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Slide 1-

Diagnostic Cytopathology & Significance of Biopsy Investigation Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague https://www1.lf1.cuni.cz/~jdusk/
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Morphological Diagnostic Methods Clinical Pathological
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Morphological Diagnostic Methods Clinical: macroscopy of lesions visible with the naked eye invisible with the naked eye - IMAGING (X-ray, sonography, scintigraphy, endoscopy, CT,…) magnifying glass - colposcopy
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Morphological Diagnostic Methods Pathological macroscopy microscopy ultrastructure IMAGING
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Morphological Diagnostic Methods Pathological macroscopy of lesions autopsy report biopsy description cytology material description
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Morphological Diagnostic Methods Pathological microscopy cytology minibiopsy - cytoblock histology
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Cytology (FNAB) often both first and final dg. method outpatient low cost procedure done by an experienced (cyto)pathologist surprisingly effective has some limits (!)
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CYTOLOGY IS VERY EFFICIENT IN EARLY NEOPLASM DIAGNOSTICS
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ESPECIALLY, IF CLINICO-MORPHOLOGICAL COMMUNICATION WORKS
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Expectations Clinician from his pathologist: confirmation of neoplasm dg. nosological classification grading, staging prognosis reaction to the therapy recidive recognition
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Expectations Pathologist from his clinician: information: local.,size, duration, former dg. a treated neo, clin. dg. diagnostic material acquisition correct interpretation of the pathologist´s report
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Getting Cytology Material surface – smeared, brushed, scraped cavities – punctured, aspirated deep solid lesions - aspirated
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Processing Cytology Material smears cytospins, cytosedimentation cytoblock
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Minibiopsy - Cytoblock from FNAB advantage of easy material taking together with more tissue architecture information histology &, immunohistochemistry methods available multilayered tissue phragments readable
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Cytology Material Staining gynecology smears - polychrome other materials –MGG, HE, polychrome, all other methods cytoblock – multiple methods
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Goals of Cytological Investigation Screening – detection of symptomless lesions Diagnosis of pathological lesions found introductory (followed by histol.) final
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Gynecological oncologic cytology laboratory investigation standard Authors: MUDr Alena Beková, MIAC MUDr Pavel Tretiník, MIAC Oponents: doc. MUDr J. Dušková, CSc,FIAC MUDr Eva Svobodová
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Cytology - Evaluation staining and evaluation – minutes Bethesda system : material quality and quantity group diagnosis dg. as close to histology as possible recommendation
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Bethesda System 2001
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Suitable for Evaluation without limits limited by… non processed processed but limited for evaluation of squamous cell abnormalities due to…. .
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General Categorisation negative for intraepith. lesion or malignancy intraepith. lesion or malignancy squamous or glandular other pathology endometral cells in women over 40 yrs
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Interpretation negative for intraepithelial lesion or malignancy Microorganisms Trichomonas mycosis vs. candidosis shift - bact. vaginitis bacteria Actinomyces like cell changes of HSV type
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Interpretation negative for intraepithelial lesion or malignancy Other non-neoplastic changes reactive inflammation (+ repair) IUD atrophy
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Bethesda - cervical cytology classification 1. normal 2. benign cellular changes 3. ASCUS 4. L SIL 5. H SIL 6. Atypiae of glandular cells 7. susp. adenoca
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Interpretation epithelial abnormalities squamous ASC-US ASC-H LSIL CIN 1, HPV HSIL CIN2, CIN3, CIS susp. invasion squamous ca
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Interpretation epithelial abnormalities squamous ASC-US ASC-H LSIL CIN 1, HPV HSIL CIN2, CIN3, CIS susp. invasion squamous ca
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Bethesda System 2001
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Cytology getting sample needle 0.6-0.8mm min. 2 punctions aspiration nonaspiration – reduction of the blood content cyst: evacuate and aspirate with the second punction the periphery fluid: whole volume for cytology
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Peroperation Biopsy dg. during minutes morphological artefacts (combination with cytology) limited extensity of investigation limited time
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„Classical“ Biopsy (formol paraffin technique) simple may be done in two days immuno reactions two days more further sectioning two days more oncol. dg. - WHO classification typing, grading, staging prognostic factors
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Biopsy any tissue removed from a living patient is a COMPULSORY subject to do not follow the tendency to discard „unimportant“ materials (nevi, tonsillae, uteri, intestine, endometrial curretage…..) !
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Biopsy do not crush small samples taking imprint cytology !!! adequate amount of fixation solution (sample: fixative = min. 1:10) wide neck bottle tightly closed for transport but openable without rough violence flat sample – spread and tighten on a bearing socket mark discrete suspicious lesion with a stitch before fixation
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CYTOLOGYLOVE IT or LEAVE IT L. Cardozzo