Lab Pathogical Testing
-Cytology:
* Sputum, Urine, Nipple Discharge
-Papanicolaou Smear:
* And Liquid Based preps
-Biopsy:
* Cervical,
... [Show More] Endometrial, Skin
-Fine Needle Aspiration:
* Breast and Thyroid
-Kidney Stone Analysis:
* Composition
-Gallstone Analysis:
* Composition
Sputum Cytology
-Sample: First morning sample is best.
* Refrigerated - NO Preservative
-Who needs it?
* Most useful in patients with abnormal chest X-ray, productive cough and negative bronchoscopy.
* Bronchoscopy & lung biopsy used more often now.
-Clinical Significance:
* Trachea, bronchus and lung malignancies
* Benign cellular changes due to:
+ infection, toxin exposure, viral pneumonitis.
* Eosinophils are often present in sputum
from asthmatic patients
-Interfering Factors:
* Failure to adequately rinse mouth prior to collection
Insufficient sample QNS
* Saliva instead of sputum
Urine Cytology
Indications:
-Cancer & inflammatory diseases of kidney, ureters, bladder, or urethra.
-Viral diseases: CMV
-Useful for screening populations at risk for bladder cancer > smokers, aniline dye workers, patients tx'd for GU cancers.
Specimen Collection: Urologist
-Usually collected by cytoscopy
-Can use voided CCMS urine
-Sample refrigerated > NO Preservative
Clinical Significance:
-GU Inflamm:
* epithelial hyperplasia, atypical cells, RBCs, WBCs.
-Indication of viral disease:
* CMV (cytomegalic cell inclusions)
* measles (cellular inclusion bodies)
-Celiac Disease increases the risk for Chronic Bladder infections which can progress to interstitial cystitis
Nipple Discharge
Normal only during lactation, although pregnancy, perimenopause, and oral contraceptives may cause "normal" changes.
Indications:
-Nipple d/c occuring at other than normal times, especially unilateral
-About 3% of breast cancers and 10% of benign breast lesions are associated with abnormal nipple d/c
-Generally limited to patients without palpable breast masses or other evidence of possible breast cancer
Procedure:
-Identify side, nipple washed and pat dry
-Obtain discharge with stripping motion and spread onto glass slide
-Fixative applied to slide
Clinical Significance:
-Aids in identification of benign conditions:
* mastitis (subareolar abcess)
* intraductal papilloma
-Aids in identification of malignant conditions: * intraductal cancer
* intracystic infiltrating cancer
Interfering Factors:
-Drugs that alter hormone balance (OCs, fertility meds, testosterone)
Pap Smear
Premise:
-Collection of cervical & endometrial cells
shed in cervical & vaginal secretions
-used to screen for presence of normal and abnormal cells.
Optimal Time:
-Collect during the week following cessation of menses, in the Proliferative phase, i.e. two weeks after the start of menses, day 14.
Purpose:
-Identify cellular changes that place patients at risk for cervical cancer.
-50 million US women get annual Pap:
-3.5 million (7%) have an abnormality requiring additional follow up evaluation.
-A Pap smear is only moderately sensitive but highly specific test that can have small false-positive rates when properly performed.
Hematoxylin and OG/EA Reagents:
-used to stain cells
-Nucleus: Hematoxylin stains nucleus blue
-Cytoplasm > OG/EA > Orange G dye and EA Eosin & Fast Green
Pap Smear
-Indications
Indications:
-You need to know for this class
-Women at the onset of sexual activity,
or greater than or equal to age 18
-At least annually for 3 consecutive years to establish baseline
-After hysterectomy for benign disease
-History of DES exposure: diethyl stilbestro > clear-cell vaginal CA
* Was used as a fertility drug, female daughters had various gynecological abnormalities
-Following treatment of cervical pre-invasive disease or cancer (CIN: cervical intra-epithelial neoplasia)
-Pre-natal screening
-Note: Pap tests are not reliable for detection of endometrial lesions
-Note: Pap smears have a 15-25% False Negative rate (mostly from collector error)
-Transformation Zone is particularly susceptible to cancerous changes.
Pap Smear
-Indications: From the American Cancer Society
-Screening should begin approximately three years after a women begins having vaginal intercourse, but no later than 21 years of age.
-Screening should be done every year with regular Pap tests or every two years using liquid-based tests.
-At or after age 30, women who have had three normal test results in a row may get screened every 2-3 years. However, doctors may suggest a woman get screened more if she has certain risk factors, such as HIV infection or a weakened immune system.
-Women 70 and older who have had three or more consecutive Pap tests in the last ten years may choose to stop cervical cancer screening.
-Screening after a total hysterectomy (with removal of the cervix) is not necessary unless the surgery was done as a treatment for cervical cancer.
Risk Factors for Cervical Cancer
-Number 1 risk factor:
* Human Papilloma Virus infection: a sexually transmitted virus
-Beginning sexual activity at an early age
-Multiple sexual partners
-Having sexual partners who have had multiple sexual partners
-Low socioeconomic status
-Having many children
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
-Smoking
* niccotine concentrates in the cervix
-Long-term use of oral contraceptives [5-9 yr. use = 3x risk invasive cancer]
HPV: Human Papilloma Virus
-Small, double-stranded DNA viruses infect endocervical glandular or stratified squamous epithelium
-Virus attacks and stimulates proliferation of cells: vagina, cervix, and anal-rectal area
-Most clinical presentation is asymptomatic
-It is believed that Ab's develop within 12 -15 mos after infection
-Over 100 HPV types have been identified, likely more exist
-LOW RISK HPV types: 6/11/42/43/44
-6 & 11 benign lesions: CONDYLOMATA ACUMINATA & mild dysplasia
-16 & 18 are more commonly associated with CIN & CIS
-50% OF CERVICAL CANCER CASES ARE CAUSED BY HPV-16
-Types 31, 33, or 51 assoc. with either condyloma, OR CIN & CIS
Standard 1943 Pap Smear Collection
-Scraper, broom & and glass slide
-Sampling dependent on physician skill
-Cells may remain on scraper
-Cells maybe thick & clumped on the non-homogenized sample
-The Computer & Cytologist examines slides
-Blood, mucus on slide interferes
-Maximum chance to see PATHOGENS (they stay whole & in tact)
2005: Liquid Based "Pap Smear" Collection (Thin Prep)
-Autocyte SurePath or Thin-Prep Collection Kits
-Sampling device spatula/cytobrush/broom placed directly into a liquid preservative
-100 percent of the cells collected get to the lab.
-The PrepStain instrument processes the material onto a glass slide for evaluation.
-Computer pre-examines the slides to flag abnormal cells
-The Cytologist examines flagged slides longer
-Blood, mucus removed from sample, so not a problem!
-Reduction of preserved Pathogens!
-Can get cells from endo-cervix too (a good thing!)
6/8/2006 FDA Approved HPV Vaccine: Gardasil
GARDASIL is designed to target
-HPV types 16/18 and types 6/11:
-70% of cervical cancers,
-90% of cases of genital warts.
-A quadrivalent human papillomavirus types 6, 11, 16, 18.
-Recombinant investigational vaccine, prevented 100 percent of high-grade cervical pre-cancers & non-invasive cervical cancers (CIN 2/3 and AIS) associated with human papillomavirus (HPV) types 16 and 18 in a new phase III study.
-DOSING: 3 injections over 6 months at $120 per dose.
Gardasil Deaths: May 24, 2007
3 deaths reported www.americanchronicle.com
-FDA reports 3 deaths of girls after injection of Merck's Gardasil vaccine
-Three cases of Guillain-Barre Syndrome
FDA rushed these vaccines into production without long term studies.
-Judicial Watch (Washington, DC) Public interest group that investigates and prosecutes government corruption, released documents obtained from the USFDA under the provisions of the Freedom of Information Act, detailing 1,637 reports of adverse reactions to the Gardasil HPV vaccine.
-As of May 11, 2007, the 1,637 adverse vaccination reactions reported to the FDA via the Vaccine Adverse Event Reporting System (VAERS) included 371 serious reactions. Of the 42 women who received the vaccine while pregnant, 18 experienced side effects ranging from spontaneous abortion to fetal abnormities.
-Side effects published by Merck & Co.: pain, fever, nausea, dizziness and itching, paralysis, Bells Palsy, Guillain-Barre Syndrome, and seizures. [Show Less]