fnac.final.24.05.2014
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FINE NEEDLE ASPIRATION CYTOLOGY
EXFOLIATIVE CYTOLOGY.
DEFINITION
Scientific study of cells obtained from tissues or body secretions to identify disease.
TYPES
Based on sampling techniques, cytology is classified into the following:
1. Exfoliative Cytology.2. Abrasive Cytology.3. Aspiration Cytology.
EXFOLIATIVE CYTOLOGYBased on spontaneous shedding
of cells derived from the lining of an organ into a cavity.
Contents of the sample are derived from several sources.
Examples: vaginal smear, sputum, urine, CSF, and body effusions.
The material is collected spontaneously or by a syringe or a cotton swab.
ABRASIVE CYTOLOGY
Cells are obtained directly from the surface of the target of interest.
Samples are taken by scraping, brushing, or washing.
Examples: cervical scraper, endoscopy, and gastric lavage.
Samples can be obtained from superficial or deep lesions.
ASPIRATION CYTOLOGY
Samples are obtained from solid tissues that are not connected to a hollow viscus.
A needle with or without a syringe is used.
Simple, safe, rapid, cost effective, and require no special clinical skills.
Virtually every organ in the body is accessible to this method.
Introduction to Cytology.Recognizing and classifying cells.Fixation and preservation in
cytology.Methods of preparation in
cytology.Stains and staining in cytology.Gynecological cytology: methods
of collection.Gynecological cytology: normal
and functional cytology.
Gynecological cytology: abnormal cytology
Respiratory tract cytology.Urinary tract cytology.Gastrointestinal tract cytology.Cytology of fluids and body
effusions.Fine Needle Aspiration Cytology.
Abnormal non-neoplastic gynecological cytology(slides).
Abnormal neoplastic gynecological cytology (slides).
Respiratory tract cytology(slides). Cytology of urinary tract, GIT, and
body effusions(slides).
ROLE OF DIAGNOSTIC CYTOLOGY. Diagnosis and management of cancer Benign lesions Intraoperative pathological diagnosis Non neoplastic and inflammatory
conditions, Diagnosis of specific infections Cytogenetic Hormonal assessment status in women Cell of origin
HISTORICAL PERSPECTIVE
Histopathology >100 years - Last 50 years birth of cytopathology - mainly
exfoliative cytology Scandinavia 1950S -1960S ; Sodestroem and
Franzen in Sweden and Lopez cardozo in Holland
Performed by ‘professional hybrids’ - clinicians who used it for rapid diagnosis
FNAC - DEFINITION
Aspiration of cells/ tissue fragments using fine needles ( 22 , 23, 25 G) ; external diameter 0.6 to 1.0 mm
1.5 inches long needle ( radiologists use longer needles) Diagnostic materials in the needle and not in the syringe
even in cystic lesions
CLINICAL SKILL REQUIRED
Familiarity with general anatomy eg thyroid vs other neck swelling
Ability to take a focused clinical history Sharp skill in performing physical
examination eg solid vs cystic, benign vs maligant lesions
CLINICAL SKILL REQUIRED -2
Good knowledge in normal cellular elements from various organs and tissue and how they appear on smears eg fats cells vs breast tumour cells
Comprehensive knowledge of surgical pathology
CLINICAL SKILL REQUIRED -3
Ability to translate traditional tissue patterns of lesions to their appearance in smears
CYTOLOGY VS HISTOLOGY
Papillary carcinoma of thyroid - follicular variant
CYTOLOGY VS HISTOLOGY - 2
Granular Cell Myoblastoma
WHO SHOULD DO FNA?
Clinicians Cytotechnologists Radiologists Pathologists
The one who examines the patients , does the aspiration, makes the smears, interprets the cytology is the best one to do FNA -
PATHOLOGIST
CURRENT STATUS
Palpable lesions Outpatients , in- patients Thyroid , breast, lymph nodes, salivary
glands , soft tissue lumps... Lung, intra-abdominal and retroperitoneal by
radiologic imaging : CT, ultrasound, flouroscopy
LIMITATIONS
Soft vs hard ( bone) lesions Solid vs cystic lesions Poor cellular yield vs poor technique Reactive vs specific diseases eg reactive
lymphadenitis vs Hodgkins disease Diffuse vs nodular lymphoma
COMPLICATIONS
Needle trauma granulation tissue
formation granuloma formation Sarcoma like changes Needle linear tract
haemorrhage tissue necrosis
Interfere with surgical pathology
ADVANTAGES
Fast - early diagnosis Less pain, less trauma No anaesthesia Acceptable by patients and doctors Accurate
HOW TO INTERPRET?
Aspiration materials eg colloid, blood, mucus?
Cellular yield vs acellular yield Smear pattern - 3 dimensional balls vs flat
monolayered sheet os cells Cohesiveness vs discreet cells Cell morphometry
ADJUNCT TOOLS
Cell blocks Histochemistry Immunohistochemistry Electron microscopy Flow cytometry Immuno electron microscopy Molecular pathology -In situ hybridization,
PCR etc
ADJUNCT TOOLSIHC
cytology
Cell block
45 yr old woman with lytic bone lesion
Histo - thyroid
Histo -bone
FUTURE DIRECTIONS
Aspirating non palpable lesions using MRI Molecular pathology eg In Situ Hybridization Replacing diagnostic surgical pathology? Combined with MRI - replacing autopsy?
Thank you.Thank you.
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