CYTOPATH

OLOGY
GENERAL ASPECTS OF CYTOLOGY
 Cytopathology:
is a branch of pathology that studies and diagnoses diseases on the
cellular level.

 The most common use of cytopathology is the Pap smear, used to detect
cervical cancer at an early treatable stage.

 Two methods of collecting cells for analysis are:

1) Cells are extracted from fluid shed into the body cavities. For example,
in pleural fluid, ascitic fluid, or in the case of the Pap smear, cells scraped
from the cervix.
2) Fine Needle Aspiration Cytology
PAP SMEARS FOR DIAGNOSIS OF
CERVICAL CARCINOMAS
 Scraping of exo- and endo-cervical surfaces, spread in clean slides
and stained with papaniclao stain.

 It is a routine test, in females above 35 years, in developed

countries to early diagnose cervical cancers.
NORMAL PAP CERVICAL SMEARS
 Normal exocervical smear  Normal endocervical smear
INFLAMMATORY CERVICAL SMEARS
 Acute inflammatory smear  Chronic inflammatory smears
MALIGNANT CERVICAL SMEARS
 Sq.C.C. of cervix  Cervical adenocarcinoma
BODY FLUID CYTOLOGY
 Cytologic analysis of body fluids e.g. pleural, ascetic or synovial fluids,
C.S.F.

 Collection of the fluid in clear tube and centrifuged. The sediment is either
plenty and enough to make a tissue block or scanty and be spread in clean
slides to be fixed, stained and examined.

 Tissue blocks are processed as any tissue biopsy.

 The supernatant fluid is kept in refrigerator till final diagnosis.

 Suspected inflammatory smears should be microbiologically examined.

CELLULAR BOFY FLUIDS
 Cellular pleural cytology;  Cellular ascitic fluid; lymphocytes,
lymphocytes, reactive mesothelial PNL and metastatic carcinoma
cells cells
FINE NEEDLE
ASPIRATION
CYTOLOGY
DEFINITION
 FINE NEEDLE ASPIRATION CYTOLOGY (FNAC):

Also called fine needle aspiration biopsy (FNAB) and fine needle
aspiration (FNA): is a diagnostic procedure sometimes used to
investigate superficial (just under the skin) lumps or masses. In this
technique, a thin, hollow needle is inserted into the mass to extract
cells that will be examined under a microscope, e.g. breast masses,
thyroid nodules, superficial lymph nodes….etc.

Deeper, small or un-accessble masses are aspirated using ultra-

sound guided samples e.g. deeply seated breast masses, hepatic
nodules or retroperitoneal abdominal masses.
SPECIAL INSTRUCTIONS
 Include patient's name, age, previous malignancy, drug therapy, radiation
therapy, and all other clinical information on the request form.

 It is very important to specify the source of the specimen along with clinical
history and clinical impression.

 If a cyst is aspirated, indicate this fact on the request form; it will most likely
be hypocellular but will not be a false-negative.

 If the patient has a known diagnosis of malignancy, please include that

information on the request form.

 Whatever the specimen source, please include your clinical impression and
reason for doing the aspiration (e.g. “fine-needle aspiration on lymph node:
suspect lymphoma Vs metastatic carcinoma Vs infectious process”).
PROCEDURE
• Before the procedure is started, vital signs (pulse, blood pressure,
temprature, etc.) may be taken. Very anxious patients may want to be given
an I.V. sedation. For patients with less anxiety, oral medication can be
prescribed to be taken before the procedure.

• The skin above the area to be biopsied is swabbed with an antiseptic

solution and draped with sterile surgical towels.

• The skin, underlying fat, and muscle may be numbed with a local
anaethetic, although this is often not necessary with superficial masses.
PROCEDURE
• Use a small gauge needle to avoid dilution with blood. Immobilize
the palpable mass with your nondominant hand. Using a syringe
holder will allow you to keep your nondominant hand on the mass.

• Insert the needle into the mass and pull back on the syringe plunger,
creating negative pressure, using it as a cutting tool.

• Make short 5 mm “in-and-out” motions until you see material

coming into the hub of the needle. When you start to see material
in the hub, stop, release negative pressure on the syringe, and
pull out to make the slides. Do not aspirate material into the
syringe or dilute with blood or saline. This interferes with making
good direct smears.
PROCEDURE
• If you do not see any material at all in the hub or syringe, continue
the short 5 mm strokes until you have done 15-20 strokes. Pull out
and attempt to express material on slides.

• Repeat the above procedure again using a clean needle for a

second pass (and more passes if needed).

• Spread cells or aspirated material on labeled glass slides. The

slides should be labled with the name of the patient or with the
patient’serial number of the lab.

• The patient's vital signs are taken again, and the patient is removed
to an observation area for about 3 to 5 hours.
COMPLICATIONS OF FNAC
• As with any surgical procedure, complications are possible. Fortunately, major
complications due to thin needle aspiration biopsies are fairly uncommon, and when
complications do occur, they are generally mild.

• Since sterility is maintained throughout the procedure, infection is rare. But should
an infection occur, it will be treated with antibiotics.

• Bleeding is the most common complication of this procedure.

• A slight bruise may also appear.

• If a lung or kidney biopsy has been performed, it is very common to see a small
amount of blood in sputum or urine after the procedure. Only a small amount of
bleeding should occur. During the observation period after the procedure, bleeding
should decrease over time. If more bleeding occurs, this will be monitored until it
subsides. Rarely, major surgery will be necessary to stop the bleeding.
FNAC OF BREAST MASSES
 Benign breast lesion;  Malignant breast lesion; ductal
fibroadenoma carcinoma
FNAC; LIVER
 Normal hepatocytes  Hepatocellular carcinoma
FNAC; THYROID GLAND
 Benign thyroid lesion; colloid  Malignant thyroid lesion; papillary
goitre. carcinoma.
THANK
YOU!