THE CYTOLOGY LABORATORY

Transcription

1 THE CYTOLOGY LABORATORY OF PATHOLOGY CASE WESTERN RESERVE UNIVERSITY AND UNIVERSITY HOSPITALS CLEVELAND, OHIO 48 THE INSTITUTE

2 I I Motifs from medieval guilds, zodiac signs of Libra and Cancer, the urine flask, and the Egyptian key of knowledge are interlaced in the grillwork. Bas-reliefs in stone of Morgagni, Virchow, Rokitansky, Pasteur, John Hunter, Bichat, Cohnheim and W e l c h, border the sides and the top of the tall doors. But when you pass through the entranceway and enter the cytology laboratory you will see skilled medical people at w o r k on medical problems of today and on the challenge of those of the future. Procedures and equipment that were unknown when the building was dedicated in 1928 are taken for granted today; for the building, and the people in it, As you approach the entrance to the Institute of Pathology at Case Western Reserve University in Cleveland, you are immediately struck by the outer bronze doors, for they are an impressive tribute to the medical heritage of the past. have changed with the needs of the times. Staff members of the Institute have played leading roles in bringing about revolutionary changes in the medical curriculum. Within the Institute is housed the Department of Pathology, which serves the educational complex of the Case Western Reserve University, the Health Science Center, and the University Hospitals of Cleveland and its affiliated units. As its needs grow, more space was required, and now a new addition is under construction. In order to accomplish the overall aims of the department, to provide a proper balance of teaching, research, and patientservice, the department is organized into specialized sections representing the major interdisciplinary areas of medicine. Cytology is one of the many different disciplines represented. A laboratory devoted to the study of the cell was first opened 49

3 cellular changes were classified in terms of their parent lesion of origin rather than by any numerical system of reporting. Failures in detection led to refinements in the methods of collection, and unconfirmed cellular findings led to more comprehensive tissue sampling. Teamwork in the Case Western cytology laboratory. While one cytotechnologist examines the specimen, another checks the files on the case. at the Institute of Pathology in 1948 at a time when prominent academicians condemned this approach. However, Dr. Howard T. Karsner, then director of the Institute, sanctioned such an evaluation, and assigned Dr. James W. Reagan, then a Fellow in pathology and now professor of pathology and director of the Cytology Laboratory, to undertake such an evaluation and to d e t e r m i n e whether or not cellular samples from patients accurately reflected the presence of neoplastic disease. Dr. Reagan is a member of the Board of Directors of the American Society of Clinical Pathologists and chairman of its Publications Committee. 50 Dr. Reagan enlisted the cooperation of the Department of O b stetrics and Gynecology, which collected cellular samples from all women undergoing surgical pelvic operations. The cellular changes in preoperative smears from the cervix were ultimately correlated with the histopathologic findings in the surgical specimens. Gynecologists from the community contributed cellular samples from women w i t h unusual lesions, thereby facilitating the study. Unfortunately, pathologists w h o dealt with cellular evidence interpreted their findings in terms of the anticipated histopathologic process. Thus, from the beginning, Today the Laboratory of Cytology of the Institute of Pathology provides service for the in-patients and out-patients of the University Hospitals of Cleveland and its affiliated units, and for those of physicians of the medical community. The laboratory is located close to the Section of Surgical Pathology. The facility occupies 1000 square feet of space, 350 of which are devoted to microscopy, 300 to staining and processing, 100 square feet primarily for related research. The facility is divided into two units. One deals w i t h material from the female genital tract, and the other with samples from all other sources. In an attempt to provide an ideal environment for microscopic evaluation, staining and processing are separated from areas in which microscopy is carried out. For many years the pathologists associated with the laboratory participated in screening, but now screening is done by the technical staff. The cytotechnologists have specialized areas of interest and The first of numerous analytic studies dealing with the cellular evidence appeared in 1951, but even before this time, pathologists w h o dealt with cells realized that what had once been a simple investigation had become a demanding service responsibility.

4 J. J %# w* r f HP *»%. Air * ^.f J % dv V V : Here are some examples of the fine specimens prepared at the Case Western Institute of Pathology's Cytology Laboratory. Upper left Cells derived from microinvasive cancer of the uterine cervix. Even minute evidence of invasion may be reflected in the cellular structure. Upper right Cells derived from carcinoma in situ of the uterine cervix. When rec- ognized in this stage of development, cancer can be cured in almost 100 per cent of the cases. Center left Cells from reserve cells hyperplasia and atypical metaplasia of the uterine cervix. These changes simulate those of early cancer but can be distingushed by those found on cytology. Center right Cells from dysplasia originat- ing in metaplastic epithelium of the uterine cervix. This change has an unpredictable course and may be the forerunner of a more serious change. Lower left Atypical cells derived from dysplasia simulate those of cancer. Lower right Small cell carcinoma of uterine cervix. This is the most serious form of cervical cancer. LABORATORY MEDICINE MARCH

5 individually bring their material directly to the pathologists w h o, in their presence, arrive at a d i agnosis. Samples are reported in terms of the patholigic process i. e., "adenocarcinoma metastatic to the uterus," or "adenocarcinoma primary in the uterine cervix," and emphasis is placed on the significance of the disease in terms of the patient. The number of research personnel varies with the demands of the project. The cytotechnologists are often utilized for research studies and all of the technical staff are involved in teaching. Since its inception, more than 1,700,000 slides have been processed, representing examinations of specimens from more than 1,200,000 patients. The current annual workload of material from about 37,000 patients, representing approximately 120,000 slides, does not utilize the full service potential of the staff. The work load is controlled because service is only one of the functions of the laboratory. The majority of samples are from the female genital tract, but an increasing variety and number of samples are from other sites. In samples, imprints are prepared from tissue removed during surgery. The personnel are concerned with teaching medical students, cytotechnologists, resident physicians, and pathologists w h o desire postgraduate study. Dr. lames W. Reagan, professor of pathology and director of the Cytology Laboratory of the Institute of Pathology, Case Western University, Cleveland, Ohio. Miss Justine L. Neuman, RN, MT (ASCP) CT, chief cytotechnologist of the Cytology Laboratory. 52 The medical student is introduced to the study of the cell The laboratory personnel includes two pathologists w h o are also concerned with surgical pathology, six registered cytotechnologists (CT, ASCP) w h o are responsible for the screening, two technicians w h o process and stain the samples, and a secretary.

6 early in his career, prior to his exposure to histopathology. W i t h this orientation, he is much more perceptive in evaluating the cellular elements of a tissue section. The indoctrination in cytology ends with a class exercise in which the student deals with cellular unknown. Residents in pathology from this and other institutions are encouraged to master cytology before acquiring experience in surgical pathology. From 3 to 6 months, full-time training in cytology is provided. The six-month training period for cytotechnologists includes approximately 200 hours devoted to lectures, demonstrations and review sessions; 50 hours devoted to examinations; and 600 hours of laboratory exercises. All personnel participate in a weekly " u n k n o w n session" conducted by a staff pathologist. Insofar as possible, pathologists seeking postgraduate study are accommodated in the laboratory. The teaching material accumulated during the past t w o decades is used to provide workshops and teaching exercises for pathologists w h o are unable to visit the laboratory. It is estimated that during the past 10 years more than 5000 pathologists have studied the accumulated teaching material at regional and national meetings. Inasmuch as the laboratory is located in an academic atmosphere, considerable importance is placed upon service, teaching, and research functions. No longer Histopathologic studies, which are more comprehensive, have become essential training for optimal patient care. The importance attached to this approach to cytology has served as a constant challenge for those working in the pathology laboratory. The dedication of the staff has contributed to the evolution of the discipline and to the establishment of high standards. During the 20 years of existence of the Cytology Laboratory of Case Western Reserve University, a better understanding and an increased awareness of cellular biology have been achieved, and improved methods have been developed for the study and diagnosis of human disease. JEWETT BLOOD a u t o m a t e d for your protection SAFETY ALARM During this period all didactic lectures and discussions are conducted by staff pathologists, and emphasis is placed on cytopathologic correlation and the significance of the method. Frequent examinations are given and all trainees are required to take the final examination, which consists of 100 cellular unknowns. is this field of study merely a method for screening of cancer. It has grown into a sensitive d i agnostic procedure which often complements the conventional biopsy, and it has many different applications. SYSTEM Should the temperature of the Blood Bank fall or rise dangerously, a buzzer sounds and a light flashes to alert hospital personnel. Standard on all cylindrical and counter-top models. Optional, extra: An additional alarm signal may be installed at a remote location if desired. AUTOMATIC DUAL C O N T R O L S Should the temperature control that cycles the unit fail to open, the second control AUTOMATICALLY operates the Blood Bank within safe limits until the control is made operative again. Standard on all cylindrical and counter-top models. RECORDING THERMOMETER 7-day, spring-wound recorder gives permanent, continuous record of blood temperatures on 8-inch, easy-toread charts. In the event of fluctuation due to power failure, etc., pathologist can determine usefulness of blood affected. Hospital has accurate record to answer technical or legal questions. Optional, extra: for use on all cylindrical and counter-top models. MODEL CT-1 Counter-top blood bank answers the need of small hospitals and clinics for ample blood storage capacity plus flat counter surface. ILLUSTRATED MODEL CT-3 Larger capacity counter-top model providing the most economical use of laboratory space. Factory-set automatic controls. MODEL CTF-1 Jewett blood plasma freezer maintains a constant temperature of 3 0 C. and stores 75 to 82 plasma packs. Features automatic defrosting and audio-visual alarm system. LITERATURE Send for Blood Bank Booklet #863A THE rtcpmobftatoft co.. INC. 2 LBTCHWORTH STRBBT BUFFALO. NEW YORK MANUFACTURERS OF REFRIGERATORS OF EVERY TYPE FOR INSTITUTIONS Since 1849 Circle No. C 1 4 on Reader Service Card for more information 53