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Fnac.final.24.05.2014

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  • 1. FINE NEEDLE ASPIRATION CYTOLOGY EXFOLIATIVE CYTOLOGY.
  • 2. DEFINITION Scientific study of cells obtained from tissues or body secretions to identify disease.
  • 3. TYPES  Based on sampling techniques, cytology is classified into the following: 1. Exfoliative Cytology. 2. Abrasive Cytology. 3. Aspiration Cytology.
  • 4. EXFOLIATIVE CYTOLOGY Based on spontaneous shedding of cells derived from the lining of an organ into a cavity. Contents of the sample are derived from several sources. Examples: vaginal smear, sputum, urine, CSF, and body effusions. The material is collected spontaneously or by a syringe or a cotton swab.
  • 5. ABRASIVE CYTOLOGY Cells are obtained directly from the surface of the target of interest. Samples are taken by scraping, brushing, or washing. Examples: cervical scraper, endoscopy, and gastric lavage. Samples can be obtained from superficial or deep lesions.
  • 6. ASPIRATION CYTOLOGY  Samples are obtained from solid tissues that are not connected to a hollow viscus.  A needle with or without a syringe is used.  Simple, safe, rapid, cost effective, and require no special clinical skills.  Virtually every organ in the body is accessible to this method.
  • 7. Introduction to Cytology. Recognizing and classifying cells. Fixation and preservation in cytology. Methods of preparation in cytology. Stains and staining in cytology. Gynecological cytology: methods of collection. Gynecological cytology: normal and functional cytology.
  • 8. Gynecological cytology: abnormal cytology Respiratory tract cytology. Urinary tract cytology. Gastrointestinal tract cytology. Cytology of fluids and body effusions. Fine Needle Aspiration Cytology.
  • 9. Abnormal non-neoplastic gynecological cytology(slides). Abnormal neoplastic gynecological cytology (slides). Respiratory tract cytology(slides). Cytology of urinary tract, GIT, and body effusions(slides).
  • 10. ROLE OF DIAGNOSTIC CYTOLOGY.  Diagnosis and management of cancer  Benign lesions  Intraoperative pathological diagnosis  Non neoplastic and inflammatory conditions,  Diagnosis of specific infections  Cytogenetic  Hormonal assessment status in women  Cell of origin
  • 11. HISTORICAL PERSPECTIVE Histopathology >100 years - Last 50 years birth of cytopathology - mainly exfoliative cytology Scandinavia 1950S -1960S ; Sodestroem and Franzen in Sweden and Lopez cardozo in Holland Performed by ‘professional hybrids’ - clinicians who used it for rapid diagnosis
  • 12. FNAC - DEFINITION  Aspiration of cells/ tissue fragments using fine needles ( 22 , 23, 25 G) ; external diameter 0.6 to 1.0 mm  1.5 inches long needle ( radiologists use longer needles)  Diagnostic materials in the needle and not in the syringe even in cystic lesions
  • 13. CLINICAL SKILL REQUIRED  Familiarity with general anatomy eg thyroid vs other neck swelling  Ability to take a focused clinical history  Sharp skill in performing physical examination eg solid vs cystic, benign vs maligant lesions
  • 14. CLINICAL SKILL REQUIRED -2  Good knowledge in normal cellular elements from various organs and tissue and how they appear on smears eg fats cells vs breast tumour cells  Comprehensive knowledge of surgical pathology
  • 15. CLINICAL SKILL REQUIRED -3  Ability to translate traditional tissue patterns of lesions to their appearance in smears
  • 16. CYTOLOGY VS HISTOLOGY Papillary carcinoma of thyroid - follicular variant
  • 17. CYTOLOGY VS HISTOLOGY - 2 Granular Cell Myoblastoma
  • 18. WHO SHOULD DO FNA?  Clinicians  Cytotechnologists  Radiologists  Pathologists The one who examines the patients , does the aspiration, makes the smears, interprets the cytology is the best one to do FNA - PATHOLOGIST
  • 19. CURRENT STATUS  Palpable lesions  Outpatients , in- patients  Thyroid , breast, lymph nodes, salivary glands , soft tissue lumps...  Lung, intra-abdominal and retroperitoneal by radiologic imaging : CT, ultrasound, flouroscopy
  • 20. LIMITATIONS  Soft vs hard ( bone) lesions  Solid vs cystic lesions  Poor cellular yield vs poor technique  Reactive vs specific diseases eg reactive lymphadenitis vs Hodgkins disease  Diffuse vs nodular lymphoma
  • 21. COMPLICATIONS  Needle trauma  granulation tissue formation  granuloma formation  Sarcoma like changes  Needle linear tract haemorrhage  tissue necrosis Interfere with surgical pathology
  • 22. ADVANTAGES  Fast - early diagnosis  Less pain, less trauma  No anaesthesia  Acceptable by patients and doctors  Accurate
  • 23. HOW TO INTERPRET?  Aspiration materials eg colloid, blood, mucus?  Cellular yield vs acellular yield  Smear pattern - 3 dimensional balls vs flat monolayered sheet os cells  Cohesiveness vs discreet cells  Cell morphometry
  • 24. ADJUNCT TOOLS  Cell blocks  Histochemistry  Immunohistochemistry  Electron microscopy  Flow cytometry  Immuno electron microscopy  Molecular pathology -In situ hybridization, PCR etc
  • 25. ADJUNCT TOOLS IHC cytology Cell block 45 yr old woman with lytic bone lesion Histo - thyroid Histo -bone
  • 26. FUTURE DIRECTIONS  Aspirating non palpable lesions using MRI  Molecular pathology eg In Situ Hybridization  Replacing diagnostic surgical pathology?  Combined with MRI - replacing autopsy?
  • 27. TThhaannkk yyoouu.. EEnnjjooyy tthhee ssuubbjjeecctt aanndd lleeaarrnn iitt..

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