of Quality Control in Cytology?
Ensuring accuracy and consistency in cytological diagnostics ## Footnote This includes aspects such as slide and staining quality.
75
What types of stain quality are mentioned?
* Pap * Romanowsky (MGG) ## Footnote These stains are essential for cytological evaluations.
76
What is necessary for sample preservation in cytology?
Coverslipping and sample preservation ## Footnote Proper preservation is crucial for accurate analysis.
77
What may be needed for low-cell samples?
Reprocessing ## Footnote This helps to enhance the quality of the sample for evaluation.
78
What does EQA stand for?
External Quality Assessment ## Footnote In the UK, this is managed by UKNEQAS.
79
What aspects does the External Quality Assessment Scheme cover?
* Stain quality * Digital interpretation * Diagnostic accuracy and lab consistency ## Footnote These components are critical for maintaining high standards in cytological practices.
80
Who performs primary slide screening in cytology?
* SHOs * Registrars * Medical Scientists ## Footnote These professionals are involved in the initial evaluation of cytological samples.
81
What is marked during primary slide screening?
Suspicious cells ## Footnote Initial diagnosis is suggested based on these markings.
82
Who issues the final report in cytology?
Consultant Pathologist ## Footnote The consultant provides the definitive diagnosis and report.
83
What may be included in the final report issued by a Consultant Pathologist?
* SNOMED/SNOP coding * Additional molecular/ICC/IHC testing ## Footnote These additions enhance the diagnostic detail and utility of the report.
84
What type of reports are generated in cytology?
Computer-generated and validated reports ## Footnote This process ensures accuracy and reliability in the reporting of findings.
85
What is developing in the UK regarding cytology reporting?
BMS (Biomedical Scientist) reporting schemes ## Footnote These schemes are emerging and may also be implemented in Ireland.
86
What is required for implementation of BMS reporting schemes?
Specialist diploma ## Footnote This qualification is necessary for Biomedical Scientists to report independently.

Cell Pathology (35 decks)

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