•
Role of
histopathology
and cytology
in oncology
Shaimaa kamal
• assistant lecturer
• DEPT OF PATHOLOGY
• FMBU
DIAGNOSIS OF NEOPLASM
Depend on triple test
CLINICAL
IMAGING
LABORATORY
&PATHOLOGY
data
ROLE OF PATHOLOGY
PRE- operative
SURGERY
intra operative
CYTOLOGY
CNP
FROZEN SECTION
CYTOLOGY
SCREENING
DIAGNOSIS
PRELIMINARY
DIAGNOSIS
POST oprative
PARAFFIN
IHC
ISH
DEFINITIVE
DIAGNOSIS
CYTOLOGY
• MINIMALY INVASIVE
• CHEAP
• RAPID
• SCREENING - DIAGNOSIS
• HIGH ACCURACY
• LIMITATION : NO ARCHITECTURE
Diagnosis of Abnormality/Pathologic
feature of human organs, mainly
malignant disease (Important : Early
diagnosis of malignancy)
Cyto-hormonal Examination
(effect/abnormality female
hormones)
Sex Chromatin Examination
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-Superfisial
mass (lymph node, thyroid, soft tissue, head & neck)
- Deep mass (liver, ovary, lung, bone)
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FIX IN ALCOHOL 96%
IMAGING GUIDED FNAB
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Requirement Specimens:
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Gathering from deep cough
It should be Fresh,the best is morning sputum
If sputum < :
- Collecting within 12-24 hours in a
bottle + alcohol 70%
- Add expectorant 2-3 days before
sputum collection
Better in 3x Delivery, with 3 days interval
1x Collection  Accuracy 37 %
5x Collection  Accuracy 88 %
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DELIVERY and SMEAR PREPARATION :
- It has life span about 3 hours
- Smear it on object glass  alcohol 95% fixation ( 15 mnts)
- sputum + alcohol 70% smear on object glass
air drying (without fire heating)
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• To justify lung malignancy
• To state kind of tumor definetely
• Diagnosis sensitivity almost 88%
• To Prove tumor showed on X-Ray Photo
/bronchoscopy
• To find tumor location ?
• Peripheral Lung Tumor 
unsatisfactory result
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False Positif:
False Negatif :
- Lung Abcess
- Bronkhiektasis
- TBC
- tumor unreliable with bronchus
- bronchial stenosis
- Tumor Localization : pheripher/superior
- Tumor Structure : oat cell Ca
THE DIAGNOSIS OF LUNG CELL CARCINOMA IS BEST BASED ON
COMBINATION OF CYTOLOGY RADIOLOGY AND BRONCHOSCOPY
EXAMINATION, .
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Protective Materials (-) 
Alcohol fixation 50% aa
/
: Morning Urine 50 CC
Morning
Direct voided urine
Morning
Urine catheter
1818
Clean Catch
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Speciment collection: Suprapubic Needle Aspiration
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Attention
• 1-3 hours (room
temperature)
• > 48 h
(refrigerator)
urine + alcohol 50% aa 
sentrifuge 2500 RPM (10 mnts)
smear
precipitate on
object glass )
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alcohol 95% fixation
(15 mnts)
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Squamous Cells
Transitional Cells
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Changing position of Patient
Punctie 100-200 CC
Fixation with alcohol 50% aa
Sentrifuge 2500 rpm (10 mnts)
Smear on object glass(+egg albumin)
Alcohol 95% (10 mnts)
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Fixation
• 1ml of heparin + 100ml of effusion fluid to prevent
clotting
• N.B.: do not use alcohol in fixation of fluid before
spread cytological smear on glass slides
Cell block
Adding plasma and thrombin
solution
Wrapped in filter paper
Heparinized
bottles (3 units
heparin/ml)
Unfixed
Cytocentrifuge preparation
Alcohol-fixed
Papanicolaou-stained
Placed in a cassette
Air-dried cytocentrifuge preparation
Embedded in paraffin
(Hematologic malignancy is
suspected)
Cut and H&E stain
Female Genital Cytology
• PAP TEST / Pap smear
• Carcinoma Endometrium Detection
• Cytohormonal Examination
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Female Genital Cytology
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PAP SMEAR EXAMINATION
Introduction
METHODS
INTREPRETATION
Married Woman:
• Every year
• Have certain symtomps ( Abnormal
pervaginam Bleeding)
High Risk Woman :
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First Sexual intercourse at <20 year
Pervaginam Labor >3
Cervicitis with bad higiene
Multipartner Sexual Intercourse
High risk Sexual Partner
Woman >40 years old
Woman with contact bleeding
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Introduction
Patient Preparation
METHODS
Examiner Preparation
INTREPRETATION
Cultivation Method
Fixation
Coloring
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HOME
Introduction
Patient Preparation
METHODS
Examiner Preparation
INTREPRETATION
Cultivation Method
Fixation
Coloring
32
HOME
Introduction
Patient Preparation
METHODS
Examiner Preparation
INTREPRETATION
Cultivation Method
Fixation
Coloring
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HOME
Introduction
Patient Preparation
METHODS
Examiner Preparation
INTREPRETATION
Cultivation Method
Fixation
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PAP SMEAR
Introduction
METHODS
INTREPRETATION
Adequacy
Cultivation
Evaluation
Method
Report System
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HOME
NORMAL CERVICAL SQUAMOUS EPITHELIUM
SUPERFISIAL, INTERMEDIATE
& PARABASAL CELL
CELL ENDOSERVIX
Introduction
METHODS
INTREPRETATION
Adequacy Evaluation
Report System
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HOME
Introduction
METHODS
INTREPRETATION
HPV Infection
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HPV INFECTION
KOILOCYTOSIS & NIS
CIN Image from Kolposcopy View
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Introduction
METHODS
CIN I
LSIL
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Introduction
METHODS
• CIN II
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Introduction
METHODS
CIN III
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Introduction
METHODS
SQUAMOUS CELL Ca
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MILD
SEVERE
MODERATE
CA INVASIVE
Introduction
METHODS
ADENO Ca
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Tissue Acquisition Devices - Types
and Indications
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FNA ( Fine –needle aspiration)
Core biopsy
Vacuum assisted core biopsy
Fine needle localization devices
Minimally Invasive Procedures Types &
Indications
►FNA
►Core
►Cysts,
Needle Biopsy
►Drainage
of
Core Needle Biopsy
(Mammotome)
masses
►Abscess
and post
surgical collections
►Pre-Operative
collections
►Fine Needle
Localization
►Vacuum-Assisted
►Solid
Lymph nodes
Large
►Solid
masses smaller
than 5mm and
calcifications
FINE NEEDLE ASPIRATION
Most popular technique of biopsy for breast palpable
and nonpalpable lesions.
ADVANTAGES
Virtually atraumatic
Rare to even cause a hematoma
Simple to perform
DISADVANTAGES
Extremely dependent on level of cytological interpretation.
High percentage of insufficient, material aspirates (34%-40%).
Cytology doesn’t differentiate between in situ from invasive disease
TECHNIQUE-EQUIPMENT
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10-20-30 ml LUER-LOK syringe
21-23-25G needles
Needle length 3.6-7.8cm
Glass slides
95% alcohol fixative
Anesthesia is optional
ASPIRATION TECHNIQUE
• After placement of needle, a syringe is
connected.
• Suction is applied by pulling the plunge of
the syringe.
• Sampling needle should be moved back and
forth rapidly within lesion.
• Needle is angled in multiple directions.
TECHNIQUE FOR F.N.A.
• Vertical or oblique
needle insertion.
• Needle should be
oriented
perpendicularly to
ultrasonic beam.
• Needle shaft and
tip should be
visualized during
procedure.
FINE NEEDLE ASPIRATION
Pre-FNA
Post-FNA
CORE NEEDLE BIOPSY - CNB
• First described in 1982 by Perlinggren,
Sweden.
• Cutting needle fits in automated springloaded biopsy gun.
• Most accurate results with 14-gauge.
• Needle consists of inner tissue sampling
needle and outer cutting needle.
CORE NEEDLE BIOPSY - CNB
• 17mm tissue slot is located
4mm from end of inner
needle.
• Prebiopsy position , outer
needle covers inner needle.
short &
• Inner needle isThrow
advanced
forward, moving
slot
longtissue
(15/22mm)
within lesion.
• Outer needle slides over inner
needle, cutting a tissue
sample and securing it in slot.
Throw short &
long (15/22mm)
Trigger
Safety device
DISPOSABLE SEMIAUTOMATIC
BIOPSY NEEDLE
Stylet
Hub
Main part
Plunger
CNB - TECHNIQUE
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Patient in supine position.
Skin disinfection with alcohol or polydine.
Probe is disinfected with alcohol
Probe may be covered with sterile plastic sheath.
Sterile gel or alcohol should be used as coupling
agent.
• Local anesthesia.
• Skin incision, 2-3mm.
Needle placement with ultrasound
guidance - TECHNIQUE
• Transducer is placed
on patient’s skin so
both lesion and path of
needle are visible.
• Needle position is
documented with
longitudinal and
transverse scans.
Ultrasound guidance-Technique
Core Sampling
• 5 or more cores require reinsertion and
repositioning of needle.
• Visual inspection of samples.
CNB - TECHNIQUE
• Specimen placed in
formalin and sent for
histological diagnosis.
• 5-10 minutes
compression.
• Bandaging applied.
Advantages of Core Biopsy
• 96%-100% concordance between CNB and
surgery.
• No insufficient samples.
• Histological tissue diagnosis allows
differentiation of IDC from DCIS.
Disadvantages of Core Biopsy
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Multiple insertions and removal of the needle.
Later samples composed predominantly of blood.
May be nondiagnostic in small lesions
Retrieval of calcifications is difficult
Incomplete characterization of ADH
and DCIS
COMPLICATIONS AND RISKS
• Fainting.
• Hematoma 6-30%.
• Seeding of needle track by malignant cells.
Vacuum-Assisted Mammotome®
 Histology
 Large, contiguous tissue samples
 Less precise targeting required
because of vacuum assistance
 Ability to place a marker at the biopsy site
 Sutureless
 Single insertion
Vacuum-Assisted Biopsy:
Advantages
• Suction of the blood out of the biopsy cavity.
• Only one insertion of the needle.
• Larger specimen- 11G or 8G.
Vacuum-Assisted Biopsy:
Advantages
 Significant improvement in the retrieval of calcifications
Vaccum assisted biopsy:
Advantages
• More accurate characterization of ADH and DCIS,
DCIS and IDC.
• Reduction in the underestimation of ADH and DCIS
comparatively to core biopsy.
FROZEN SECTION
EXAMINATION DURING SURGERY
WITHIN 15-20 MINUTES
FROZEN SECTION REPORT WILL BE USED
AS A BASIS FOR THE SURGEON TO MAKE A
DECISION DURING SURGERY :
DIAGNOSIS
SENTINEL NODE
MARGIN STATUS
FROZEN SECTION
IF FROZEN SECTION DIAGNOSIS
IS
BENIGN
STOP
RADICAL
SURGERY
MALIGNANT
MORE
SURGERY
HISTOPATHOLOGY
PARAFIN SECTION
DEFINITIVE DIAGNOSIS
– SUBTYPE
– HISTOLOGIC GRADE
– INVASION :
SKIN, PERITUMORAL ANGIOLYMPHATIC
VESSEL, MUSCLE, LYMPH NODE
MARGIN STATUS
TNM
HISTOPATHOLOGY
GROSS
PARAFIN BLOCK
ENABLE FOR THIN SECTIONING
• CYTOLOGY
– CELL ANALYSIS
• HISTOPATHOLOGY
– CELL & TISSUE
ARCHITECTURE
– SMEAR
– BIOPSY
– FLUID
– FNAB
• INCISIONAL
• EXCISIONAL
– OPERATION
SPECIAL TECHNIQUES
• HISTOCHEMISTRY
– DETECT THE CHEMICAL SUBSTANCES IN THE
CELL/TISSUE (INSITU)
• IMMUNOHISTOCHEMISTRY
– DETECT ANTIGEN IN THE CELL/TISSUE (IN SITU)
• IN SITU HYBRIDIZATION
– DETECT DNA IN THE CELL.
SPECIAL TECHNIQUES
AIMS :
PROBLEMATIC CASES (DIAGNOSTIC)
BIOLOGIC BEHAVIOUR (PROGNOSIS)
TREATMENT RESPONS / OPTION
CUT OFF VALUE : 10%
ER/PR POSITIF
ER/PR NEGATIF
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A 46 year old man had liver tumor 10 cm which was suspected
malignant from USG examination . The doctor also found ascites in his
abdomen and nodul at his right lung, sputum examination showed class
V. The doctor want to know whether the liver tumor is primary tumor or
metastatic from lung tumor.
What kind of examination does the doctor need to know preoperative
diagnosis for the liver tumor ?
a.Histopathology from open biopsy.
b.FNAB liver tumor with USG guiding.
c.Frozen section.
d.Histopathology from lobectomy of the liver.
e.MRI ( Magnetic Resonance Imaging ).
Shaimaa kamal
THANK YOU
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