Message from our Director of Cytopathology
Dr. Ashley Flowers
Cytology is an exciting field that encompasses the diagnostic aspect of pathology where the diagnoses are made by the study of cells instead of the study of histologic sections as in surgical pathology. The field of Cytology is divided into exfoliative and aspiration cytology. Exfoliative cytology includes gynecologic cytology (the Pap Test), anal paps, fluids, to include cerebrospinal fluid (CSF), urine, pleural, peritoneal fluids, bronchial washes as well as, ureteral, esophageal, and bronchial brushes.
Aspiration cytology is the field where tissues, primarily tumors, are sampled by means of a needle. Virtually all organs can be sampled by needle. Rapid interpretation can be offered at the bedside or immediately after a radiologic assisted biopsy. Any palpable mass is amenable to sampling and it is for the most part performed by a pathologist. The deep aspirates (non-palpable) are performed by radiologists.
The field of aspiration biopsy, called fine needle aspiration (FNA), has advanced the field of Cytology and made it to be on par with Surgical Pathology in the diagnostic arena. The power of the FNA service is that it allows the cytopathologist to be in a very important and central position in the field of diagnostic pathology. The cytopathologist is an integral part of the medical team since he or she gets consulted in the case of most nodules/masses found. In many occasions, the FNA obtains the diagnosis while the surgical/core biopsy inadequately samples the mass. Performing rapid interpretation on FNA biopsies is rewarding, challenging, and a big responsibility since the cytopathologist, after examining the tissue, is responsible for obtaining and triaging the tissue for as many tests as necessary and in the proper fashion. If necessary, tissue is obtained for flow cytometry, cell block for IHC and/or molecular testing, or glutaraldehyde for electron microscopy in order to take care of the patient in the most efficient manner.
The field of cytology is exciting and relevant since it is at the center of diagnostic medicine. We established the Cytopathology Fellowship in 1996 accepting 2 fellows since 1999. Our Fellowship is structured. There are a series of lectures, Journal Club and conferences including those with glass slides around our 18 head microscope. Our fellows, like our residents, engage in interdepartmental conferences, presenting cases to clinicians, and in yearly research projects that they present in national conferences and publish their work in recognized journals.