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Foundations of Pathology > L7 - Serous Effusion Cytology > Flashcards

L7 - Serous Effusion Cytology Flashcards

1
Q

Serous effusion

A
  • Accumulation of fluid is an abnormal finding
  • medical history of neoplasia-confirm metastasis
  • Recurrent effusion –determine cause
  • Benign disease-confirm cause
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2
Q

Serous Effusion Cytology

A

• Valuable for diagnosis of spectrum of benign and neoplastic conditions

Diagnosis dependent on:

  • Collection
  • Preparation
  • Application of adjunct tests
  • Approach to reporting
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3
Q

Accuracy and limitations

A
  • More sensitive than biopsy
  • Allows adaptation of adjunct tests
  • Sensitivity 58-64% (true positives)
  • Specificity-97-100% (true negatives)
  • PPV 99.3-100% (positive test : all positives)
  • NPV 56-80%(negative test : all negatives
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4
Q

Effusion cytology

A

How useful is the test:

  • Sensitivity 58% (Range 22-81%)
  • Specificity 97% (Range 91-100%)
  • Individual reports show improvement using adjunct testing
  • Clinicians still nervous
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5
Q

Influences on Accuracy

A
  • Sample quality
  • Laboratory preparation
  • Extent of laboratory investigation
  • Diagnostic experience
  • Number of cases seen by the laboratory
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6
Q

Specimen Collection

A
  • Volume: 180-200ml
  • Advantage of added anticoagulant
  • Fresh /refrigerated

Provision for dealing with clotted specimens:

  • Mechanical manipulation to release trapped cells
  • Fix tenacious clots in NBF and process
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7
Q

Anticoagulant

A

Formula:

  • Sodium Citrate - 4gms
  • Glucose - 6gms
  • Distilled water - 240ml
  • Sodium Azide - 0.24gms

• Use at 10% v/v

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8
Q

Effusion Specimen

A
  • Volume: 180-200ml
  • Advantage of added anticoagulant
  • Fresh /refrigerated

Provision for dealing with clotted specimens:

  • Mechanical manipulation to release trapped cells
  • Fix tenacious clots in NBF and process
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9
Q

Serous Effusion Cytology

A

Clues for laboratory preparation initiatives:

  • Clinical information
  • Macroscopic appearances (colour, viscosity)
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10
Q

Transudate

A
  • less than 3g/100ml serum
  • Poorly cellular
  • Associated with alteration in vascular hydrostatic and osmotic pressure
  • Develops in cardiac failure, hypoproteinaemia
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11
Q

Exudate

A
  • more than 3g/100ml
  • Highly cellular
  • Develops in bengin infection or neoplasia
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12
Q

Changing the cell concentration

A
  • Centrifugation, Cytocentrifugation

* Liquid based preparation devices (ThinPrep, SurePath)

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13
Q

Blood contamination reduction

A
  • Gradient centrifugation
  • Mixing specimen with lysing agent
  • Fixing smears in haemolytic fixative
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14
Q

Smears and staining

A

Smear technique:

  • Squash
  • Blood film
  • Cytospin

Minimum 2 smears:

  • Air dried - Giemsa
  • Wet fixed - Papanicolaou
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15
Q

Purpose of a cell block

A
  • Improves diagnostic accuracy:
  • May contain material not seen in smears
  • May show morphological details not seen in smears
  • Platform for special stains and adjunct tests
  • Provides a permanent reserve of cells
  • Method of preparation –trap cells in an inert support medium, fix in NBF, process as a biopsy
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16
Q

Special Stains and IHC

A
  • Smears useful for some histochemical stains e.g. PAS+/-Diastase
  • IHC on smears (preservation issues for some markers, require standardisation and controls)
  • Histochemical and IHC usually performed on cell block sections (NBF fixation, serial section tracking)
  • Special staining allows for differential diagnosis of reactive / mesothelioma /adenocarcinoma.
17
Q

Ultrastructural studies

A
  • May be of assistance when morphology and IHC are equivocal
  • Cell button fixed in 2.5% glutaraldehyde
18
Q

Flow cytometry

A

Serous effusion applications:

  • Lymphoma studies
  • DNA ploidy analysis
  • Immunophenotyping using monoclonal antibodies against epithelial markers
19
Q

“Advanced” Adjunct Tests

A
  • Targeted therapies-EGFR and HER2/Neu using FISH, CISH
  • Therapeutic response markers-NAC1-ovarian carcinoma, Inhibitor of Apoptosis Protein IAPmalignant mesothelioma
  • RT-PCR assay of human cancer gene MN/CA9
  • TRAP assay: telomeric repeat amplification protocol – in situ test to distinguish benign/malignant effusions.
20
Q

Malignant effusions- Adenocarcinnoma

A
  • Highly cellular
  • Tendency for neoplastic cells to form microglandular structures-balls, papillae
  • Nuclear criteria usually satisfied
  • Secretory product can often be identified
  • Often with clinical history
21
Q

Malignant Mesothelioma

A
  • Monotonous population
  • Retains some mesothelial characteristics
  • Overlap of morphology with adenocarcinoma demands the use of specific cell markers to distinguish the tumour type

Foundations of Pathology (15 decks)

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