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 is this?
Normal lymph node
What is this?
Metastatic adenocarcinoma
