Practical Cytopathology: A Diagnostic Approach

Fernando Schmitt^*
*Correspondence: Fernando Schmitt, Department of Pathology, University of Porto, Porto, Portugal, Email:

Keywords

Cellular diagnosis • Cancer diagnosis • Autoimmune disorders • Clinical practise

Introduction

In the field of pathology, cytopathology holds a crucial position in the diagnosis of various diseases. It involves the examination of individual cells to detect abnormalities and provide accurate diagnoses. With the advent of advanced laboratory techniques and the development of innovative technologies, cytopathology has become an integral part of modern medicine. This article aims to provide a comprehensive overview of cytopathology, including its techniques, applications, and significance in clinical practice. Cytopathology is a branch of pathology that focuses on the study of individual cells to diagnose diseases. It involves the collection of cellular material through non-invasive procedures, such as fine-needle aspiration, brushings, or exfoliation techniques. The collected cells are then examined under a microscope to assess their structure, function, and any pathological changes that may indicate the presence of a disease [1].

Fine-needle aspiration is one of the most common techniques used in cytopathology. It involves the insertion of a thin needle into a suspicious lesion or mass to obtain cellular material for examination. FNA is widely used to diagnose various conditions, including thyroid nodules, breast masses, and lymph nodes. The collected cells are stained and examined under a microscope to identify any abnormalities. Brushings and washings are techniques employed to collect cells from body cavities, such as the respiratory tract, gastrointestinal tract, and urinary tract. A brush or a swab is used to collect cellular material from the mucosal surfaces, and the collected cells are then processed and examined under a microscope. These techniques are valuable in diagnosing conditions like lung cancer, gastrointestinal malignancies, and urinary tract infections. Liquid-based cytology is a technique that improves the quality and efficiency of cell collection and processing. In this method, the collected cells are suspended in a liquid medium, which is then processed to create a thin layer of cells on a slide. This technique reduces the presence of obscuring factors, such as blood or mucus, and allows for better visualization and analysis of cellular morphology. Liquid-based cytology is commonly used in cervical cancer screening, where it has replaced conventional Pap smear tests in many settings [2].

Cytopathology plays a crucial role in the diagnosis of cancer. By examining cellular samples, cytopathologists can identify malignant cells, determine the type and stage of cancer, and guide treatment decisions. The use of cytopathology in cancer diagnosis extends to various organs, including the breast, lung, prostate, thyroid, and cervix. Early detection of cancer through cytopathology increases the chances of successful treatment and improves patient outcomes. Cytopathology also aids in the diagnosis of infectious diseases caused by bacteria, viruses, fungi, and parasites. By examining cellular samples, cytopathologists can identify the causative agents and assess the inflammatory response in affected tissues. For example, the examination of sputum samples can help diagnose tuberculosis, while the analysis of cerebrospinal fluid can detect the presence of viral or bacterial meningitis. The examination of cellular samples in cytopathology can provide valuable insights into autoimmune disorders. By assessing cellular morphology and identifying specific cellular markers, cytopathologists can differentiate between normal and abnormal immune responses. This information is essential in diagnosing conditions such as systemic lupus erythematosus, rheumatoid arthritis, and vasculitis [3].

Literature Review

Cytopathology allows for the early detection of diseases, including cancer. By identifying cellular abnormalities at an early stage, healthcare professionals can initiate appropriate treatments promptly. Early diagnosis significantly improves patient outcomes and increases the chances of successful treatment. Most cytopathology techniques are minimally invasive and can be performed on an outpatient basis. This reduces patient discomfort, eliminates the need for surgical interventions, and facilitates rapid recovery. Additionally, the non-invasive nature of cytopathology allows for repeated sampling, enabling monitoring of disease progression and treatment response over time. Cytopathology plays a vital role in assessing the risk of developing certain diseases. For example, cervical cytology (Pap smear) is routinely used to screen for precancerous changes and early-stage cervical cancer. The identification of abnormal cells in the cervix allows for appropriate surveillance and preventive measures, reducing the incidence and mortality rates associated with cervical cancer [4].

Advancements in cytopathology techniques, such as molecular analysis of cellular samples, have facilitated personalized medicine approaches. By analysing specific genetic or molecular alterations within cells, cytopathologists can tailor treatment strategies to individual patients. This precision medicine approach ensures targeted therapies and better patient outcomes. Obtaining adequate cellular material for analysis is crucial in cytopathology. Insufficient sampling or the presence of obscuring factors can affect the accuracy of the diagnosis. Continuous efforts are being made to optimize sampling techniques and improve the quality of cellular material obtained. Although cytopathology is highly accurate, there can be challenges in interpreting cellular morphology, especially in cases where atypical or rare presentations are encountered. The integration of molecular techniques, such as fluorescence in situ hybridization (FISH) and next-generation sequencing (NGS), can enhance diagnostic accuracy and provide additional information to guide treatment decisions [5,6].

Discussion

The field of cytopathology is witnessing advancements in automation and the use of artificial intelligence (AI). Automated slide scanners and AI algorithms can aid in the analysis of cellular samples, improving efficiency and reducing human error. These technologies have the potential to revolutionize cytopathology and enhance diagnostic capabilities further. Cytopathology plays a pivotal role in the diagnosis of various diseases, including cancer, infections, and autoimmune disorders. By examining individual cells, cytopathologists can provide accurate and timely diagnoses, enabling appropriate treatment strategies. The field of cytopathology continues to evolve with advancements in technology and techniques, allowing for more precise and personalized approaches. The future of cytopathology holds promise in improving diagnostic accuracy, expanding the range of diseases that can be diagnosed, and ultimately contributing to better patient outcomes.

Conclusion

Cytopathology is an essential discipline within the field of pathology that plays a crucial role in the diagnosis of various diseases. Through the examination of individual cells, cytopathologists can provide accurate and timely diagnoses, enabling appropriate treatment strategies. The techniques used in cytopathology, such as fine-needle aspiration, brushings and washings, and liquid-based cytology, allow for the collection and analysis of cellular material from different parts of the body. The applications of cytopathology are vast and encompass various areas of medicine. It is instrumental in the diagnosis of cancer, enabling the identification of malignant cells, determination of cancer type and stage, and guiding treatment decisions. Cytopathology also aids in the diagnosis of infectious diseases by identifying causative agents and assessing the inflammatory response in affected tissues. Additionally, it plays a vital role in the diagnosis of autoimmune disorders, distinguishing between normal and abnormal immune responses.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Schmitt, Fernando C., Lukas Bubendorf, Sule Canberk and Ashish Chandra, et al."The World Health Organization Reporting System for Lung Cytopathology."Acta Cytologica67 (2023): 80-91.

Google Scholar, Crossref, Indexed at

2. Layfield, Lester J., Zubair Baloch, Tarik Elsheikh and Leslie Litzky, et al. "Standardized terminology and nomenclature for respiratory cytology: The papanicolaou society of cytopathology guidelines."Diagn Cytopathol 44 (2016): 399-409.

Google Scholar, Crossref, Indexed at

3. Hiroshima, Kenzo, Akihiko Yoshizawa, Akemi Takenaka and Reiji Haba, et al. "Cytology reporting system for lung cancer from the Japan Lung Cancer Society and Japanese Society of Clinical Cytology: An interobserver reproducibility study and risk of malignancy evaluation on cytology specimens."Acta Cytol 64 (2020): 452-462.

Google Scholar, Crossref, Indexed at

4. Canberk, Sule, and Marianne Engels. "Cytology samples and molecular biomarker testing in lung cancer advantages and challenges."Virchows Arch 478 (2021): 45-57.

Google Scholar, Crossref, Indexed at

5. MacMahon, Heber, David P. Naidich, Jin Mo Goo and Kyung Soo Lee, et al. "Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017."Radiology284 (2017): 228-243.

Google Scholar, Crossref, Indexed at

6. Gopinath, Balasubramanian, and Natesan Shanthi. "Computer-aided diagnosis system for classifying benign and malignant thyroid nodules in multi-stained FNAB cytological images." Australas Phys Eng Sci Med 36 (2013): 219-230.

Google Scholar, Crossref, Indexed at