thin prep morphology (cervical cytology)

Hologic Proprietary © 2012

ThinPrep® Morphology


ThinPrep® MorphologyNormal Cytology

Hologic Proprietary © 2012Hologic Proprietary © 2012

Cytotechnologist & Pathologist Training

• Microscopic Sessions

• Evaluation Modules

• Competency Assessment Modules


ThinPrep® Process

Copyright © 2012 Hologic, All rights reserved.Copyright © 2012 Hologic, All rights reserved.


ThinPrep® Characteristics

• Liquid Based Fixation

• Cell Size

• Smear Pattern

• Specimen Background

• Similarities > Differences



Liquid Based Fixation• Enhanced Cytoplasmic Detail

• Enhanced Nuclear Detail

• Variability in Nuclear Staining



Cell Size• “Proportionately” Smaller

• Single Cells More Prominent

• Cells Round-Up in Solution



Smear Pattern• Mechanical Artifact Eliminated

• Cellular Material Not Pulled Out in Mucus

• Tissue Architecture Maintained



Specimen Background• Cleaner Background• Cellular Debris More Clumped• “Clues” in the Background• “RATTY” Background:

Infectious agent, Cytolysis, Blood, Disease



Screening Technique• Systematic

• Slow

• Slight Overlap



Guidelines for Estimating Cellularity¹

FN20 eyepiece/10x obj.




THIN PREP DIAM MM

20

Area(mm²)

314.2

# Fields @ FN20 10X

100

# Cells/Field for 5K Total

50.0

# Fields @ FN20 40X

1600


3.1

# Fields @ FN22 10X

82.6


60.5

# Fields @ FN22 40X

1322


3.8

FN = Field Number


10xFN 22

10xFN 22



FN 22

10xFN 20



FN 2210 x



Endocervical Cells

Honeycomb / Palisading Arrangements Maintained

Round-Up in Solution More Tightly Packed Groups Smaller Cell Groups/Single Cells Nuclei “Busier”


Squamous Metaplasia

Sheets/Cobblestone Arrangements Dense, Homogeneous Cytoplasm Cells Often Single Cells Appear Smaller & Rounder


Endometrial Cells

Tight 3D Cell Clusters Loose Cell Clusters with

Vacuolated Cytoplasm Single Cells More Prominent Nuclei “Busier” Menstrual Blood Lysed


Atrophy

• Well Preserved Sheets of Parabasal Cells

• Endocervical Cells May Be Distinguished

• Bare Nuclei “Reduced”• “Atrophic Vaginitis” Pattern More

Clumped


Trichomonas vaginalis

Frequently Smaller

Internal Structure Readily Identifiable

Classic “Trich” Pattern Maintained


Candida spp.

• Classic Cell Clumping

• Reactive Squamous Cells with Engulfed WBC’s

• Distinguish Mucus Strands from Pseudohyphae


40 x40 x



Actinomyces

• Organized Clusters of Branching Filamentous Bacteria

• Associated Blue Staining Bacteria


Herpes Simplex Virus

Ground Glass Nuclei

Multinucleation with Nuclear Molding

Classic Eosinophilic Nuclear Inclusions


Reactive Changes:

• Slight Nuclear Enlargement• (2X Intermediate Cell Nucleus)

• Perinuclear Halos• Cytoplasmic Vacuolization & • Bi-chromasia• Clumped WBC’s• Enhanced Cellular Detail

Inflammation


Reactive Changes:

• Sheets of Cells with Engulfed WBC’s

• Sheets of Cells More Rounded

• Greater Depth-of-Focus

• Sheets of Cells Less “Pulled Out”

Repair


ThinPrep® Morphology

Epithelial Cell Abnormalities



• Liquid Based Fixation

• Cell Size

• Smear Pattern

• Specimen Background

• Similarities > Differences


Epithelial Cell Abnormalities - Squamous

ASC-US• Occur in Sheets or Singly• Nuclei 2 ½ - 3X Intermediate Nucleus• Uniform Chromatin Distribution• Decrease in Preparation Artifact



LSIL• Increased Nuclear Detail• Irregular Nuclear Membrane• Nuclei 3 - 4X Intermediate Nucleus• Sharp, Irregular Cytoplasmic

Cavitation (HPV Effect)


40 x40 x




HSIL• Sheets & Syncytial Groupings

Maintained• Cytoplasmic Borders More Distinct• Isolated, Immature Cell Forms;

Function as “Clue”• Nuclear Membrane Irregularities


k




Squamous Cell Carcinoma• Tumor Diathesis Maintained• Distinctive Necrotic Background

Pattern • Greater Depth-of-Focus to Cell

Groups• Prominent Chromatin Clearing• Nucleoli More Prominent


Epithelial Cell Abnormalities - Glandular

Atypical – Endocervical cells (NOS)– Endometrial cells (NOS)– Glandular cells (NOS)

Atypical– Endocervical cells, favor neoplastic– Glandular cells, favor neoplastic

Endocervical adenocarcinoma in situ



Endocervical adenocarcinoma in situ (AIS)• Abnormal Architectural Patterns Maintained• Nuclear Crowding With Hyperchromasia• Pseudostratification, “Feathering” Identified• Rosettes & Strips• Nucleoli Often Present



Adenocarcinoma• 3D Cell Clusters Maintained• Well Preserved Nuclear Features• Tumor Diathesis May Be Noted


A B



Trademark Statement

CytoLyt, Hologic, PreservCyt, ThinPrep, and UroCyte are registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States. CytoLyt, Hologic, PreservCyt, ThinPrep, UroCyte and associated logos are trademarks of Hologic, Inc. and/or its subsidiaries in other countries.


Bibliography

[1] Solomon, Diane, and Ritu Nayar, eds. The Bethesda System for Reporting Cervical Cytology. 2nd edition, 2004.

ADS-00690 Rev. 001ADS-00690 Rev. 001

thin prep morphology (cervical cytology)

Health & Medicine