Cytology and Biopsy Flashcards
What is cytology?
Microscopic examination of thin layer of cells on a slide
How are the cells for cytology obtained?
Fine needle aspiration (FNA)
Direct smear of nipple discharge
Scrape nipple with scalpel
What would you look for in a slide of bloody nipple discharge?
Duct ectasia
Intraductal papilloma
Intraductal carcinoma
What is the first step in FNA?
Localise lump between fingers
What angle do you insert the needle in FNA
45 degree angle
How do you aspirate in FNA?
Aspirate using in and out action while applying negative pressure
When would you use ultrasound in FNA?
When there is an impalpable area
What is the C1 in the cytology scoring system?
Unsatisfactory/ Insufficient cells for diagnosis
What is the C2 in the cytology scoring system?
Benign
What is the C3 in the cytology scoring system?
Atypical-probably benign
What is the C4 in the cytology scoring system?
Suspicious-probably malignant
What is the C5 in the cytology scoring system?
Malignant
What is the curative management of cysts?
Aspiration
When would the fluid from a cyst NOT be discarded?
Blood stained
Residual mass
What are the advantages of FNA?
Simple procedure
Inexpensive
Immediate results
What are the limitations of FNA?
Can’t assess invasion
Can’t assess grade
What are the disadvantages of FNA?
False positives and false negatives
What are rare complications of FNA?
Pain
Haemorrhage
Fainting
When is core biopsy performed?
It is performed in all symptomatic cases with clinical, radiological or cytological suspicion
After what screening is a core biopsy usually performed?
Mammography
What can a core biopsy diagnose?
Architectural distortion and micro-calcification
What can a core biopsy confirm?
Invasion
Tumour type and grading
Immunohistochemistry
What is immunohistochemistry?
Confirms hormone receptor status
What s the procedure of a core biopsy?
A strand of tissue is extracted
The sample is then fixed in formalin
Describe the cellularity in benign vs malignant
Benign-Low/moderate cellularity
Malignant- High cellularity
Describe the cohesion of cells in benign vs malignant
Benign- Cohesive groups of cells
Malignant- Loss of cohesion
Describe the cell size in benign vs malignant
Benign-Cells are uniform size
Malignant- nuclear pleomorphism
Describe the nuclei in benign vs malignant
Benign- Bare oval (bipolar) nuclei in background
Malignant- Absence of bipolar nuclei
Describe the layout of cells in benign vs malignant
Benign- Flat sheets of cells
Malignant- crowding/overlapping of cells
Describe the chromatin in benign vs malignant
Benign- Uniform chromatin pattern
Malignant- Hyperchromasia
What is a suggestive feature in lobular carcinoma?
Cytoplasmic vacuoles
What is a suggestive feature in tubular carcinoma?
Cells arranged in tubes
