Cytology: Tips and Telemedicine
Who would have thought an evening spent watching a ‘cytology’ webinar could have taught me more than all the years I spent staring down the lens of a microscope at vet school.
Anne Lanevschi DVM,MVSc, Dipl ACVP, Dipl ECVCP, a leading veterinary clinical pathologist managed to achieve this within the space of an hour. The succinct and practical information offered by Anne over this short space of time has inspired me to dust off my microscope and broaden my horizons beyond the diagnosis of lipomas and mast cell tumours.
Over the course of the webinar Anne offered several ‘top’ tips on how to make the most of cytology without being led astray by technical errors and artefacts. Of all the advice offered, there was one ‘major’ tip involving sampling techniques that Anne stressed we should take on board above everything else: When performing a fine needle aspirate (FNA) , the ‘needle only technique’ should always be used in preference to aspiration. By using a back and forth and rotational technique, a high cellular yield should be obtained with minimal haemodilution. If a vascular organ is being sampled, the needle should not be reorientated and sampling should be performed quickly. The method of aspiration should only be used if the ‘needle only technique’ is unsuccessful and no more than one ml of back pressure should be applied.
Anne also stressed the importance of slide preparation and reminded us to always look after our stains. Tips included storing them in a dark place when not in use and using a separate set of stains when preparing ear swabs to prevent contamination.
Under The Microscope
Now to the part that challenges me: Attempting to correctly assess the cellularity of an aspirate under the microscope. Anne’s advice is to be methodical and always try to assess every sample in the same way. Cellularity should be assessed from low / moderate to high power fields and an inventory of what is seen should be written down. The following set of questions should always be asked: Are the cells inflammatory or non-inflammatory? If they are inflammatory, what leucocytes can you see? If they are non-inflammatory, are the cells round, mesenchymal or epithelial? Are these cells benign or malignant?
Anne showed us a number of case examples demonstrating each of these categories forming a strong base from which I can now assess my own cases without feeling overwhelmed by the perceived complexity of what is seen.
If In Doubt
There will be some occasions when we are not confident about assessing particular cytology cases. Under these circumstances, Anne’s final tip of the session was ‘if in doubt – refer’.
This takes me nicely to Anne’s concluding topic of conversation, ‘telemedicine’, a concept recently introduced to the UK having been successfully implemented within the US for the past 10 years. ‘Telemedicine’ involves the referral of images taken in practice where further advice for cases is required. Practitioners can tap into expertise provided by UK and Europe’s leading consultants encompassing all disciplines of veterinary care, including radiology, cardiology, dermatology, neurology, oncology, ophthalmology, exotic animal medicine. This is a practical and efficient way of gaining the advice from experts without ‘losing’ cases to referral centres. The reports generated by this service can even be used to generate CPD points. For further information please refer to the website www.televetdx.com.