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Current Use of LBC in Non-Gynae Cytology. Christine Payne Thames Valley Cytology Society March 2005. Liquid Based Cytology. What is it? Nothing new in cytology; eg FNA into saline urine into alcohol fixative This has facilitated maximising the sample and partial fixation .

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current use of lbc in non gynae cytology

Current Use of LBC in Non-Gynae Cytology

Christine Payne

Thames Valley Cytology Society

March 2005

liquid based cytology
Liquid Based Cytology
  • What is it?
  • Nothing new in cytology;

eg FNA into saline

urine into alcohol fixative

This has facilitated maximising the sample and partial fixation

liquid based cytology3
Liquid Based Cytology
  • Why is it different?
  • At present there are two major commercial companies offering LBC for use in the NHSCSP.
  • Both procedures can also be used for preparation of non-gynae.
advantages
Advantages
  • The advantages are
  • Maximising the cellularity of the sample
  • Removal of excess blood
  • Excellent fixation
  • 1 representative slide
  • Extra material available for further testing
disadvantages
Disadvantages
  • Cost is the major factor.
  • Hardware may become available through the Cervical Screening Programme
  • The cost must be weighed against the benefits for medical and BMS time
  • Also the reduction of inadequate or non diagnostic samples.
  • Personal preference
samples to process
Exfoliative samples

Urines

Sputa

Bronchial washings

Bronchial brushings

Body fluids

Aspiration samples

FNA Head and neck

FNA Lymph nodes

FNA Lung

FNA Liver

FNA Breast

Samples to Process
thyroid fna
Thyroid FNA
  • Need special mention
  • Most other samples can be diagnosed purely on the ThinPrep sample, but colloid is difficult to evaluate ( ? The same in Surepath), and LBC only is not recommended in our laboratory.
bronchial washings
Bronchial Washings

BronchialWashings

slide15

Bronchial washings

Bronchial washings

lbc in aspiration cytology
LBC in Aspiration Cytology
  • ENT routinely use LBC only with the exception of Thyroid Aspirates
  • Other FNA sites usually both air dried and LBC are taken
case study
Case Study
  • An 82 year old man presented to ENT OPD with a large skin lesion behind the ear.
  • Biopsy and FNA were performed on the lesion and an adjacent lymph node
  • LBC preps made from the PreservCyt solution using T2000, and stained using Papanicolaou technique.
diagnostic dilemma
Diagnostic Dilemma
  • The material from the lymph node was difficult to evaluate with certainty, as the population of small hyperchromatic cells could have been lymphoid or small cell carcinoma.
  • The aspirate from the lesion was helpful in forming the provisional diagnosis
diagnostic confidence
Diagnostic Confidence
  • The fact that the same cells were present in the lesion as in the lymph node added confidence to the probable diagnosis of small cell (neuroendocrine) carcinoma.
  • The biopsy result was correlated with the cytology
small cell neuroendocrine tumour
Small Cell Neuroendocrine Tumour
  • The differential diagnosis lies between a metastatic small cell carcinoma, most likely from lung and a primary Merkel Cell Tumour of the dermis.
  • As the chest x-ray is reported clear, then a Merkel Cell tumour is probable.
merkel cell tumour
Merkel Cell Tumour
  • Merkel cell carcinoma is a rare tumour; locally aggressive and frequently metastatic. Classically difficult to distinguish from metastatic bronchogenic small cell carcinoma and non-Hodgkin’s Lymphoma.
  • Cells may be less pleomorphic with uniform rounded rather than “oat” shaped nuclei, although “oat like” type can occur.
epilogue
Epilogue
  • Double entry on the computer system.
  • FNA of the Lymph Node one week previous.
  • Reported as “probably reactive”