Role of cytology and biopsy in the investigation Flashcards
What is cytology?
Microscopic examination of a thin layer of cells on a slide obtained by:
- Fine Needle Aspiration
- Direct smear from nipple discharge
- Scrape of nipple with scalpel
What is the role of cytology?
Symptomatic Clinic
“Triple assessment” of patient by surgeon, radiologist and cytopathologist
Sample of main lesion or FNA of axillary node/satellite lesions
What are the different types of masses?
Cystic- fluid
Solid
What is the equipment required in a FNA?
- 23G needle
- 10ml syringe +/- Cameco holder
- Alcohol swab
- Cotton wool, sticking plaster
- Glass slides, pencil
- +/-Vial with saline for needle washings
What is the technique of FNA
- Ensure patient is comfortable
- Examine to locate lump
- Swab area
- Localise lump between fingers
Insert needle (45o)
Aspirate using in and out action applying negative pressure on syringe
Release pressure and remove needle
What is US guided FNA done on?
Impalpable area seen on US
What are important considerations from the patient in FNA?
- Informed of procedure
- Comfort
- Chaperone
What are important considerations from safety in FNA?
- Appropriate PPE
- Dispose of needle
- Care handling fresh material/ infection risk
Label this
What is seen in benign cytology?
- low/ moderate cellularity
- cohesive groups of cells
- flat sheets of cells
- Bare oval (bipolar) nuclei in background
- cells of uniform size
- uniform chromatin pattern
What is seen in malignant cytology?
- high cellularity
- crowding/overlapping of cells
- loss of cohesion
- nuclear pleomorphism
- hyperchromasia
- absence of bipolar nuclei
Usually diagnosis non specific ie. adenocarcinoma NOS.
What is seen in this image?
What is seen in this image?
What is the cytology scoring system?
- C1 Unsatisfactory/ Insufficient cells for diagnosis
- C2 Benign
- C3 Atypia (probably benign)
- C4 Suspicious (probably malignant)
- C5 Malignant
What do cysts aspiration do?
Aspiration is curative
- Fluid discarded unless
- fluid is bloodstained
- there is residual mass
What are the advantages of cytology?
- Simple procedure - can be done at clinic
- Well tolerated by patients
- Inexpensive
- Immediate results
What are the limitations of cytology?
- False Negatives
- False Positives
- Invasion cannot be assessed
- Grading cannot be done
Accuracy not 100%
What are the limitations of cytology?
- Sampling (lesion missed)
- small lesions
- small tumour in larger area of thickening
- Technical (difficult to examine cells)
- suboptimal smears (blood, thick, cells smeared)
- Interpretation (features similar)
What are the complications of FNA?
- Pain
- Haematoma
- Fainting
- Infection, Pneumothorax –rare
What are the contraindiciations of FNA?
None
What is important about a nipple lesion?
- Nipple discharge - spread directly on to slides
- Duct ectasia macrophages only
- Intraduct papilloma benign cells in papillary groups
- Intraduct carcinoma (DCIS) malignant cells
Nipple scrape
- Paget’s Disease (squamous cells and malignant cells ) v
- Eczema (squamous cells from epidermis only)
What is this?
Normal lymph node
What is this?
Metastatic adenocarcinoma
What is a core biopsy?
- All cases with clinical OR radiological OR cytological suspicion
- Breast screening – especially architectural distortion and microcalcification
- Pre-operative classification
- Rarely open biopsy
What equipment is required for a core biopsy?
- 14 G needle
- Intact tissue strand
- Formalin fixed
What does a core biopsy help do?
- Confirm invasion
- Tumour typing and grading
- Immunohistochemistry – receptor status
