Utility of Rapid Cytologic Techniques in the Autopsy Setting
Paul A VanderLaan, Jeffrey F Krane, Gayle L Winters. Brigham and Women's Hospital, Boston, MA
Background: Interest in the autopsy may be augmented by providing families and clinicians with more timely results. Rapid cytologic techniques employed during the prosection may provide quick and accurate pathologic diagnoses as well as maximize the educational experience in an academic hospital setting. Few publications have addressed the utility of cytologic techniques as an immediate diagnostic tool in the autopsy setting.
Design: Over a 2 month period of time at a tertiary care academic hospital, rapid cytologic diagnostic techniques were applied to 41 consecutive autopsy cases when focal lesions were present (24 male, 17 female, age range 31-100 years). Air-dried touch preparation, smear, and fine needle aspiration slides were stained with a Hemacolor rapid stain, and evaluated during the prosection by a cytology fellow with cytology attending consultation. Results were included in preliminary autopsy diagnoses and correlated with final histologic outcomes.
Results: Focal lesions amenable to cytologic sampling were present in 49% (20/41) of all autopsy cases over this time period. Of these, 15% (3/20) represented the primary tissue diagnosis of previously unknown malignancy, 50% (10/20) confirmed metastatic foci of a known primary tumor, 15% (3/20) identified fungal/bacterial infectious processes, and 5% (1/20) identified benign reactive processes. Mononuclear cell populations without discernible microorganisms were found in 10% (2/20) of cases, subsequently shown on histology to be fungal in nature. Non-diagnostic findings were present in one case, a lung nodule which on histology was proven to be a reactive pneumocyte process.
Conclusions: The application of rapid cytologic techniques to selected autopsy cases with focal lesions is a quick, simple, and low-cost adjunct to gross findings which provided important diagnostic information in 95% of cases. The cytologic material in this study provided good overall cytomorphology, and in a number of cases directed the prosector's dissection and established the first pathologic diagnosis of malignancy. Inclusion of cytologic diagnoses was well received by clinicians attending autopsy conference, and provided more immediate and definitive pathologic diagnoses to clinical questions which were included in the preliminary autopsy diagnosis. From an educational standpoint, this approach helped familiarize junior residents to the evaluation of cytologic specimens, provided subsequent cytologic-histologic correlation, and improved the quality of the autopsy experience.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 4, Monday Morning