Liquid Based Cytology, Slides of Pathology

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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