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Diagnostic Cytopathology & Significance of Biopsy Investigation

Diagnostic Cytopathology & Significance of Biopsy Investigation. Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague https://www1.lf1.cuni.cz/~jdusk/. Morphological Diagnostic Methods. Clinical Pathological. Morphological Diagnostic Methods. Clinical:

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Diagnostic Cytopathology & Significance of Biopsy Investigation

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  1. Diagnostic Cytopathology & Significance of Biopsy Investigation Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague https://www1.lf1.cuni.cz/~jdusk/

  2. Morphological Diagnostic Methods • Clinical • Pathological

  3. 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

  4. Morphological Diagnostic Methods • Pathological • macroscopy • microscopy • ultrastructure • IMAGING

  5. Morphological Diagnostic Methods • Pathological • macroscopy of lesions • autopsy report • biopsy description • cytology material description

  6. Morphological Diagnostic Methods • Pathological • microscopy • cytology • minibiopsy - cytoblock • histology

  7. Cytology (FNAB) • often both first and final dg. method • outpatient low cost procedure • done by an experienced (cyto)pathologist surprisingly effective • has some limits (!)

  8. CYTOLOGY IS VERY EFFICIENT IN EARLY NEOPLASM DIAGNOSTICS

  9. ESPECIALLY, IF CLINICO-MORPHOLOGICAL COMMUNICATION WORKS

  10. Clinician from his pathologist: confirmation of neoplasm dg. nosological classification grading, staging prognosis reaction to the therapy recidive recognition Expectations

  11. Pathologist from his clinician: information: local.,size, duration, former dg. a treated neo, clin. dg. diagnostic material acquisition correct interpretationof the pathologist´s report Expectations

  12. GettingCytology Material • surface – smeared, brushed, scraped • cavities – punctured, aspirated • deep solid lesions - aspirated

  13. ProcessingCytology Material • smears • cytospins, cytosedimentation • cytoblock

  14. advantage of easy material taking together with more tissue architecture information histology &, immunohistochemistry methods available multilayered tissue phragments readable Minibiopsy - Cytoblock from FNAB

  15. Cytology Material Staining • gynecology smears - polychrome • other materials –MGG, HE, polychrome, all other methods • cytoblock – multiple methods

  16. Goals of Cytological Investigation • Screening – detection of symptomless lesions • Diagnosis of pathological lesions found • introductory (followed by histol.) • final

  17. 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

  18. Cytology - Evaluation • staining and evaluation – minutes • Bethesda system: • material quality and quantity • group diagnosis • dg. as close to histology as possible • recommendation

  19. Bethesda System 2001 <http://bethesda 2001.cancer.gov>

  20. Suitable for Evaluation • without limits • limited by… • non processed • processed but limited for evaluation of squamous cell abnormalities due to…. .

  21. General Categorisation • negative for intraepith. lesion or malignancy • intraepith. lesion or malignancy squamous or glandular • other pathology endometral cells in women over 40 yrs

  22. Interpretation • negative for intraepithelial lesion or malignancy • Microorganisms • Trichomonas • mycosis vs. candidosis • shift - bact. vaginitis • bacteria Actinomyces like • cell changes of HSV type

  23. Interpretation • negative for intraepithelial lesion or malignancy • Other non-neoplastic changes • reactive • inflammation (+ repair) • IUD • atrophy

  24. 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

  25. Interpretation • epithelial abnormalities • squamous • ASC-US • ASC-H • LSIL CIN 1, HPV • HSIL CIN2, CIN3, CIS • susp. invasion • squamous ca

  26. Interpretation • epithelial abnormalities • squamous • ASC-US • ASC-H • LSIL CIN 1, HPV • HSIL CIN2, CIN3, CIS • susp. invasion • squamous ca

  27. Bethesda System 2001 <http://bethesda 2001.cancer.gov>

  28. 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: wholevolume for cytology

  29. Peroperation Biopsy • dg. during minutes • morphological artefacts (combination with cytology) • limited extensity of investigation • limited time

  30. „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

  31. 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…..) !

  32. 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

  33. CYTOLOGYLOVE IT or LEAVE IT L. Cardozzo

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