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2.2 Cellular Pathology > Diagnostic Cytology > Flashcards

Diagnostic Cytology Flashcards

1
Q

What is diagnostic cytology
(4)

A

The analysis of cytological specimens to aid the diagnosis of disease - not a screening test

Various body sites
Various specimen types
Various preparation techniques

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2
Q

What is another application of diagnostic cytology other than in a hospital setting?

A

Cell analysis e.g.

Cell culture work
Morphological analysis of cells
Biochemical analysis
Molecular biology based analysis - genomics/proteomics

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3
Q

What are the two diagnostic applications of cytology

A

Pathology e.g. morphological diagnosis

Differential diagnosis e.g. type/classification of pathology

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4
Q

What are some diagnostic applications of cytology in the lab

A

Benign vs malignant
Primary vs metastatic
Site of origin
Management strategies
Therapeutics

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5
Q

What body sites are samples for cytology from
(9)

A

Body cavities
Respiratory tract
Head and neck
Male/female genital tract
Urological
Neurological (CSF)
Soft tissue and bone
GIT
Organs and systems
- thyroid
- lymphoid
- breast
- liver
- kidney
- pancreas

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6
Q

What specimen types would you expect in cytology

A

Fluids
Washings
Brushings
Fine Needle Aspirates (FNA)
Urine
CSF

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7
Q

What kinds of fluids would you see in cytology
(3)

A

Often drains
- e.g. liver tumours cause build up of cavity fluid (ascites) -> this can be drained and sent to cytology or it could be aspirates by a needle
- e.g. thyroid cyst fluid etc

Cells in suspension

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8
Q

Give an example of a washing you would see in the lab
(4)

A

Abdominal washings -> someone under surgery e.g. hysterectomy

Surgeon will do a wash out of the body cavity afterwards

Will test to see if there are any malignant cells in the wash out

If so patient will have to go for chemotherapy

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9
Q

Give an example of a brushing you would see in the lab

A

Bile duct brushing
-> brush on end of endoscope

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10
Q

Give an example of a fine needle aspirate

A

Needle is washed out -> cells from FNA put into a fluid and sent to a lab

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11
Q

What is so important about CSF

A

You might only get a few drops to use

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12
Q

What miscellaneous specimens would you get in cytology
(4)

A

Imprints
Scrapings e.g. skin
Smears e.g. cervical
Faeces -> looking for fat globules in children failing to thrive

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13
Q

What is the principle behind FNA?
(3)

A

Cells are aspirated from a solid lesion using a fine needle under negative pressure (vacuum) and processed for microscopic examination

Can always go back and get more

Patients can often tolerate 2 or 3 FNA without anaesthesia

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14
Q

What are the five most common FNAs

A

Lung (Transbronchial/Percutaneous/ EBUS)

Thyroid (Patient management)

Lymph node (Reactive/primary/metastatic)

Breast (symptomatic/Steriotactic)

Salivary gland (Patient management)

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15
Q

What is an EBUS?
(3)

A

Endoscopic bronchial ultrasound

Mostly used for mediastinal lymph nodes

Use ultrasound and FNA to access lymph nodes instead of having to go for surgery to open the chest

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16
Q

FNA can be used on what internal organs

A

Liver
Pancreas
Kidney
Prostate

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17
Q

FNA can be utilised along with what imaging

A

CT Scan
Ultrasound
EUS

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18
Q

Write about the examination of thyroid tissue
(5)

A

FNA: patient management

High levels of follicular cells -> patient needs to go on for further investigation -> could be Benign vs malignant tumour

Therapeutic

Consideration:
- blood stained
- colloid (purple material, cracking when dry)

Hertle cells seen in hashimotos

Nuclear vaculation classic for papillary carcinoma of the thyroid

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19
Q

What fluid types can you get in the lab

A

Body cavity fluids
- Pericardial
- Pleural
- Peritoneal

Ascitic fluid
- Abdomen

Cyst fluid
- Breast, Ovarian, thyroid, others

Joint fluid (synovial)

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20
Q

What is mesothelioma?
(3)

A

Cancer that begins in the tissue mesothelium that lines the lungs, heart, stomach and other organs

3D balls of cells with inflammatory cells in the background

Often cells high in protein

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21
Q

What do signet cells indicate

A

Carcinoma

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22
Q

Give three examples of metastatic disease and how you would test for them

A

Melanoma (Melan A)
Ovarian cancer (Cytokeratin 7)
Ductal carcinoma of breast (Oestrogen receptor)

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23
Q

What respiratory samples could you get
(5)

A

Sputum (not very often, this usually goes to micro)
Bronchial Wash/aspirate
Broncho-alveolar lavage
Bronchial brush
FNA
- transbronchial
- percutaneous
- Endoscopic bronchial ultrasound (EBUS)

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24
Q

What are the two developments in bronchoscopy

A

EBUS
ROSE

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25
What is an EBUS (6)
Endoscopic bronchial ultrasound Allows us to target lymph nodes Ultrasound lets us see contrast Allows for staging and diagnosis on the same sample Might not even need to do a bronchoscopy -> can go straight to lymph nodes -> late stage If no indication of lymph node involvement (early stage) then they will go for bronchoscopy only However lung cancer is often only seen in late stage where the lymph nodes are affected
26
What is ROSE? (3)
Rapid on-site evaluation of fine needle aspirates (FNA) Specimen management Adequate samples for diagnosis and ancillary testing Have we enough cells for downstream analysis and have the cells been preserves correctly -> are there sufficient abnormal cells
27
What should you consider for biopsies
Small fragments Assessment of invasion
28
What should you consider for cytology samples (4)
Mucus Blood Biological hazard Representative specimen
29
What should you consider for larger resections
Fixation Perfusion of fixative
30
What should you consider for biological hazards
Fresh or unfixed tissue
31
How would you investigate lung cells (6)
Benign vs Malignant Primary -> squamous, adeno or small cell carcinoma Secondary -> metastatic from where Ancillary studies - differential diagnosis - Therapy related
32
What are the two main types of lung cancer? (2)
Small cell versus non-small cell carcinoma NSC = squamous cell carcinoma vs adenocarcinoma
33
How is typing a lung tumour important for therapeutics
Tyrosine kinase inhibitors (EGFR and ALK) Immunotherapy such as PD-L1
34
What are two names of EGFR inhibitors
Erlotnib Gefitinib
35
What is a name of an ALK inhibitor
Crizotinib
36
Comment on the stats for lung cancer in Ireland
Over 2500 cases per year Single most common cancer death Approx 1800 deaths a year Incidence in you women higher than EU average but decreasing in men Reduction in squamous carcinoma but increase in adenocarcinoma Only 55% live over 1 year after diagnosis 15% survive overall Difficult to diagnose and treat
37
What increases risk of lung cancer (6)
Smoking (up to 90% of cases) Environmental Radon Asbestos Environmental carcinogens Chronic lung disease
38
How does smoking cause lung cancer (5)
Cytochrome p450 activation GST inactivation DNA repair genes Apoptosis bcl-bax pathway p53, kras, Rb, E-cadherin-beta catenin complexes
39
Comment on p53 and lung cancer
p53 protein and antibodies can be measured in blood as a prognostic inficator
40
What is chromogranin used for?
detection of small cell carcinoma
41
What percentage of lung cancer are small cell carcinomas
15%
42
What percentage of lung cancer are non small cell lung cancer
65%
43
What are the three types of NSCLC
Squamous cell carcinoma Adenocarcinoma Large cell carcinoma
44
What percentage of NOS/other?
20%
45
Write about the laboratory diagnosis is lung cancer (6)
Need to use IHC/Molecular methods to sub-class lung tumour Keratins -> CK5/6, CK7/CK20 p63 TTF-1 Napsin A Chromogranin
46
What therapeutics is there for lung cancer
EGFR ALK
47
What markers are used for NSCLC classification
p63 TTF-1 Napsin A
48
What is considered a promising marker for squamous cell carcinoma?
PD-L1
49
What are the treatment options for squamous cell carcinoma
Surgery Chemotherapy Radiotherapy
50
What growth patterns are seen in adenocarcinoma
Glandular, papillary, mucins producing and lepidic growth patterns
51
What are the oncogenic drivers of adenocarcinoma? (5)
EGFR KRAS ALK MET BRAF
52
What percentage of adenocarcinomas are caused by EGFR
10-40%
53
Why would an EGFR mutation be considered a good thing in adenocarcinoma
These respond to tyrosine kinase inhibitors
54
What happens to ALK in adenocarcinoma
ALK rearrangement in 5% of adenocarcinoma Responds to Crizontinib
55
What happens in most of the lung cancer treatments?
Between 6 months to 2 years, patients will develop resistance Research into strategies/treamtents to overcome resistance
56
Write about small cell lung cancer (7)
High grade tumours - present with early metastases - fatal in 2-4 months if untreated - less than 7% survive more than 5 years Cisplatin and Etoposide used for treatment Prophylactic cranial irradiation can be used if patient responds to chemotherapy at primary site Rapid development of resistance -> relapse in 6-12 months with resistance
57
What ancillary studies are there for Lung cancer (4)
Histochemistry but limited applications Tumour classification -> site of origin and primary or secondary, adeno, squamous, small cell, melanoma etc Flow cytometry -> non-Hodgkins Lymphoma Prognostic and therapy markers
58
Write about immunocytochemistry
Important in diagnostic cytology and research Fixation - alcohol fixation, air dried or special fixation protocols Cell blocks Application: - identify or confirm cell type - identify cell constituents Identify primary origin of metastatic tumours - especially in fluids and FNAs Prognostic and therapy markers
59
Write about quality control (6)
Documentation of any discrepancy Remedial action Quality of the slide preparation Quality of the stains Quality of coverslipping Re-process sample - Limitation if low cell yield
60
What is UKNEQAS? (5)
New EQA scheme for diagnostic cytology Staining quality - PAP and MGG Interpretive scheme - Digital format
61
Write about screening (5)
Primary screening of slides - SHO/Registrars/Medical scientists Mark cells of interest Suggest diagnosis Reporting session with Consultant Developments in UK for BMS reporting (specialist diploma)
62
Write about Reporting (6)
Consultant reports the case Additional tests may be requested at this stage -> often pre-requested at FNA procedure Allocate SNOMED/SNOP codes Computer generated report Authorised and edited if necessary Validated and released

2.2 Cellular Pathology (29 decks)

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