Current Use of LBC in Non-Gynae Cytology

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Current Use of LBC in Non-Gynae Cytology

• Christine Payne
• Thames Valley Cytology Society
• March 2005

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Liquid Based Cytology

• What is it?
• Nothing new in cytology
• eg FNA into saline
• urine into alcohol fixative
• This has facilitated maximising the sample and
  partial fixation

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Liquid Based Cytology

• Why is it different?
• At present there are two major commercial
  companies offering LBC for use in the NHSCSP.
• Both procedures can also be used for preparation
  of non-gynae.

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Advantages

• The advantages are
• Maximising the cellularity of the sample
• Removal of excess blood
• Excellent fixation
• 1 representative slide
• Extra material available for further testing

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Disadvantages

• Cost is the major factor.
• Hardware may become available through the
  Cervical Screening Programme
• The cost must be weighed against the benefits for
  medical and BMS time
• Also the reduction of inadequate or non
  diagnostic samples.
• Personal preference

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Samples to Process

• Exfoliative samples
• Urines
• Sputa
• Bronchial washings
• Bronchial brushings
• Body fluids

• Aspiration samples
• FNA Head and neck
• FNA Lymph nodes
• FNA Lung
• FNA Liver
• FNA Breast

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Thyroid FNA

• Need special mention
• Most other samples can be diagnosed purely on the
  ThinPrep sample, but colloid is difficult to
  evaluate ( ? The same in Surepath), and LBC only
  is not recommended in our laboratory.

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Normal female urine
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Urine high grade TCC
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Urine high grade TCC - HP
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(No Transcript)
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Sputum squamous carcinoma
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Bronchial Washings
Bronchial Washings
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Bronchial brushings and washings
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Bronchial washings
Bronchial washings
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Bronchial brushings
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Bronchial brushings
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Squamous cancer in bronchial brush
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Poorly differentiated squamous carcinoma
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Bronchial brush small cell x 400
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Bronchial Brushings with Small Cell
Undifferentiated Carcinoma
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Bronchial Brush Adenocarcinoma
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Bronchial Brush
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Bronchial Brush
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Leiomyosarcoma
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Transbronchial FNA Small Cell Carcinoma
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LBC in Aspiration Cytology

• ENT routinely use LBC only with the exception of
  Thyroid Aspirates
• Other FNA sites usually both air dried and LBC
  are taken

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Ductal Carcinoma Breast
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Lymph Node Metastatic Melanoma
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Metastatic Melanoma
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Neck Node Mets from the Lung
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Pleomorphic Adenoma
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Pleomorphic Adenoma
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? Branchial Cyst
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Case Study

• An 82 year old man presented to ENT OPD with a
  large skin lesion behind the ear.
• Biopsy and FNA were performed on the lesion and
  an adjacent lymph node
• LBC preps made from the PreservCyt solution using
  T2000, and stained using Papanicolaou technique.

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Lymph Node (1)
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Washing from Lymph Node (2)
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Diagnostic Dilemma

• The material from the lymph node was difficult to
  evaluate with certainty, as the population of
  small hyperchromatic cells could have been
  lymphoid or small cell carcinoma.
• The aspirate from the lesion was helpful in
  forming the provisional diagnosis

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Washing from Lesion (1)
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Diagnostic Confidence

• The fact that the same cells were present in the
  lesion as in the lymph node added confidence to
  the probable diagnosis of small cell
  (neuroendocrine) carcinoma.
• The biopsy result was correlated with the
  cytology

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Histology of Biopsy
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Small Cell Neuroendocrine Tumour

• The differential diagnosis lies between a
  metastatic small cell carcinoma, most likely from
  lung and a primary Merkel Cell Tumour of the
  dermis.
• As the chest x-ray is reported clear, then a
  Merkel Cell tumour is probable.

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Merkel Cell Tumour

• Merkel cell carcinoma is a rare tumour locally
  aggressive and frequently metastatic. Classically
  difficult to distinguish from metastatic
  bronchogenic small cell carcinoma and
  non-Hodgkins Lymphoma.
• Cells may be less pleomorphic with uniform
  rounded rather than oat shaped nuclei, although
  oat like type can occur.

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Epilogue

• Double entry on the computer system.
• FNA of the Lymph Node one week previous.
• Reported as probably reactive

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FNA (1)
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Images for this presentation were sourced at the
Royal Gwent Hospital, Wales