Cytological examination

The role of cytology within laboratory diagnostics

Cytological and morphological examinations are applied according to diagnostic necessity. Their use is somewhat limited in outpatient settings, whereas diagnostic investigation expands significantly in inpatient care.

In addition to cytology, the basic outpatient minimum includes:

• Complete blood count (CBC) and urinalysis.
• Blood glucose determination.
• In large medical centers, this panel is supplemented by bacteriological, biochemical, and immunological tests.

If a patient is scheduled for surgery, a cytological report alone is insufficient. Mandatory preoperative preparation in the outpatient clinic includes blood tests for syphilis (Wassermann reaction — RW), HIV infection, and hepatitis viruses A, B, and C. In the inpatient setting, this panel is significantly expanded: blood type and Rh factor (Rh) are determined, a coagulogram is performed (including the prothrombin index), along with a biochemical blood test, ECG, chest fluorography (FLG), and a throat swab for diphtheria (BL). Preparation is concluded with a clearance from a general practitioner. In cases of immune disorders, the immune status is additionally assessed, including reactions with monoclonal antibodies.

Cytological diagnostics in gynecologic oncology

The most prominent example of the cytological method in practice is the detection of cervical cancer (Carcinoma of the Cervix). It is the second most common cancer in women worldwide, with a peak incidence between the ages of 25 and 40 (especially in Africa, Central/South America, and Asia).

The disease is typically discovered clinically, with the Pap smear (Pap smear) playing a leading role. In the presence of pathology, the cytological examination generally yields a positive result. Additionally, the lesion can be visualized via colposcopy.

Risk factors that provoke cellular changes include:

• Infection with human papillomavirus (HPV) types 16 and 18.
• Early onset of sexual activity and multiple partners.
• Smoking and states of immunosuppression.

Clinically, the process manifests as abnormal uterine bleeding (including postcoital bleeding) and atypical vaginal discharge.

Radiological diagnostics: the next step after cytology

If cytological examination confirms the presence of tumor cells, staging according to the FIGO system is necessary to ensure an accurate prognosis and select treatment tactics (surgery for early stages, or chemoradiotherapy for stage IIb and above). Radiological diagnostics assess the degree of tumor differentiation, its size, depth of invasion, and lymph node involvement.

1. MRI (Magnetic Resonance Imaging): The modality of choice. It allows for a precise distinction between early and late stages. It demonstrates tumor localization (endocervical or exophytic), the depth of stromal invasion, extension into the lower uterine segment, and involvement of the parametrium. In endometrial cancer, MRI also provides ideal assessment of myometrial invasion.
2. Computed Tomography (CT): Has low soft-tissue contrast, making it poor at detecting early parametrial invasion (positive predictive value of only 58%). However, in advanced stages, accuracy reaches 92% (visualizing ureteral obstruction, hydronephrosis, and uterine enlargement with hydro- or hematometra).
3. Ultrasound (US): Transvaginal and transrectal approaches assess the local process, but are limited in visualizing the pelvic walls. The tumor appears as an irregular hypoechoic mass (sometimes mimicking a leiomyoma).
4. PET/CT: Used primarily for restaging when recurrence is suspected.

Functional and topical diagnostic methods

While cytology studies cellular composition, tissue viability and functional state (e.g., in dentistry) are assessed instrumentally.

Electric pulp testing (EPT) is used to assess morphological changes in the dental pulp. The clinician wears rubber gloves and uses a plastic spatula to prevent current leakage. Intact teeth and teeth with initial caries respond to 2–6 µA. In deep caries, excitability decreases to 20–40 µA (a sign of inflammation). Necrosis of the coronal pulp responds at 60 µA, and root pulp necrosis at 100 µA and above. Normal periodontium is sensitive to 100–200 µA. EPT determines only the localization of the lesion (a decrease from a single cusp indicates a localized process, while a decrease from all cusps indicates total involvement of the coronal pulp), but not its extent.

To assess microcirculation, the following methods are used:

• Biomicroscopy: visualization of blood flow velocity and vascular morphology.
• Rheography: recording of pulse-wave oscillations in mucosal resistance.
• Photoplethysmography: assessment of local blood flow via optical density.
• Polarography: assessment of tissue oxygenation levels.

Class and exam questions

What else to study on this topic

• FIGO clinical staging system for cervical cancer
• Electric pulp testing: topical diagnostics of pulp inflammation
• Inpatient preoperative preparation: coagulogram and biochemistry
• MRI in gynecologic oncology: differentiation of stromal and parametrial invasion
• Functional methods for assessing blood flow: rheography and polarography

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