Cytology and Biopsy

Question 1

What is cytology?

Answer 1

Microscopic examination of thin layer of cells on a slide

Question 2

How are the cells for cytology obtained?

Answer 2

Fine needle aspiration (FNA)
Direct smear of nipple discharge
Scrape nipple with scalpel

Question 3

What would you look for in a slide of bloody nipple discharge?

Answer 3

Duct ectasia
Intraductal papilloma
Intraductal carcinoma

Question 4

What is the first step in FNA?

Answer 4

Localise lump between fingers

Question 5

What angle do you insert the needle in FNA

Answer 5

45 degree angle

Question 6

How do you aspirate in FNA?

Answer 6

Aspirate using in and out action while applying negative pressure

Question 7

When would you use ultrasound in FNA?

Answer 7

When there is an impalpable area

Question 8

What is the C1 in the cytology scoring system?

Answer 8

Unsatisfactory/ Insufficient cells for diagnosis

Question 9

What is the C2 in the cytology scoring system?

Answer 9

Benign

Question 10

What is the C3 in the cytology scoring system?

Answer 10

Atypical-probably benign

Question 11

What is the C4 in the cytology scoring system?

Answer 11

Suspicious-probably malignant

Question 12

What is the C5 in the cytology scoring system?

Answer 12

Malignant

Question 13

What is the curative management of cysts?

Answer 13

Aspiration

Question 14

When would the fluid from a cyst NOT be discarded?

Answer 14

Blood stained

Residual mass

Question 15

What are the advantages of FNA?

Answer 15

Simple procedure
Inexpensive
Immediate results

Question 16

What are the limitations of FNA?

Answer 16

Can’t assess invasion

Can’t assess grade

Question 17

What are the disadvantages of FNA?

Answer 17

False positives and false negatives

Question 18

What are rare complications of FNA?

Answer 18

Pain
Haemorrhage
Fainting

Question 19

When is core biopsy performed?

Answer 19

It is performed in all symptomatic cases with clinical, radiological or cytological suspicion

Question 20

After what screening is a core biopsy usually performed?

Answer 20

Mammography

Question 21

What can a core biopsy diagnose?

Answer 21

Architectural distortion and micro-calcification

Question 22

What can a core biopsy confirm?

Answer 22

Invasion
Tumour type and grading
Immunohistochemistry

Question 23

What is immunohistochemistry?

Answer 23

Confirms hormone receptor status

Question 24

What s the procedure of a core biopsy?

Answer 24

A strand of tissue is extracted

The sample is then fixed in formalin

Question 25

Describe the cellularity in benign vs malignant

Answer 25

Benign-Low/moderate cellularity

Malignant- High cellularity

Question 26

Describe the cohesion of cells in benign vs malignant

Answer 26

Benign- Cohesive groups of cells

Malignant- Loss of cohesion

Question 27

Describe the cell size in benign vs malignant

Answer 27

Benign-Cells are uniform size

Malignant- nuclear pleomorphism

Question 28

Describe the nuclei in benign vs malignant

Answer 28

Benign- Bare oval (bipolar) nuclei in background

Malignant- Absence of bipolar nuclei

Question 29

Describe the layout of cells in benign vs malignant

Answer 29

Benign- Flat sheets of cells

Malignant- crowding/overlapping of cells

Question 30

Describe the chromatin in benign vs malignant

Answer 30

Benign- Uniform chromatin pattern

Malignant- Hyperchromasia

Question 31

What is a suggestive feature in lobular carcinoma?

Answer 31

Cytoplasmic vacuoles

Question 32

What is a suggestive feature in tubular carcinoma?

Answer 32

Cells arranged in tubes