Section of Cytopathology The Section of Cytopathology provides a diverse cytopathology service and also runs a large training program. The Cytopathology Service comprises three main areas: Exfoliative Cytopathology Fine Needle Aspiration Service Image Analysis Exfoliative Cytopathology Exfoliative Cytopathology encompasses gynecologic specimens, including Pap Smears, Non-Gynecological specimens and Outside slides. Specimens are received from various clinics and inpatient floors in the main processing lab. Specimens are concentrated, stained, cover slipped, slides for special studies and cellblocks prepared and the specimens sent to the cytotechnologists for preliminary screening. In contrast to most hospitals and because of the high prevalence of pre-neoplastic lesions, most of our gynecological cytopathology specimens are required to be evaluated by a cytopathologist. Fine Needle Aspiration Service With the advent of managed care, the demand for low-cost, high-turnaround types of diagnostic procedures has increased, and FNA biopsies fulfill these requirements. This service comprises both superficial aspiration and deep aspiration components. At MDACC, many FNA biopsies are performed by cytopathologists. The aspirated material is immediately smeared, stained and evaluated, and a preliminary diagnosis is issued while the patient is still waiting in the clinic. The deep aspirations are procured by radiologists under guidance (including fluoroscopy, CT scan and ultrasound) and require immediate cytological assessment of adequacy, specimen triage and subsequent interpretation. In cases of unclassified neoplasms, lymphoproliferative disorders and breast cancer, additional passes are obtained for immunocytochemistry markers, flow cytometry, cytogenetic and molecular studies as indicated. In many instances, the FNA diagnosis is reinforced by ancillary tests on the aspirated cells, and the clinical findings are the working diagnosis on which definitive therapy is based. Because of the diversity and primary diagnostic nature of many of the aspiration specimens, heavy emphasis is placed on the use of ancillary studies for both diagnosis and prognosis (ie. lymphoma surface markers, ER/PR, proliferation index by Ki67 and DNA ploidy. A final cytopathology report integrates all the ancillary studies. Through the FNA service, a cytopathology tumor bank has been established. All remaining aspirated tissues/cells are stored for future research studies. The bank comprises over 5,000 lymphomas, breast carcinomas and melanoma aspirates. The total number of stored cases is about 11,000 specimens. Some of the archived material has been used in the development of several research projects. Image Analysis The image analysis laboratory provides an interactive DNA quantitation service for ploidy, proliferation and antigen quantitation (estrogen and progesterone receptors and Ki-67).