Every year, nearly 87,000 cytopathology cases are handled within Pathology-DNA. These include 64,000 cervical smears, of which 43,000 smears are examined within the Population-based screening program for Cervical Cancer. The other cases consist of exfoliative cytology such as brushings or washings, or fine needle aspirations. This includes urine, pleural fluid, ascites, lung material, fine needle aspirations obtained from lymph node, thyroid gland or breast, among others. In some cases additional research is needed to give a more detailed answer to the clinicians’ questions.
Cytopathology, or the study of normal and abnormal cells, focuses mostly on single cells that are obtained from tissues or organs spontaneously, or by fine needle aspiration, brushings or washings. However, because of limited interpretability of the interrelationship between cells, not all questions can be answered by these kind of studies. In particular, differences in shape and size of the nucleus and/or cytoplasm of single cells are examined. Sometimes these cells still form smaller or larger distinguishable groups, which allows for studying their arrangement. For cytopathology, cells are smeared on a glass slide or spotted on it with the aid of a cytocentrifuge. Subsequently, the cell preparations are stained, after they have been dried on ambient air or fixed in acetone/methanol, for example. These stained slides are first examined by cytopathologic technicians, who have specialized in recognizing normal and abnormal cells. Afterwards, they report their findings to the cytopathologist. Together with the cytopathologist abnormal cells can be further examined to obtain the correct diagnosis. Slides for ancillary studies and cell block preparations are made as needed. Frequently, these studies provide an answer to diagnostic questions, although further histopathologic investigations may be needed when cytopathology alone is insufficient.
Uniform working method
- When it comes to gynecological specimens, all three laboratories of Pathology-DNA use the so-called thin layer method. By means of the same equipment (ThinPrep®, Hologic) Pathology-DNA aims for a uniform workingmethod;
- Specialized studies such as high risk HPV determinations are centralized at our DNA-location at the Jeroen Bosch hospital in Den Bosch;
- Standardized protocols are unanimously agreed on and executed uniformily at all three locations of Pathology-DNA
The ThinPrep Imaging-system consists of the T3000 and T5000 processors and T5000 auto charger. These systems are capable of automatically scanning cells and groups of cells based on advanced computer technology. This technique enables the system to process the samples and prepare single cell layers on glass slides. After these preparations, the slides are stained and examined. These automated processes significantly reduce the workload for cytopathology technicians and also reduce the chance of errors. Moreover, a considerable reduction of the Referral-to-Diagnosis time is achieved. By using the same equipment in all three laboratories, a uniform procedure is realised for analysis of cervical smears.