Cytology: Doc, Just tell me, “Is This Lump Cancer or Not?”

Cytology in History

Much information can be gathered by observing the cell and/or its surroundings under a light microscope.

More than 170 years ago, scientists/pathologists recognized that accurate diagnosis of cancer could be determined by simply observing the structure of the cell under a light microscope.

A cytological diagnosis can be simple to perform, saves patients hundreds of dollars ( essentially pennies on a dollar as compared to tissue diagnosis), and typically is less painful than an open tissue biopsy; surely less scarring and debilitating. More importantly, Cytology creates practicality for mobile pathology and rapid diagnosis.  In fact, the only materials needed for a pathologist to make a definitive cytological diagnosis are a slide (generally less than $1), non-toxic stain/fixative (generally less than $5), and a light microscope.  So this gives you an idea just how inexpensive cytological diagnostic testing can be. For example, when you factor in the above expense and the professional services, the fee for cytological diagnosis could be as little as $50 dollars, depending on the type of cytological evaluation done.  Not bad, eh?

Dr. Gates demonstrates the simplicity and low expense to study cells for an accurate diagnosis

The Immediate Use of Cytology? To determine if a growth is cancerous or not (benign or reactive). And, it should be the mainstay in diagnostic pathology.  This is what I use in my practice to prioritize  further diagnostic study on cytological samples from my patients when assessing cancer diagnosis through Fine Needle Aspiration (FNA), or simple body fluid smears/touch imprints, as with pap smear, or blood smear for example.  And, I am literally able to save them frustration, anxiety, and expense, by giving my patient a cellular diagnosis on the spot.

Here are the criteria that are typically helpful when assessing cellular disease:

1) Reactive versus Neoplastic: Reactive implies benign appearing cells, i.e. having usual preservation of the cell’s normal shape and size, mixed with inflammatory cells, or showing degenerative changes with or without inflammatory cells.  Neoplastic implies loss of cellular maturation, as well as an abnormal growth pattern that is different from normal mature cells of the same origin.

2) Neoplasia: a) Benign Growth; or  b) Cancerous Growth

3) Benign Growth:

a) Low cellularity (low number of cells); tightly cohesive cells.

b) Maintain Cellular Polarity (i.e. usual structure of nuclear size, shape, and position in the cell with cytoplasm)

c) Demonstrate minimal maturation arrest.

4)  Cancerous Growth (May Not Apply to Hematological Cancers):

a) High Cellularity (increased number of cells); loosely cohesive cells,usually in various sized clusters or singly.

b) Loss of cellular polarity (i.e, cell nuclear size, shape, and position vary from one cell to the other with respect to cytoplasm.

c) Pleomorphism/Polymorphism: This means that cells of same origin, i.e. epithelial, or stromal, or neural, etc, have variation in nuclear membrane irregularity, often with the size of the nucleus being enlarged and distorting the cell cytosol/cytoplasm and cell membrane.

d) Proliferative index: Generally, normal cells are in resting phase of growth; so to see many cells, and/or evidence of cellular division is a sign of rapid, abnormal cell proliferation, i.e. mitotic index.

e) Cell growing within cell.  Normal cells (other than placental cells or certain types of hormonal cells and the likes) do not grow within other cells, ie. cup and saucer, cell nuclear fusion, etc.

f) Marked cell-maturation arrest (a cancer cell may not resemble the original cell, having features of embryonic cell, or undifferentiated cell)

5. Hematological Cancerous Growth:

a) Monoclonal, which means a proliferation of one cell type, i.e. myeloblast or lymphoblast, etc, which often times requires special studies as indicated below

b) Lack of appropriate maturation sequence of individual hematological cell when compared to other cells of same origin, often expressing genetic or chromosomal abnormality as in dysplastic changes.

Special cytochemistries, or cytogenetics or other molecular studies can now be performed on cellular samples to objectively and accurately confirm cellular abnormality/diagnosis, as needed.  This also essentially eliminates subjective interpretation of cytological results.

Cellular Images of Diagnostic Features Can be Provided Via DIGITAL DIAGNOSTIC REPORTS (for transparency and Evidence for Diagnosis).

We make every attempt to save our patients time and money by simply doing cellular procedures over open tissue biopsy.  Open tissue biopsy tends to be more painful, debilitating, risky and yes, “expensive.”

Thanks for reading.

Jackson L. Gates, MD, Medical Diagnostic Choices, MDC-Atlanta