Practical Cytopathology A Diagnostic Approach to Fine Needle Aspiration Biopsy 1st Edition PDF
94.33 MB PDF
This book is a result of many years of observation and analysis and reporting of fine needle aspiration biopsy (FNAB) smears by the contributing authors. As we trained and gained experience as cytopathologists and taught cytology, we examined, re-examined, and photographed cases, reviewing them with colleagues and trainees. We began to recognize specific patterns in the smear slides that defined particular inflammatory processes or tumors in a particular organ or a limited range of organ systems. These low-power patterns depend not only on the type of cells present but also on the types of fragments of epithelial and stromal tissue and on the background “environment.” This “mind’s eye” approach to pattern recognition is similar to the intellectual processes that a child develops when learning to distinguish between silhouettes of various types of mammals or an ornithologist uses when bird watching.
In this book, we introduce a practical step-by-step algorithmic approach to the diagnosis of lesions subjected to FNAB. This involves recognizing a pattern under low power and using high power to confirm the diagnosis suggested by the pattern. If the high-power features reinforce the low-power pattern impression, a specific diagnosis is reached, but if the high-power features are discrepant, the pattern is reassessed at low power and the process repeated until a diagnosis or perhaps a differential diagnosis is synthesized. Each low-power pattern may be pathognomonic for a particular lesion, or it may raise a differential diagnosis for a subset of lesions that shares a pattern in a particular organ, and can be further subdivided based on unique specific cytomorphologic criteria. Where needed, core or surgical biopsy and ancillary tests can be used based on the FNAB triage. This practical diagnostic approach is the distillation and then step-by-step presentation of the process by which an experienced cytopathologist or cytotechnologist makes a very rapid diagnosis of a lesion under low power.
Each low-power smear pattern is composed of specific key elements as defined by the various authors of the various chapters in this book. To illustrate these, we composed sketches, which embody the key features and provide an immediate “mind’s eye” rendition of the various smear patterns, and one of us (MZ) then converted these into cartoons.
We envision that this book will serve as a practical “field guide” for cytotechnologists and cytopathologists based on pattern recognition, particularly when they are studying cytology or extending their reporting into new organ systems. It is not meant necessarily to supplant the huge library of books previously published on the subject of FNAB that use a more encyclopedic approach, but the authors believe it will serve as a first comprehensive resource when approaching a FNAB case.
We encountered many and sometimes common influences during our training in cytopathology, as we developed the teaching and diagnostic approach we use on a day-to-day basis that is detailed in this textbook. We would like to acknowledge and thank the many who have taught us cytopathology through pathology trainee programs, tutorials, and writings, especially Torsten Lowhagen and his colleagues at the Karolinska Hospital in Stockholm, Britt-Marie Ljung and Theodore Miller in San Francisco, and Svante Orell in Adelaide, Australia. Also we would like to thank our co-authors for all their efforts and the Elsevier editorial staff for their continued support in finishing this textbook.
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