• 23.Cytology
  • Cytology Introduction; The key points of cytology
  • The cytological examination is applicable to organs where the sample can easily be obtained. An advantage is that multiple samples can be obtained.
    In Japan, the cytological diagnosis are divided into two categories;
    1) Cytology for screening of precancerous lesion (cancer check for uterine cervix and lung)
    2) Cytology for pathological diagnosis. (e.g. breast tumor, thyroid tumor, peritoneal effusion)
  • For the pathological diagnosis, Hematoxylin-Eosin staining is common. For routine diagnostic cytology, the Papanicolaou and Giemsa stain are recommended
  • Papanicolaou stain; The material is smeared on the slide glass, and fixed in 95% ethanol.
    The slide are stained with light green(green), Orange G(orange), eosin (pink), bismarck brown (brown) and hematoxylin (blue), By Papanicolaou methods, fully keratinized cells stain in orange and it is easy to detect abnormal keratinized cells.
    Using the cytological specimens, we are able to observe whole mount of cells, have better for detect intracytoplasmic granule of inclusion body.
  • Today, the reporting system of cytology is different for each organ and each laboratory, although the reporting system tends to be structure around the clinical objective of the specimen/stain.
    In cytology that is carried out for the purpose of screening the presence of neoplasms and the potential for malignancy (e.g. squamous cell carcinoma of the lung, or uterine cervix), the reporting system is designed to report outcomes relating to these measures. Multiple classification systems, designed to capture relevant information to the above, exist and are in used in Japan depending on tissue type e.g. classification of sputum in mass surveys (The Japan Lung cancer Society), the cytological classification of cervical cancer, Japan Maternal Protection association (screening cytology)
  • However for some solid tumors where cytological biopsies are used, most prominently thyroid and breast masses, there is no current established grading system employed in Japan. In the case of these specimens one of three classifications may be present in the pathological report;
    1) Presence of tumor cells, 2) absence of tumor cells, 3) difficulty of diagnosis.

    This final category should be interpreted with care as it may have multiple meanings including;
    1) Difficult disease for diagnosis (in cases of highly differentiated carcinoma and follicular carcinoma of thyroid gland)
    2) The condition of the specimen being poor, it is difficult for diagnosis (insufficient material).
    (diagnostic cytology)
    In addition, although the cytology report will be non-subjective, the consideration and/or experience of the cytopathologist may be included.
  • Thus in making any interpretation from a cytological report it is important to first understand the local institutional guidelines for the specific tissue that you are dealing with in order to determine the correct interpretation of what is written.
  • The communication of the cytological diagnosis to the patient is the duty of the attending physician.

    In the case of any uncertainty or doubt about aspects of the cytological diagnosis it is important that attending physician to communicates with the cytotechnologist or pathologist in order to best serve the patient.