Cytopathology:
Technique and Interpretation
Dr Tarek Atia
Definition of cytopathology
• Cytopathology is the study of normal and
abnormal exfoliated cells in tissue fluid.
• The exfoliated cells reflect the normal and
abnormal morphology of the tissue from which
they are derived.
Types of exfoliated cytopathology
• Natural spontaneous exfoliation
– Natural covering epithelium: skin, urinary
tract, vagina, and cervix.
– Glandular epithelial secretion: Breast (Nipple
secretion).
– Sputum
– Urine
• Exudates and transudate:
 Exudates is a clear, yellowish, watery substance,
with few cells and low protein content
 Transudate is a pale yellow and cloudy substance
rich in cells and protein content.
• Pleural fluid
• Peritoneal fluid
• Pericardial fluid
• Joint fluid
• CSF
• Artificial enhanced exfoliation:
– Scrapings from cervix, vagina, oral cavity, and skin
– Brushing and lavage: bronchi, GIT, and urinary tract
– Fine needle aspiration (FNA) for:
• Body cavity fluid: pleural, pericardial & peritoneal fluids
• Cysts: neck, breast & ovary
• Solid tissue: body organs, tumors & other swell
Role of cytopathology
• Early detection of unsuspected diseases (malignant or
pre-malignant lesions).
• Confirmation of suspected diseases without surgical
trauma.
• Diagnosis of hormonal imbalance.
• Useful in flow up the course of disease or monitoring
therapy.
Advantage of Cytopathology
- Rapid diagnosis
- Inexpensive
- Simple
- Non-invasive; no injury to tissue allowing repeated
sampling
- It is better in evaluating the infectious diseases.
- Supplement or replace frozen section or biopsy
- It is better for hormonal assay
- Cytopathological smear cover a wider surface than that
involved in surgical biopsy.
Disadvantage of Cytopathology
• Interpretation of the morphological cellular changes is
based only on individual cell observation.
• Not always finally diagnosis, so it is confirmed by
histopathology (surgical biopsy) in some cases.
• Not determine the size and type of lesion of some cases.
Factors that determine the appearance of cells
• Type of the technique used (Scraping, Brushing or lavage).
• Level of cell maturation at the time of cell collection.
• Nature of the parents tissue: soft tissue, cyst, solid organ.
• Medium of the exfoliated cells.
• Interval between the sample collection and staining of
the exfoliated cells.
• Type of fixative, stain, and processing of the technique
used.
• PAP smear: named after Dr. George
Papanicolaou (1883-1962)
• Vaginal smears from guinea pigs (1917)
• Women (1920)
• Hormonal cycles
• Pathological conditions (1928)
TakingtheSample
The Pap Smear:
Cytologic screening for cervical cancer
• Cervical cancer screening has decreased morbidity
and mortality
– Deaths from cervical cancer decreased from
26,000 to less than 5,000 between 1941 and 1997
Pap smears are not perfect
• For a high grade lesion, the sensitivity of a single
pap smear is only 60-80%
• Estimated false negative rate is 30-50%
• Requires adequate specimen collection
• Requires adequate cytological review
• Requires adequate patient and physician follow-up
– 10% of women with cervical cancer had inappropriate
follow-up.
• Requires access to care
– 50% of women with cervical cancer were never
screened and 10% had not been screened within 5
years of diagnosis.
• Who to screen: Any woman with a cervix who has
ever had sexual activity.
• When to screen: Start within 3 years of onset of sexual
activity or by age of 21, whichever is first.
• Screening frequency: Yearly until three consecutive
normal pap smears, then may decrease frequency to every
three years
When to stop routine screening
• Age 65 and “adequate recent screening”
– Three consecutive normal pap smears
– No abnormal pap smears in last 10 years
– No history of cervical or uterine cancer
• Hysterectomy for benign disease
• Hysterectomy for invasive cervical cancer