The Pathology laboratory consists of two areas: Histopathology and Cytopathology. Histopathology involves the study of tissue and Cytopathology involves the study of cells, both of which are derived from various organs of the human body.

Histopathology and Cytopathology Department plays a key role in the diagnosis, prognosis and treatment of benign and malignant diseases. Biolab’s Histopathology and Cytopathology Department brings together state-of-the-art technologies; histology, cytology, immunohistochemistry, as well as molecular biology and cytogenetics techniques. Our personnel include expert pathologists and highly trained staff to provide comprehensive diagnostic and personalized service to clients.

The department also works closely with microbiology and infectious diseases departments on the genotyping of the HPV virus.

Cytopathology

Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. Cytopathology or “cytology” is generally used on samples of free cells or tissue fragments. It is commonly used to investigate diseases involving a wide range of body sites, often to aid in the diagnosis of cancer but also in the diagnosis of some infectious diseases and other inflammatory conditions. For example, a common application of cytopathology is the Pap smear, a screening tool used to detect precancerous cervical lesions that may lead to cervical cancer.

Cytopathology can be used to diagnose a condition and spare a patient from surgery to obtain a larger specimen. An example is the thyroid gland; many benign conditions can be diagnosed with cytopathology and the patient can go back to normal activities right away.

Sampled fluid/ tissue from a patient is smeared onto a slide and stained then examined under the microscope by the pathologist to determine whether a disease is present and what is the likely diagnosis.

Cytopathology is most often used as a screening tool to look for disease and to decide whether more tests need to be performed. An example of screening would be the investigation of a breast lump. In combination with examination by the clinician and imaging tests, a needle aspirate of the lump submitted for cytology will show whether the breast cells are suspicious for cancer or not. If they look suspicious, a core biopsy with a larger needle may be performed which takes more tissue, allowing for a definitive diagnosis to be made before deciding what type of surgery is required (local removal of the lump or removal of the whole breast).

Cell collection

There are two Sampling techniques used for collecting cells for cytopathologic analysis: exfoliative cytology, and intervention cytology.

Exfoliative cytology

In this method, cells are collected after they have been either spontaneously shed by the body ("spontaneous exfoliation"), or manually scraped/brushed off of a surface in the body ("mechanical exfoliation"). An example of spontaneous exfoliation is when cells of the pleural cavity or peritoneal cavity are shed into the pleural or peritoneal fluid. This fluid can be collected via various methods for cytopathologic analysis.

Examples of mechanical exfoliation include cervical Pap smears. This involves the insertion of a speculum into the vagina to allow the clinician to directly view the cervix. The cervix is then gently scraped to retrieve cervical cells which are smeared directly onto glass slides at the bedside and submitted to a laboratory for examination. The material from the cervical scrape can also be directly tested for wart virus (Human Papilloma Virus), the major risk factor for the development of cervical cancer.

After sampling, two main techniques can be used: conventional cytology and liquid-based cytology. With the latter, the sample is placed in a liquid that is then processed for further investigation.

Intervention cytology

In intervention cytology the pathologist or clinician intervenes into the body for sample collection.

Fine-needle aspiration, or fine-needle aspiration cytology (FNAC): A needle is inserted into the area of the body being examined, sometimes with the use of imaging (e.g. ultrasound or CT scan) to ensure that the suspicious area is being sampled. This procedure may be performed after injection of local anesthetic to numb the skin, or even under light sedation if involving a deep organ or tissue. The cells retrieved are expressed onto a slide and prepared in a similar way to the cervical smear. If fluid is aspirated (e.g. within from a thyroid cyst), it may first be spun by a centrifuge so that the cell-containing sediment collects at the bottom of the test tube, allowing the best material to be sampled for examination.

Further information about the specimen may be gained by special stains to highlight the cells and background material on the slide, in a similar way to histopathology sections. Immunohistochemical stains and molecular testing may be performed, particularly if the sample is prepared using liquid based cytology.

Future directions:

Frozen section diagnosis
Sometimes, it is necessary for the surgeon to determine if he/she has removed all of the cancerous tissue from the patient intra-operatively. At this point, the tissue is sent from the Operating Room to the Histology department, quickly frozen using a special (cryostat) device and a slide is cut, prepared and stained for review and a diagnosis is made, all within 15-20 minutes. A preliminary diagnosis is made whilst the surgery is still in progress.

For further information, please contact:

• Dr. Nasrat Babouq, Consultant Histo-Cytopathologist, n.babouq@biolab.jo
• Dr. Ahlam Awamleh, Consultant Histopathology & Cytopathology, a.awamleh@biolab.jo
• Ali AlDmour, Specialist technologist, a.aldmour@biolab.jo