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Liquid Based Cytology, Slides of Pathology

Since the mid-1990s, techniques based around placing the sample into a vial containing a liquid medium that preserves the cells have been increasingly used. The media are primarily ethanol-based. Improvised method, can be used as a substitute. Works on different principle to ultimately give accurate results. Proper sample acquisition - a cell that is not in the sample cannot be evaluated.

Typology: Slides

2018/2019

Uploaded on 04/10/2019

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Liquid based cytology
By
Dr. Varughese George
Department of Pathology. MGMCRI
DR. VARUGHESE GEORGE
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Liquid based cytology

By Dr. Varughese George Department of Pathology. MGMCRI DR. VARUGHESE GEORGE

HISTORY

  • (^) Idea of LBC -1970.
  • (^) 1987 – NHS CSP (National Health Service Cervical Screening Programme)
    • successful in decreasing the incidence and mortality(80% prevention) Dr.Georgios Papanikolaou (1920)

Basic principle :

The technique of removing cells from the
surface of the cervix
scraping with a wooden spatula
and
smearing on the glass slide
staining and examining them
microscopically

****Ideal focus of sampling to obtain adequacy is Squamo-columnar Junction**

Why a PAP?

  • (^) The test aims to detect potentially pre-
cancerous changes (cervical intraepithelial
neoplasia (CIN) or cervical dysplasia), which
are usually caused by HPV or any other
denovo mutations
  • (^) The test may also helps to detect infectious
agents and abnormalities of the cervix

How to perform?

  • (^) Not done during menstruation.
  • (^) Insert a speculum into the patient's vagina, to allow access to the cervix.
  • (^) Samples are collected from the outer opening or os of the cervix using an Ayre’s spatula (conventional PAP),an endocervical brush, or a plastic-fronded broom.(LBC)
Reporting according to Bethesda
classification[2014]

Specimen type Conventional PAP smear LBC Adequacy : Epithelial(8000- 12,000 cells well preserved and well visualised. Glandular components(10 well preserved cells in groups/single) For LBC - squamous cells) Glandular components(10 well preserved cells in groups/single) General categorization: Negative for intraepithelial lesion or malignancy[NILM] –organisms, other non neoplastic findings. Epithelial cell abnormalities – squamous cells, glandular cells.

Interpretation/result :

  • (^) Squamous cell abnormalities (SIL)
    • (^) Atypical squamous cells of undetermined significance (ASC-US)
    • (^) Atypical squamous cells - cannot exclude HSIL (ASC- H)
    • (^) Low-grade squamous intraepithelial lesion (LGSIL or LSIL)
    • (^) High-grade squamous intraepithelial lesion (HGSIL or HSIL)
    • (^) Squamous cell carcinoma.
  • (^) Glandular epithelial cell abnormalities
    • (^) Atypical Glandular Cells not otherwise specified (AGC or AGC-NOS) of endometrial ,endocervical and glandular
    • (^) Atypical Glandular Cells favouring neoplastic – endocervical and glandular

Reporting format

  • (^) ** Bethesda system of reporting is followed in Conventional pap smear as well as LBC

Reasons for Unsatisfactory Smear The following inhbits intepretation of 75 % of smear : -

  • (^) Squamous epithelial component scanty/absent
  • (^) Obscuring blood
  • (^) Inflammation
  • (^) Thick areas
  • (^) Mucus
  • (^) Poor Fixation
  • (^) Air Drying
  • (^) Artifact
  • (^) Contamination

Reasons to improve the PAP

smear

  • (^) New collection devices (brooms and
brushes rather than spatulas/Q tips, etc)
  • (^) Liquid-based Pap Tests rather than smears
  • (^) Ancillary tests such as HPV detection
  • (^) Computerized screening devices.

TYPES

  • (^) FDA- APPROVED
  • (^) 1. Thin –Prep
  • (^) 2. Sure Path
  • (^) FDA-Not Approved
  • (^) Cytoscreen
  • (^) Turbitec
  • (^) Cellslide
  • (^) Papspin

Other uses of LBC

  • (^) Non-gynaecologic cytopreparation
  • (^) 1. thyroid cyst fluid examination
  • (^) 2. Oral pathology lesions
  • (^) 3. body fluids –pleural effusions, urine
  • (^) 4. brushing samples