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Εργαστήριο Διαγνωστικής ΚυτταρολογίαςΙατρικής Σχολής Παμεπιστημίου Αθηνών

Πανεπιστημιακό Γενικό Νοσοκομείο «ΑΤΤΙΚΟΝ»

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Who is a Cytologist?Who is a Medical Cytologist? Cytopathology: Diagnostic test or

Medical Consultation?

Dominant questions

World Association of Societies of Pathology 1981 O A Nasseem Husain

Dr. Robert Hooke, he built and described the small elements since as “cells” or little boxes. He not only coined the word cell but measured them. 1665

History landmarks

In 18th century French Medical Doctors wanted to apply the new instrument called microscope for diagnostic purposes. They were assured by the French Faculty of Medicine that

there was no place for the microscope in medicine.

Dr Kidd: First, I do not believe in Cytology, and secondly if it is true I do not think God means us to know it

f

1838 Műller (“these minute globular cells which form the real seminium

morbi in several forms of carcinoma” this distinguished carcinomas from

sarcomas)1854 Beale: “The microscope and its

application to Clinical Medicine”

First description of tumor cells in urine

1858 Virchow : Rejected the humoraltheory of disease and claimed that all

cells come from other cells and the origins of the disease lie in cell defects,

the failure of the cell itself

History landmarks

Vaginal Secretion not in connection with the diagnosis of

cancer

1844 Donne 1847 Pouchet

Vaginal Secretion in connection with the diagnosis of cancer

1871 Richardson1886 Friedlaender

With histological examination of little piece of excised tissue-ten

years later known as biopsy

History landmarks

1940 Appearance of cytology laboratories

1950 The first screening program

1928 Papanicolaou1928 Babes

1927 Dudgeon and Patric 1930 Martin & Ellis

1934 Dudgeon and Barrett 1937 Russel

1974 Zajicek

Middle Ages: Abulcasim descr ibed an aspiration technique using a needle for

the diagnosis of goiter. 1847 First descr iption from Kűn, the

same year this technique is officially repor ted for cell investigation by Schleiden

and Schwann (Cell Theory) 1900-1950 FNA is used instead of

frozen section 1950-1980 sporadic applications Since 1980 is a method for pre-

surgical diagnosis

History landmarks

World Association of Societies of Pathology 1981

The main pioneers and activists in the field of Cytopathology have one thing in common: They were

not histopathologists

History landmarks

O A Nasseem Husain

Specialty % Histopathologists 36,6 Gynecologists/Surgeons 34,8 Physician/Haematologists 7,6 Anatomists 0,27 Medical Cytologists 8,85 Non-medical graduate 12,85

Who does cytology in Europe

We use the gener ic name of “pathologist” for all who work in a laboratory and this

results in a range of histopathologists (sometimes termed morbid anatomists), chemical pathologists, microbiologists or

pathologists and haematologists or haematopathologists.

The term Histopathologist is used to identify the “tissue pathologist”

The term Cytopathologist is proposed to identify the “cell pathologist”

Pathology

Cytology is the study of cellular form and refers to an impor tant specialty in laboratory medicine,

which concentrates on establishing the diagnosis of disease by

examination of small number of cells

Alan Stevens - James Lowe

Diagnostic Cytology

Sampling Exfoliative cytology FNA

Sample Conventional LBC

Cytology keywords

Cells Smears Cell Blocks

Target Flat lesions Cystic/Fluid Solid

Transpor tation

Cell disaggregation

Area of smear examination

Removal of unwanted mater ial

Cell deposition and adherence to glass

slides

Requirements for Cytological material handling

Sampling Transpor tation Fixation Cytopreparation

Diagnostic cr iter ia QCP Unified training

Cytopreparation Application of

common protocols Common Diagnostic

cr iter ia QCP Unified training

Reproducibility Objectivity

Current needs of cytopathology

1st Level:Morphological discr imination of benign from malignant lesion

2nd Level:Morphological and functional discr imination of carcinoma, lymphoma, sarcoma or melanoma

3rd Level:Investigation of metastatic malignant tumor of unknown pr imary site and/or undifferentiated carcinoma

4th Level:Theranostics

Fundamentals of diagnostic cytopathology

CYTOPATHOLOGY DEPT / MANAGEMENT

QUALITY CONTROL

FUNCTIONAL CYTOLOGY UNIT

RECEPTION/SAMPLE PREPARATION

MOLECULAR CYTOLOGY UNIT

DIAGNOSTIC CYTOLOGY

UNIT

ANALYTICAL AND QUANTITATIVE

CYTOLOGY UNIT

EXFOLIATIVE CYTOLOGY

FNA

POPULATION BASED

SCREENING

INTERPHASE CYTOLOGENETICS

UNIT

TELE-CYTOLOGY UNIT

CYTOCHEMISTRY

IMMUNOCYTOCHEMISTRY

FISH/CISH

ISH

STATIC CYTOMETRY

FLOW CYTOMETRY

PROTEOMICS

TELE CONSULTATION

E-LEARNING

Organization chart of modern laboratory

LBC Capabilities

ConventionalCytology

Capabilities

TP 5000

Panter

Cervista

MolecularCytology

Celient

CytochemistryImmunocytochemistry

FISHCISH

HL-7

HL-7

Automated staining system

Imager

CD 45

CD 20

CD 3

NHL

Laser Microdissection and cell manipulation

Quality Control & Quality Assurance

Lab performance

Who is a Cytologist?Who is a Medical Cytologist?

The pathologist with full training and proficiency qualification

Cytopathology: Diagnostic test or Medical Consultation?

Dominant questions

World Association of Societies of Pathology 1981 O A Nasseem Husain

SOCIETY NEEDS AND RESOURCES

HEALTH SERVICES COUNTRY DEVELOPMENT PROFILE

PROFESSIONAL ACTIVITIES ANALYSIS

TRAINEE AND TRAINER PROFILES

DEFINITION OF AIMS AND TRAINING CURRICULUM

DESIGN OF EVALUATION SYSTEM

PROGRAM COMPILATION AND IMPLEMENTATION

APPLICATION OF EVALUATION SYSTEM

PROFESSIONAL COMPETENCE EVALUATION

DESIGN PRINCIPLES FOR TRAINING AND HEALTH SERVICES PROVISIONING

Department of Cytopathology UGH “ATTIKON”

Director: P. Karakitsos MD, PhD, Cytopathologist

Functional Cytology UnitPersonel:

Z. Christoni Biologist

A. Spathis BiologistM. Alepaki

BiologistApplications

Cytochemistry

Immunocytochemistry

Analytical and Quantitative Cytology Unit

Personel: J. Georgoulakis, LecturerA. KaterisA. Spathis, Biologist

ApplicationsStatic CytometryFlow Cytometry

Artificial Intelligence UnitPersonel:

A. Pouliakis MScK. Koutroubas MSc, PhDT. Megalopoulou MSc

Molecular Cytology UnitPersonel:

A. Chranioti, Molecular Biochemistry

A. Spathis BiologistZ. Christoni Biologist

ApplicationsPCR/ELISA, RT PCRDNA Microarrays,

mRNAFISH

Diagnostic Cytology UnitMedical Personel University: J. Georgoulakis MD, PhD Lecturer Medical Personel NHS: M. Stamataki MD, PhD, Vice Director

D. Aninos MD, PhD, ConsultantN. Margari MD, Assistant

Technicient :S. KazikaAth. LekkaK. Konstantopoulou

Secretariat: P. TsiaraH. Athanasiadou

ApplicationsExfoliative cytologyFNA

Tele-Cytology UnitPersonel:

S. TsoukosN. Stergiou

ApplicationsTele-diagnosis (hybrid)Tele-consultation (static and hybrid)Tele-education