The Institute of Biomedical Science

www.ibmscongress.com

The work and roles of cytologists

What is a cytologist?

Cytology has three broad staff groups within in it. 

The first are medically qualified cytopathologists who study tissues and fluids at the cellular level with a microscope to diagnose and help guide treatment. Cytological investigations include the examination of surface impression preparations, the examination of preparations made from fluids such as body cavity fluids, sputum, fluid from cystic lesions, cerebrospinal fluid and fine needle aspiration (FNA) cytology of solid lesions.

Fine needle aspiration (FNA) is a very important technique used as a rapid method to determine if a solid lump of tissue is benign or malignant. By extracting some cells from the lump using a syringe and needle, and then examining these under a microscope, an experienced cytopathologist can look for the presence of abnormalities and make a diagnosis. The use of a fine needle is less painful for the patient and less invasive than a biopsy and it is possible in many instances for a diagnosis to be made in the clinic so that appropriate treatment can be planned at the time, speeding up the treatment that the patient receives.

This is an especially useful technique in diagnosing the status of breast lumps as part of the National Breast Screening service.

The second group are cytology screeners who are best known for their role within the NHS National Cervical Screening Programme detecting pre-malignant changes within the cells taken from the cervix (neck of the womb) on stained slides. Cervical screening saves over 1,000 lives in the UK each year and has drastically cut the rates of invasive cancer.

The third group is biomedical scientists who carry out all of the same roles as cytology screeners and some of the roles of Cytopathologists. Recently the role of advanced practitioner has been developed, where suitably experienced and qualified biomedical scientists take a diagnostic role similar to that of the Cytopathologist and are involved in the clinical management team for groups of patients.

Cytology is often thought of as a pathology discipline of the 20th and 21st century but it has roots going back to more than 300 years ago when the English scientist Robert Hooke made the first observations of cells in 1665.

Together with histology, cytology forms the pathology discipline of cellular pathology.

A day in the life of a...cytologist

Name: Jane Richards
Works at: Cellular Pathology Department, St Peters and Ashford Hospital
Career: Graduated with a BSc Degree in Biomedical Science from the University of Bradford completed a MSc course in biomedical science provided by the University of Hull (both courses accredited by the IBMS). Has just completed the IBMS’s Advanced Specialist Diploma in Cervical Cytology, which acts as a qualification for the grade of Advanced Biomedical Scientist Practitioner in Cervical Cytology - a grade with increased responsibility and expertise.

Work starts at 9:00 a.m. and I spend the best part of the morning screening cervical smears. This job needs quiet and concentration as my results will decide any further follow-up the patient may need. I have to decide if the smear is negative or positive i.e. pre-cancerous. If it is positive it then goes to a consultant or advanced practitioner for reporting.

In the afternoon I will assist in the many varied activities including non-gynaecological preparation. This entails preparation and staining of slides made from various body fluids i.e. urine, pleural fluid, bronchial washings and ascitic fluids to name but a few. These are prepared separately and each has a specific method and staining technique. When the slides are stained they are then taken to a consultant for diagnosis. We are looking for carcinomas, metastases, inflammation, infection etc.

We also offer semenology, which is the microscopical examination of semen for post vasectomy and infertility, and we often have to examine joint fluids for uric acid crystals which aids in the diagnosis of gout.

Another service we offer is the preparation and staining of slides from the FNA (fine needle aspiration) clinics. FNA’s can be taken from various sites including breast, thyroid, salivary glands and lymph nodes. We are called to a clinic or sometimes ultrasound department and asked to prepare the slides while the patient is still there. This method is particularly useful in the fast-track breast clinic. As the name suggests, the slides are prepared, stained and the taken to a consultant for rapid diagnosis. This enables the doctor to have a result in approximately 15 minutes.

In between all of this we also try to make time to do rapid re-screening of the morning cervical smears which is our method of in-lab quality control. Although we rarely deal with patients at first hand that doesn’t mean we forget the human story behind the sample or that effective and quick treatment of a patient depend on our work. Sometimes you see the results of a test and your heart goes out when you know what it means for the patient.

At 5:00 p.m. it’s time to go home and although we may have had an exhausting day we go home feeling good and knowing that we have played a major part in the management of the hospital patients.

Our thanks to the pathology department at Ashford's and St Peter's Hospitals and Nick Kirk, IBMS Council member and cellular pathologist at Papworth NHS Trust.

Tags: Careers, Cellular pathology, Cytology