Discrepancy between clinical-instrumental data and cytology
One of the most frequent problems is discordance (mismatch) between imaging results and morphological findings. A classic example is the diagnosis of nodular lesions. If the ultrasound picture is described as suspicious (e.g., EU-TIRADS 5), but the cytological report indicates a benign process (Bethesda II), the physician must not ignore the instrumental findings.
In such a situation, the risk of a false-negative result is high because the needle during fine-needle aspiration biopsy (FNAB) may have missed the tumor growth zone. The recommendation is unambiguous: FNAB must be repeated in the near future to completely rule out a diagnostic error.
In addition, there is an important rule for ordering laboratory tests. Prior to obtaining morphological confirmation of the diagnosis, broad laboratory diagnostics are not recommended. The only exceptions are cases where the patient has a comorbid (intercurrent) condition or their severe general condition requires immediate assessment to safely perform the biopsy itself.
Method limitations in suspected skin cancer
Cytological examination of touch imprints or scrapings can be used at the initial appointment in patients with suspected basal cell carcinoma (BCC). However, this approach carries risks.
The main problem lies in the high risk of diagnostic errors. Superficial scraping often yields false-negative (only necrotic detritus got into the material) or false-positive results. Therefore, despite the availability of cytology, absolute priority is always given to a full-thickness skin biopsy followed by a complete pathomorphological (histological) examination.
Errors in cervical pathology screening
Screening for cervical intraepithelial neoplasia (CIN) is performed in women aged 21–65 years (or younger, if sexual activity began more than 3 years ago) at 3-year intervals. The main condition for a quality analysis is sampling material strictly from the exocervix and endocervix (absent canal atresia).
The choice of method critically affects the error rate:
- Conventional cytology: has a specificity of 96.6%, but sensitivity is only 62.5% (for detecting CIN II+). The main drawback is that about 10% of smears are inadequate due to sampling or slide preparation errors.
- Liquid-based cytology: specificity is 90.3%, sensitivity is higher at 72.9%. The advantage of the method is a dramatic reduction in inadequate smears, making it much more effective for detecting LSIL and HSIL.
Management of detected abnormalities: If an abnormal smear is obtained, a frequent error is the immediate repeated sampling of material. It has been proven that smears taken within 1.5–2 months after the initial ones have extremely low reproducibility. Instead of traumatizing the cervix and obtaining a distorted picture, a professional review of the initial abnormal slides is advisable.
Incorrect management in confirmed diagnoses (using Gaucher disease as an example)
Sometimes errors are related not to cytology itself, but to misinterpretation of the patient's condition when the diagnosis is already confirmed. If the diagnosis of Gaucher disease (GD) is reliably established, the following actions are considered deeply erroneous and unnecessary:
- Repeat invasive procedures: performing repeat bone marrow punctures for cytology or laparoscopic liver and spleen biopsies.
- Surgical treatment of bone crises: a gross error that occurs when specific crises in GD are mistakenly perceived as manifestations of ordinary osteomyelitis.
- Hormone therapy: prescribing glucocorticoids in an attempt to relieve cytopenic syndrome.
- Iron treatment for anemia in untreated patients: anemia in this disease is of the "anemia of chronic disease" type, so iron preparations are strictly contraindicated.
- Splenectomy: removal of the spleen does not solve the underlying problem of metabolite accumulation.
Class and exam questions
What to do if ultrasound shows suspicious findings (EU-TIRADS 5), but cytology shows a benign process (Bethesda II)?
Fine-needle aspiration biopsy (FNAB) must be repeated in the near future, as there is a high risk of a false-negative result due to the needle missing the tumor.
Why is liquid-based cytology preferred over conventional cytology in CIN screening?
It has higher sensitivity and drastically reduces the number of inadequate smears (which reaches 10% with the conventional method), making the detection of LSIL and HSIL more effective.
Should a cytology smear be repeated immediately if an abnormal result is received?
No, repeat sampling within 1.5–2 months has very low reproducibility. It is recommended to review the existing primary slides.
Is it necessary to treat anemia with iron supplements in confirmed Gaucher disease?
No, this is incorrect management. Anemia in Gaucher disease is an "anemia of chronic disease," and iron supplements are not indicated in this case.
What else to study on this topic
- Bethesda system for thyroid cytology
- EU-TIRADS system: ultrasound signs of malignancy
- Differences between LSIL and HSIL in cytological preparations
- Pathogenesis and morphology of Gaucher disease
- Normal skin histology versus basal cell carcinoma
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