Cancer Detection and Prevention
The primary purpose of cytology is the examination of cells for the detection of cancer and pre-cancerous lesions. Many infectious organisms can also be detected by cytology, including Candida, Pneumocystis carinii, Trichomonas, Herpes Simplex Virus (HSV), and Human Papilloma Virus (HPV).

Collection of a cytology specimen is a relatively non-invasive procedure and can allow surgery to be avoided. However, when a cancerous or pre-cancerous lesion is detected, surgical biopsy is often performed as a follow-up to confirm the diagnosis. In the 1930s, cervical cancer was the leading cause of death due to cancer in women. Thanks largely to the Pap smear incidence has decreased steadily over the past several decades. Pre-invasive lesions of the cervix are now detected far more frequently than invasive cancer, and survival of patients treated for pre-invasive lesions is nearly 100%. See: American Cancer Society Facts & Figures.

Specimens
Our cytology department processes 95,000 gynecologic pap smears and 3,300 non-gyn specimens annually. That's about 365 paps and 13 non-gyn specimens daily. Non-gyn specimens include all types of cytology specimens other than pap smears, such as fine needle aspirations (e.g. thyroid, breast, lymph node), body fluids (e.g. pleural, peritoneal, pericardial), respiratory tract specimens (e.g. bronchial washings, brushings, sputums), spinal fluids, and urinary and gastrointestinal tract specimens.

Collection and Processing
In order to properly examine and interpret the cells, glass microscope slides are prepared with a uniform layer of well-preserved cells. The cells must be instantly "fixed" by immersion in alcohol or spray-fixed once they are spread on a slide. (One exception is that un-fixed direct smears can be useful for fine needle aspirations of the thyroid and lymph node.) Depending on the specimen type, it can either be sent to the lab fresh (e.g. body fluids and urine), or in a fixative solution (e.g. paps and fine needle aspirates (FNAs)), or as a direct smear fixed slide (e.g. paps and FNAs).

Specimen Collection Manual
To prepare slides from a specimen, the cyto-prep technician centrifuges (blending first if mucoid), and then prepares either direct smears or cytospins from the cell pellet. If there is a large cell pellet, a cell block can be prepared and processed similar to a histology specimen. All routine cytology slides are stained with the Papanicolaou stain. (A few special stains are used in some circumstances.)

Thin Prep®PapTest™
In 2001, our lab processed over 8,000 paps by a new liquid-based technology. Clinicians prepare conventional "pap smears" by smearing the cervical cell sample directly on a glass slide and then spray-fixing the cells. With the new liquid-based technology, the clinician instead places the cervical cell sample directly into a vial of fixative solution, and then a uniform layer of cells is created in the lab with a Thin Prep processing machine. This allows for a more uniform layer of cells, better preservation, with less obscuring by blood and inflammation. The other benefit to this new technology is that HPV and other ancillary testing can be performed from the vial of remaining specimen. See: HPV Testing.

Diagnostic Interpretation
A cytotechnologist screens all cytology slides to make an assessment of adequacy and detect any abnormalities or infection. A diagnostic interpretation is made, and then a pathologist reviews all non-gyns and abnormal paps.

The Bethesda System is a standardized terminology used for diagnostic interpretation of pap smears. (See: Bethesda System) While the Pap smear is an extremely beneficial test for the detection of cancer and pre-cancerous lesions of the cervix, false-positives and false-negatives can occur. Annual pap smears, correlation with clinical information, and biopsy confirmation of lesions are recommended. For management of patients with abnormal pap results, the American Society for Colposcopy and Cervical Pathology (ASCCP) established comprehensive, evidence-based consensus guidelines for clinicians.

Quality
As always, our cytology lab strives for the highest quality possible, and this reputation for quality is well established in the community. Here are some of the many quality services we provide for clinicians: