5
Evaluation of the Sample in Smears and Liquid-Based Preparations
It is also important to remember that the possibility of cross-
contamination is not limited to the cytopreparatory laboratory.
This is particularly true when cell blocks are processed along with
surgical pathology tissue utilizing the same formalin baths and
automated processors.
Contamination due to shedding of malig-
nant cells and tissue can occur from cell block to histology tissue block
and vice versa.
To minimize this type of cross-contamination the
following steps should be taken:
1. The histology laboratory should be notified when cell
blocks are requested from cytology specimens likely
to shed tumor cells such as ascites fluid from a known
ovarian carcinoma patient (Fig. 5.21).
2. Cassettes for cell blocks should be placed in separate
formalin baths from histology tissue cassettes.
3. Cassettes for cell blocks whenever possible should
have their own separate runs in the automated proces-
sors without surgical pathology tissue cassettes.
Specimen Mishandling
Once errors in handling the specimens are detected, a root cause
analysis should take place to help identify what, how, and why
the error happened. Understanding why a mistake occurred is
the key to develop effective quality control measures to pre-
vent it from occurring again. A review of skill-based activities,
if appropriate, to ensure appropriate level of hands-on training
should be provided in addition to the training development
process to ensure adequate guidance. For errors related to sam-
ple interpretation see Chapter 4, Diagnostic Quality Assurance
in Cytopathology.
Concluding Remarks
The parameters for evaluation of smears and liquid-based
preparations have been described in this chapter. As we have
seen, several factors play an important role in the evaluation
of the cellular sample and for optimal results good fixation
and processing techniques, availability of clinical informa-
tion, and expertise in interpretation are required. Criteria for
interpretation of gynecologic and nongynecologic samples
are described in all chapters on diagnostic cytology in this
book but observations on liquid-based preparations were
highlighted here to show differences in cell size, pattern
background, and artifacts. A comparison of nongynecologic
processing modalities and specimen cross-contamination
as well as procedures to prevent the problem were also pre-
sented. The use of adjunct techniques in diagnostic cytology is
already an important component of the specimen evaluation.
In the future the diagnostic potential of cytology will increase
with development of new fluorescent in situ hybridization
(FISH) probes and more assays to identify genetic altera-
tions that serve as therapeutic targets in addition to the use
of microarrays, allowing a global and integrative approach to
diagnosis.
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