Thin prep morphology (Cervical cytology)
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ThinPrep® Morphology
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ThinPrep® MorphologyNormal Cytology
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Cytotechnologist & Pathologist Training
• Microscopic Sessions
• Evaluation Modules
• Competency Assessment Modules
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ThinPrep® Process
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ThinPrep® Characteristics
• Liquid Based Fixation
• Cell Size
• Smear Pattern
• Specimen Background
• Similarities > Differences
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ThinPrep® Characteristics
Liquid Based Fixation• Enhanced Cytoplasmic Detail
• Enhanced Nuclear Detail
• Variability in Nuclear Staining
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ThinPrep® Characteristics
Cell Size• “Proportionately” Smaller
• Single Cells More Prominent
• Cells Round-Up in Solution
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ThinPrep® Characteristics
Smear Pattern• Mechanical Artifact Eliminated
• Cellular Material Not Pulled Out in Mucus
• Tissue Architecture Maintained
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ThinPrep® Characteristics
Specimen Background• Cleaner Background• Cellular Debris More Clumped• “Clues” in the Background• “RATTY” Background:
Infectious agent, Cytolysis, Blood, Disease
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ThinPrep® Characteristics
Screening Technique• Systematic
• Slow
• Slight Overlap
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ThinPrep® Characteristics
Guidelines for Estimating Cellularity¹
FN20 eyepiece/10x obj.
FN20 eyepiece/40x obj.
FN22 eyepiece/10x obj.
FN22 eyepiece/40x 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
# Cells/Field for 5K Total
3.1
# Fields @ FN22 10X
82.6
# Cells/Field for 5K Total
60.5
# Fields @ FN22 40X
1322
# Cells/Field for 5K Total
3.8
FN = Field Number
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10xFN 22
10xFN 22
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FN 22
10xFN 20
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Endocervical Cells
Honeycomb / Palisading Arrangements Maintained
Round-Up in Solution More Tightly Packed Groups Smaller Cell Groups/Single Cells Nuclei “Busier”
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Squamous Metaplasia
Sheets/Cobblestone Arrangements Dense, Homogeneous Cytoplasm Cells Often Single Cells Appear Smaller & Rounder
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Endometrial Cells
Tight 3D Cell Clusters Loose Cell Clusters with
Vacuolated Cytoplasm Single Cells More Prominent Nuclei “Busier” Menstrual Blood Lysed
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Atrophy
• Well Preserved Sheets of Parabasal Cells
• Endocervical Cells May Be Distinguished
• Bare Nuclei “Reduced”• “Atrophic Vaginitis” Pattern More
Clumped
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Trichomonas vaginalis
Frequently Smaller
Internal Structure Readily Identifiable
Classic “Trich” Pattern Maintained
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Candida spp.
• Classic Cell Clumping
• Reactive Squamous Cells with Engulfed WBC’s
• Distinguish Mucus Strands from Pseudohyphae
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Actinomyces
• Organized Clusters of Branching Filamentous Bacteria
• Associated Blue Staining Bacteria
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Herpes Simplex Virus
Ground Glass Nuclei
Multinucleation with Nuclear Molding
Classic Eosinophilic Nuclear Inclusions
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Reactive Changes:
• Slight Nuclear Enlargement• (2X Intermediate Cell Nucleus)
• Perinuclear Halos• Cytoplasmic Vacuolization & • Bi-chromasia• Clumped WBC’s• Enhanced Cellular Detail
Inflammation
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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
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ThinPrep® Morphology
Epithelial Cell Abnormalities
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ThinPrep® Characteristics
• Liquid Based Fixation
• Cell Size
• Smear Pattern
• Specimen Background
• Similarities > Differences
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Epithelial Cell Abnormalities - Squamous
ASC-US• Occur in Sheets or Singly• Nuclei 2 ½ - 3X Intermediate Nucleus• Uniform Chromatin Distribution• Decrease in Preparation Artifact
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Epithelial Cell Abnormalities - Squamous
LSIL• Increased Nuclear Detail• Irregular Nuclear Membrane• Nuclei 3 - 4X Intermediate Nucleus• Sharp, Irregular Cytoplasmic
Cavitation (HPV Effect)
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Epithelial Cell Abnormalities - Squamous
HSIL• Sheets & Syncytial Groupings
Maintained• Cytoplasmic Borders More Distinct• Isolated, Immature Cell Forms;
Function as “Clue”• Nuclear Membrane Irregularities
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Epithelial Cell Abnormalities - Squamous
Squamous Cell Carcinoma• Tumor Diathesis Maintained• Distinctive Necrotic Background
Pattern • Greater Depth-of-Focus to Cell
Groups• Prominent Chromatin Clearing• Nucleoli More Prominent
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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
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Epithelial Cell Abnormalities - Glandular
Endocervical adenocarcinoma in situ (AIS)• Abnormal Architectural Patterns Maintained• Nuclear Crowding With Hyperchromasia• Pseudostratification, “Feathering” Identified• Rosettes & Strips• Nucleoli Often Present
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Epithelial Cell Abnormalities - Glandular
Adenocarcinoma• 3D Cell Clusters Maintained• Well Preserved Nuclear Features• Tumor Diathesis May Be Noted
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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.
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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