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Diagnostic Cytopathology Significance of Biopsy Investigation

Morphological Diagnostic Methods . Clinical Pathological. Morphological Diagnostic Methods. Clinical: macroscopy of lesions visible with the naked eye invisible with the naked eye - IMAGING (X-ray, sonography, scintigraphy, endoscopy, CT,) magnifying glass - colposcopy. Morphologica

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Diagnostic Cytopathology Significance of Biopsy Investigation

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    1. Diagnostic Cytopathology & Significance of Biopsy Investigation

    2. Morphological Diagnostic Methods Clinical Pathological

    3. Morphological Diagnostic Methods Clinical: macroscopy of lesions visible with the naked eye invisible with the naked eye - IMAGING (X-ray, sonography, scintigraphy, endoscopy, CT,…) magnifying glass - colposcopy

    4. Morphological Diagnostic Methods Pathological macroscopy microscopy ultrastructure IMAGING

    5. Morphological Diagnostic Methods Pathological macroscopy of lesions autopsy report biopsy description cytology material description

    6. Morphological Diagnostic Methods Pathological microscopy cytology minibiopsy - cytoblock histology

    7. Cytology (FNAB) often both first and final dg. method outpatient low cost procedure done by an experienced (cyto)pathologist surprisingly effective has some limits (!)

    10. Expectations Clinician from his pathologist: confirmation of neoplasm dg. nosological classification grading, staging prognosis reaction to the therapy recidive recognition

    11. Expectations Pathologist from his clinician: information: local.,size, duration, former dg. a treated neo, clin. dg. diagnostic material acquisition correct interpretation of the pathologist´s report

    12. Getting Cytology Material surface – smeared, brushed, scraped cavities – punctured, aspirated deep solid lesions - aspirated

    13. Processing Cytology Material smears cytospins, cytosedimentation cytoblock

    14. Minibiopsy - Cytoblock from FNAB advantage of easy material taking together with more tissue architecture information histology &, immunohistochemistry methods available multilayered tissue phragments readable

    15. Cytology Material Staining gynecology smears - polychrome other materials –MGG, HE, polychrome, all other methods cytoblock – multiple methods

    16. Goals of Cytological Investigation Screening – detection of symptomless lesions Diagnosis of pathological lesions found introductory (followed by histol.) final

    17. Gynecological oncologic cytology laboratory investigation standard Authors: MUDr Alena Beková, MIAC MUDr Pavel Tretiník, MIAC Oponents: doc. MUDr J. Dušková, CSc,FIAC MUDr Eva Svobodová

    18. Cytology - Evaluation staining and evaluation – minutes Bethesda system : material quality and quantity group diagnosis dg. as close to histology as possible recommendation

    19. Bethesda System 2001 <http://bethesda 2001.cancer.gov>

    20. Suitable for Evaluation without limits limited by… non processed processed but limited for evaluation of squamous cell abnormalities due to…. .

    21. General Categorisation negative for intraepith. lesion or malignancy intraepith. lesion or malignancy squamous or glandular other pathology endometral cells in women over 40 yrs

    22. Interpretation negative for intraepithelial lesion or malignancy Microorganisms Trichomonas mycosis vs. candidosis shift - bact. vaginitis bacteria Actinomyces like cell changes of HSV type

    23. Interpretation negative for intraepithelial lesion or malignancy Other non-neoplastic changes reactive inflammation (+ repair) IUD atrophy

    24. Bethesda - cervical cytology classification 1. normal 2. benign cellular changes 3. ASCUS 4. L SIL 5. H SIL 6. Atypiae of glandular cells 7. susp. adenoca

    25. Interpretation epithelial abnormalities squamous ASC-US ASC-H LSIL CIN 1, HPV HSIL CIN2, CIN3, CIS susp. invasion squamous ca

    26. Interpretation epithelial abnormalities squamous ASC-US ASC-H LSIL CIN 1, HPV HSIL CIN2, CIN3, CIS susp. invasion squamous ca

    27. Bethesda System 2001 <http://bethesda 2001.cancer.gov>

    28. Cytology getting sample needle 0.6-0.8mm min. 2 punctions aspiration nonaspiration – reduction of the blood content cyst: evacuate and aspirate with the second punction the periphery fluid: whole volume for cytology

    29. Peroperation Biopsy dg. during minutes morphological artefacts (combination with cytology) limited extensity of investigation limited time

    30. „Classical“ Biopsy (formol paraffin technique) simple may be done in two days immuno reactions two days more further sectioning two days more oncol. dg. - WHO classification typing, grading, staging prognostic factors

    31. Biopsy any tissue removed from a living patient is a COMPULSORY subject to do not follow the tendency to discard „unimportant“ materials (nevi, tonsillae, uteri, intestine, endometrial curretage…..)

    32. Biopsy do not crush small samples taking imprint cytology !!! adequate amount of fixation solution (sample: fixative = min. 1:10) wide neck bottle tightly closed for transport but openable without rough violence flat sample – spread and tighten on a bearing socket mark discrete suspicious lesion with a stitch before fixation

    33. CYTOLOGY LOVE IT or LEAVE IT L. Cardozzo

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