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Diagnostic Cytopathology: Refining Diagnoses With the Use of Ancillary Techniques

The practice of cytology has evolved from a screening test that, although important, was not expected to be definitive (mainly used to prompt physicians to obtain a biopsy for establishing a definitive diagnosis) to a diagnostic modality used to implement therapy. In this day and age of cost containment and short hospital stays, cytology has become a major diagnostic force in clinical medicine. The majority of cytologic diagnoses can be made with the routine stains (Diff Quik and Papanicolaou). For the cytologic diagnosis to be specific the use of ancillary techniques may be necessary. The usefulness of these techniques (primarily immunohistochemistry and electron microscopy; flow-cytometry and molecular pathology (MP) will be discussed (as they are applicable) as they help refine cytologic diagnoses. A case oriented discussion will help the practicing pathologist work-up the most common differential diagnoses in the practice of cytology. In summary, the more precise way to practice cytology by utilizing all the tools available to the pathologist in the most accurate and cost-effective manner will be discussed.