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Transcript of Diagnostic Cytopathology - pau.lf1.cuni.cz · Meningitis purulenta CSF. Liquorcerebrospinalis oil...
Definition
Historic note
Cytopathology - tasks
– exfoliative
gynecological screening
urological screening and diagnostics
cytodiagnostics of body fluids – diagnosis of
inflammation, diagnostics and staging of
neoplasms
– aspiration diagnostic biopsy
Conclusions and links
Diagnostic cytopathology - contents
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
Morphological Diagnostic Methods
Pathological
macroscopy
microscopy
cytopathology
histopathology
molecular pathology
ultrastructure
IMAGING
Morphological Diagnostic
Methods Pathological
microscopy
cyto(patho)logy
minibiopsy - cytoblock
histo(patho)logy
Morphological Diagnostic Methods
Pathological
macroscopy of lesions
autopsy report
biopsy description
cytology material description
Cytology (FNAB)
often both first and final dg. method
outpatient low cost procedure
done by an experienced
(cyto)pathologist surprisingly effective
has some limits (!)
Goals of Cytological Investigation
Screening – detection of symptomless
lesions
Diagnosis of pathological lesions found
introductory (followed by histol.)
final
Expectations
Clinician from his pathologist:
confirmation of neoplasm dg.
nosological classification
grading, staging
prognosis
reaction to the therapy
recurrence recognition
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
Getting Cytology Material
surface – smeared, brushed,
scraped
cavities – punctured, aspirated
deep solid lesions - aspirated
Minibiopsy -
Cytoblock from
FNAB
advantage of easy material taking together
with more tissue architecture information
histology &, immunohistochemistry
methods available
multilayered tissue phragments readable
Cytology Material Staining
gynaecology smears - polychrome
other materials –MGG, HE, polychrome, all other methods
cytoblock – multiple methods
Gynecological
oncologic
cytology
laboratory investigation standard
Authors: MUDr Alena Beková, MIACMUDr Pavel Tretiník, MIAC
Oponents: doc. MUDr J. Dušková, CSc,FIACMUDr Eva Svobodová
Bethesda
- Classification of cervical cytology
1. normal
2. benign cellular changes
3. ASCUS
4. L SIL
5. H SIL
6. Atypia of glandular cells
7. susp. adenoca
General Categorisation
negative
for intraepith. lesion or malignancy
intraepith. lesion or malignancy
squamous or glandular
other pathologyendometral cells in women over 40 yrs
Cytology - Evaluation
staining and evaluation – minutes
Bethesda system :
– material quality and quantity
– group diagnosis
– diagnosis as close to the histology (tissue diagnosis) as possible
– recommendation
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AS
R(E
)
Year of diagnosis/ death
Trends in cervical cancer incidence and mortality „joinpoint analysis“
-1,6 %
-4,9 %
-2,8 %
Organized
cervical cancer
screening
Source: incidence, mortality, prevalance – Czech National Cancer Registry
-0,2 %
38 laboratories (accredited by Ministry of Health)
Data from laboratories
Vytvořil Institut biostatistiky a analýz, Masarykova univerzita
Central database of cervical
cancer screening
DATA EXPORT
VALIDATION
REPORTING
Expert
Guarantee
Gynekologist Histopathologist
Clinical /Cytology reports
Results of cervical screening cytology
examinations
2. ASC-US
31 162
1,41 %
1. Bez neoplastických
intraepiteliálních změn a
malignity
2 143 834
96,84 %
3. ASC-H
4 165
0,19 %
4. LSIL
21 559
0,97 %
5. HSIL 2 909 0,13 %
8. Glandular atypia
4 148
0,19 %
6. HSIL – cannot exclude invasion
166
0,007 %
7. Squamous cell carcinoma
126
0,006 %
9. Glandular cells atypia
(favour neoplastic)
185
0,008 %
10. Adenocarcinoma in situ
18
0,001 %
11. Invasive adenocarcinoma
48
0,002 %
12. Other malignancy
22
0,001 %n = 2 213 782 womenincl.5 440 other/not recorded/unable to diagnose
Examinations in 2016
The results are abnormal
(mostly ASC-US or LSIL)
in 3% of women
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15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
Agi group
Coverage by
screening
Cervical cancer screening coverage in 2016
Estimated coverage of the population aged 25–29
years in 2016: 57,9 %The rate is calculated as the ratio of the number of women examined by screening cytology in 2016 (in a
given age group) and the number of women in the target population in 2016.
Due to the fact that hash values of birth certificate numbers are not available in the registry, data can be
slightly biased by duplicate records of screening examinations in different laboratories.
Population aged 25-59
Source: Cervical Cancer
Screening Registry, IBA MU
Estimate of population coverage
by screening cytology in 2015-2016
Estimated coverage of the population aged 25–29 years
by screening cytology in 2015-2016: 78,7 %
The rate is calculated as the ratio of the number of women examined by screening cytology in 2015
or 2016 (in a given age group, age at the latest examination) and the number of women in the target
population in 2016.
Due to the fact that hash values of birth certificate numbers are not available in the registry, data can be slightly biased by duplicate
records of screening examinations in different laboratories.
0%
10%
20%
30%
40%
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60%
70%
80%
90%
100%
15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
Age group
Coverage by
screeningPopulation aged 25-59
Source: Cervical Cancer
Screening Registry, IBA MU
Interpretation
negative for intraepithelial lesion or malignancy
Microorganisms Trichomonas
mycosis vs. candidosis
shift - bact. vaginitis
bacteria Actinomyces like
cell changes of HSV type
Chlamydia trachomatis IS CO-CANCEROGEN …..
intracellular parasite
purulent inflammation
can be asymptomatic
morphologica changes „mimicking” SIL H
Source: Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, USA
Madeleine MM, Anttila T, Schwartz SM, Saikku P, Leinonen M, Carter JJ, Wurscher M, Johnson LG, Galloway DA, Daling JR.:
Risk of cervical cancer associated with Chlamydia trachomatis antibodies by histology, HPV type and HPV cofactors.
Int J Cancer. 2007 Feb 1;120(3):650-5.
Chlamydia trachomatis supresses male fertility…
90 millions of infections/yer – the motst frequent bacterial STD in the world
can be asymptomatic
severe complications (acute PID pelvic inflammatory disease,
ectopic pregnancy, infertility, infancy pneumonia)
Source: Department of Biological and Physiological Sciences and Laboratories of Investigation and
Development, Universidad Peruana Cayetano Heredia, Lima, Peru
Gonzales GF, Muñoz G, et al:Update on the impact of Chlamydia trachomatis infection on male fertility.
Andrologia. 2004 Feb;36(1):1-23.
Immigrants with a high prevalence of Gardnerella also have a high prevalence of Trichomonas. Such slides should be screened with extra care (increased risk of squamous abnormalities ) …
58,904 Immigrants and 498,405 Dutsch
imigrants from Surinam, Turkey and and the Dutch Antilles had 2,5 times
higher incidence of Gardnerella (clue cells) and Trichomonas
smears with the Gardnerella infection bear the risk of higher frequency
of squamous lesions and require extra screenming care…
Source: Leiden Cytology and Pathology Laboratory, Leiden, The Netherlands.
Boon ME, Holloway PA, Breijer H, Bontekoe TR. Gardnerella, Trichomonas and Candida in cervical smears of 58,904 immigrants participating in the Dutch national cervical screening program. Acta Cytol. 2012;56(3):242-6.
Sensitivity and specificity of the Fournier device test was comparable to Papanicolaou smears tests obtained using the traditional method with speculum examination. ….
immigrants, muslims and other minority populations participate less in cervical screening
self-sampling device Fournier(®) represents an alternative for women who do not tolerate assisted vaginal sampling
Source: Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
da Silva Rocha A, Schaeffer PG, Meurer L, et al.: Assessment of the Fournier(®) cervical specimen self-sampling device using the Papanicolaou method.
Acta Cytol. 2012;56(5):520-6.
Zdroj: Department of Family Medicine and Community Health, University of Medicine and Dentistry of New Jersey, USA.
Friedman AM, Hemler JR, et al.:Obese Women's Barriers to Mammography and Pap Smear: The Possible Role of Personality.
Obesity (Silver Spring). 2012 Feb 28. doi: 10.1038/oby.2012.50. [Epub ahead of print]
Obese women are at increased risk of developing and dying from cervical and mammary cancer, but are less likely than nonobese women to receive cancer screening
Detection of HR HPV and cytology should be combined….
study of 705 women with cytology and HC2 HR HPV
HR HPV higher sensitivity 84.5% vs. 69.7% compared to
cytology
HR HPV lower specificity 49.90 vs. 88.78% compared to
cytology
(p <
0.0001)
Zdroj: Departments of Obstetrics and Gynecology, Clinics Hospital, School of Medicine, University of São Paulo,
Brazil
Beldi MC, Tacla M, Caiaffa-Filho H, Ab'saber A, Siqueira S, Baracat EC, Alves VA, Longatto-Filho A : Implementing human papillomavirus testing in a public health
hospital: challenges and opportunities.Acta Cytol. 2012;56(2):160-5.
0,0
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14,0
Examination of hrHPV by age groups
Věk při vyšetření
Vyšetření na
1000 žen
Testing the presence of high-risk HPV (95201) (N = 26 506 examinations in 2016; data from healthcare payers)
))
Overall rate (25-59 years, 2016): 9,0 examinations per 1,000 women
Screening karcinomu děložního hrdla
Užší cílová populace, 25-59 let
N = 23 066 vyšetření
In 2015, the overall rate was 6,5 examinations per 1,000 women
www.cervix.cz
Májek, O., Dvořák, V., Dušek, L., Mužík, J., Šnajdrová, L., Gregor, J. Cervix.cz – Cervical Cancer Screening Programme in the
Czech Republic [online]. Masaryk university, Brno, 2016. [cit. 2016-04-14]. Available at WWW: http://www.cervix.cz. ISSN
1804-087X. Version 1.6f.
Definition
Historic note
Cytopathology - tasks
– exfoliative
gynecological screening
urological screening and diagnostics
cytodiagnostics of body fluids – diagnosis of
inflammation, diagnostics and staging of
neoplasms
– aspiration diagnostic cytopathology
Conclusions - links
Diagnostic cytopathology - content
urine PAP V
Cytology (FNAB)
often both first and final dg. method
outpatient low cost procedure
done by an experienced
(cyto)pathologist surprisingly effective
has some limits (!)
Cytology getting sample
needle 0.6-0.8mm
min. 2 punctionsaspiration
nonaspiration – reduction of the blood content
cyst: evacuate and aspirate with the
second punction the periphery
fluid: whole volume for cytology
MEETING of Papanicolaou
Society of Cytopathology
Martha Bishop Pitman (Boston)
EUS-FNA cytology of the pancreas
2
0
0
6
Geneve 2014
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
Not a good practice….
Cytopathology lab receives a sample
with a „self explanatory “ text:
„puncture for cytology” …???
Eurocytology 2013-15
Partners Imperial College Healthcare NHS Trust
European Federation of Cytology
Societies
Turkish Cytology Society
Czech Cytology Society
Inbrooks Ltd
Interfase
Target groups
– Cytotechnologists in training
– Cytopathologists in training
– tutors and instructors of cytology
– medical students
1
1
Projekt EUROCYTOLOGY je podporován z programu Leonardo da Vinci s cílem zlepšit přístup
k materiálům pro výcvik klinické cytologie a harmonizovat výcvik v této důležité subspecializaci
patologie v Rámci EU. Vezměte prosím v úvahu, že jednotlivé národní jazykové verze se mohou
v souvislosti s různým curriculem mírně lišit.
https://www.eurocytology.eu/
What is peculiar to this project?
Transnationality
Validation through a European Network
Dynamic tests through the use of a
specific software and image database
Use of virtual slides
Translated in several languages
Eurocytology Project 2013-2015:
The Contribution of the Czech Republic.Duskova J.1, Badger A.2, Capitanio A.3, Fassina A.4, Önal B.5, Bonora R.6, Poznanski J.7,Tötsch M.8, Dina R7.
1Prague, Czech Republic,
2Leamington Spa, United Kingdom,
3Stockholm, Sweden,
4Padova, Italy,
5Ankara, Turkey,
6Trieste, Italy,
7London, United Kingdom,
8Gent,
Belgium
Introduction: The Eurocytology website was
originally developed with Leonardo funding in
2005-7. It was formerly available in 6
languages (English, Spanish, Italian, Greek, Polish and Hungarian).
The Czech Association for Clinical Cytology
participated in the Leonardo Da Vinci
Programme 2011 initiative and became an
official partner in the second phase of the
Eurocytology project 2013-2015.
Objective: To update the Leonardo –
Eurocytology Project 2013-15 and the Czech
Society for Clinical Cytology contribution.
Methods: Description of activities undertaken
–collaboratively and internationally.
www.eurocytology.eu
Referen
ce
Conclusion: The updated website
www.eurocytology.eu increases the level
of cytopathology education
in the Czech Republic.
Results:
• All current modules of the former website
have been translated and incorporated into
the curricula of the cytotechnology and
cytopathology education.
• Prague hosted in September 2014 the
international working session.
• The Czech partners have reviewed the
updated chapters of gynaecology cytology
written by Amanda Herbert.
• The details of the platform are disseminated
during the national cytology and pathology
congresses, workshops and seminars.
• The feedback from the website users
proves increasing interest among the Czech
specialists.
• Due to lack of a language barrier the Czech
language version may serve the Slovak
colleagues tutorials as well.
The use of the
original
Eurocytology
website has
significantly
exceeded
expectations.
In 2013 it received
on average 50,000
visits and 75,000
pages downloaded
/ month.THE NEW WEBSITE
will provide during 2015
updated content of the
former chapters
The Czech
and
Slovak Republic
specialists
start to emerge
among
the website users
ADDITIONAL
PLANNED
CHAPTERS
• Colposcopy
• Self assessment
for each chapter• 10 Virtual slides for
each chapter
• Immunocytochemis
try in cytology
• Molecular
diagnostic tests in
cytology• Flow Cytometry
• The role of
Cytotechnologists
in FNA cytology
• CSF cytology
• Joint Fluid cytology
• On line
examination in
cervical cytology
• On line
examination in
diagnostic cytology
• QUATE mock
examination on
line