Sunday, February 05, 2006

Cyto

Cytology is the "Emperor's New Clothes" of Path.

Everyone around me pretends to see the illusionary enlarged hyperchromatic nuclei. Join me in prayer for the end of pap smears, breast and soft tissue FNAs. They are a scourge upon us.
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You crack me up, man. First of all, I was working up a damn B-cell NHL, not a T-cell angioimmunoblastic whatever. Secondly, heme is waaaaay too unnecessarily complicated. Cyto is straightforward. You follow certain criteria and make a dx without having to cut somebody open. If you think about it, thats pretty cool. With heme, you have to get about 12 IHC stains, then get flow, then get cytogenetics, then get B- and T-cell rearrangment PC-frickin' R studies. WTF! Make a damn call already without spending tens of thousands of dollars. Jeeech.
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From my limited exposure, cytologists tend to be quite fanatical (and also very good) at what they do.

"I trust the cells better."
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Take me out to pasture and shoot me.
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I think it may even vary from institution to institution. Different practices abound. Like here, the pulmonologists and surgeons INSIST on doing bronchoscopies with biopsy for attempted diagnosis of interstitial lung disease, which has a sensitivity of about 5%. The path attendings here say it is ingrained in the culture and they are somehow not swayed by the comments on about 95% of their transbronch biopsies "Tissue insufficient for diagnosis of interstitial lung disease."

At Wake Forest, they diagnose and treat many sarcomas based on FNA only, because one of the attendings there will make diagnoses on them. Breast FNAs are not done commonly here at all. And we almost never see sarcoma FNAs. I think perhaps the future will depend on availability of molecular tests for diagnosis, from tissue obtained by FNA. But who knows.
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