Cytological changes in cells

Fundamentals of Cytological Diagnostics

Cytological diagnostics is based on a detailed microscopic study of cellular material. The pathologist identifies the pathological process by focusing on three main criteria: the morphological features of the cells themselves, the quantitative ratio of different cell groups in the sample, and the specific arrangement of elements in the prepared specimen.

A variety of materials are used for the analysis. Most commonly, these include smears from the surface of the cervix, punctates obtained from pelvic mass lesions or the fluid of the rectouterine pouch, as well as aspirates directly from the uterine cavity.

This approach is of immense clinical significance, acting as the leading screening method during mass preventive examinations. It is especially important for patients in high-risk groups for oncological pathology. However, the method is not without flaws: its diagnostic sensitivity is rather modest and varies within 60–70%.

Papanicolaou Smear Assessment

Although traditional descriptive conclusions are often used in the Russian Federation, the Papanicolaou system (the so-called Pap test) remains the global standard and most common classification. It divides all possible cervical smear findings into five consecutive classes:

• Class I: absolutely normal cytological picture with no abnormalities.
• Class II: reactive or inflammatory changes in epithelial cells are present.
• Class III: atypia of individual epithelial elements is detected, raising suspicion of dysplasia.
• Class IV: individual cells with clear signs of malignancy are found (high suspicion of cancer).
• Class V: entire complexes of cells with malignant characteristics are present in the specimen, unequivocally indicating cervical cancer.

When formulating the results, all epithelial abnormalities (both squamous and glandular) are recorded in a special "Interpretation/Result" section. Other specific findings, such as the presence of endometrial cells in a smear from patients over 45 years of age, are also entered into this section.

Indications for Colposcopy in Cellular Alterations

The necessity for further in-depth examination—colposcopy—is determined based on the identified cytological anomalies. There are strict indications for its mandatory performance.

1. In mild cellular changes (ASCUS or LSIL reports), colposcopy is prescribed under only one condition: if the patient is found to have high-oncogenic-risk human papillomavirus (HR-HPV).
2. In pronounced cytological abnormalities, colposcopy is performed absolutely always, regardless of human papillomavirus testing results. Such changes include atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), as well as glandular cell abnormalities (AGC, AGC-NOS, AGC-FN).
3. If a woman tests positive for a high-risk human papillomavirus genotype (specifically types 16 and/or 18), colposcopy is mandatory. In this situation, the result of the cytological smear does not matter—the procedure is performed on all infected individuals.

The Role of Biopsy in Verifying Cellular Changes

If cytology and colposcopy indicate pathology, the diagnosis is confirmed using a biopsy. This is the procedure of intravital tissue sampling in a small volume for subsequent microscopic examination in order to make an accurate diagnosis. In gynecological practice, the main indication for biopsy is suspected malignant neoplasm of the cervix, vagina, or external genitalia.

Several material sampling options are distinguished:

• Excisional biopsy: involves the complete excision of a pathological piece of tissue.
• Targeted biopsy: performed strictly under the physician's visual control (during magnified colposcopy or hysteroscopy), which allows material to be taken from the most suspicious area.
• Punch biopsy: tissue sampling through a puncture with a special needle.

Cellular Changes in Central Lung Cancer

Cytological and precancerous changes have been well studied using the example of perihilar (central) lung cancer. This tumor localizes in large bronchi and develops against the background of prolonged chronic inflammation.

Precancerous changes in this case are squamous cell metaplasia and dysplasia of the bronchial epithelium. During histogenesis, the tumor forms from basal, goblet, or ciliated cells. Sputum cytology, as well as bronchoscopy with biopsy and radiological methods, plays an important role in diagnosing central cancer. The most frequent histological variants are squamous cell carcinoma and small cell lung cancer.

Macroscopically, the tumor can take a polypoid, nodular, branched, or nodular-branched form. Progression of the tumor process often leads to serious complications: atelectasis, retrostenotic abscesses, invasion into the pericardium (heart sac), esophagus, mediastinum, and vascular trunks. Invasion into large vessels can provoke life-threatening pulmonary hemorrhage.

Class and exam questions

What else to study on this topic

• Complications of perihilar lung cancer (atelectasis and retrostenotic abscesses)
• Histological forms of central cancer (squamous cell carcinoma and small cell lung cancer)
• Mechanisms of squamous cell metaplasia of the bronchial epithelium
• Features of targeted biopsy during hysteroscopy
• Interpretation of atypical glandular cells (AGC, AGC-NOS, AGC-FN)

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.