Cellularpathology is the branch of pathology that involves the study of body organs andtissues which are also known asanatomical pathology. Its roles include determining the cause of certaindiseases and the effect that they are having on the body, assisting with thechoice of treatment that will be given, aiding in giving a prognosis anddetermining what may have caused a person’s death. There are two mainsubdivisions within cellular pathology which is histopathology and cytopathology Lab Tests Online UK,2017. In recent years, cellular pathology has become more closely involved inthe direct management of patients. This report shows how clinical practice hasbeen affected by these respective technologies and how further development willgive impact on the patient through targeted therapeutics and diagnostics MaryHannon, 2009. Advanced techniques in diagnostic cellular pathology that is explainedin this report are virtual microscopy, cytopathology, flow cytometry, immunohistochemistryand tissue in situ hybridization. DISCUSSION Basic Techniques in Diagnostic Cellular PathologyBeforethe advanced techniques are widely used, some basic techniques are commonlyused.
First is gross examination which is examination of organs and tissues macroscopically to selectrelevant portions for microscopic examination. It can be accurately made in 90 % of specimens while theremaining 10 % is depending on the pathologist’s skill. However, thepathologist’s skills are rapidly declining thus lower the accuracy and precisionGeller,SA., 2014.
Secondis histopathology technique which includes fixation,embedding, and staining. Fixation is to preservetissues permanently. Tissue embedded in paraffin to be made into thinmicroscopic sections and microtome will cut into sections. Staining uses avariety of dyes to stain various cellular components of tissue Edward, C.,2018.Third is microscopy examination which are either light microscope or electron microscope can be used. Electron microscope utilizes beams of electronsrather than visible light to magnify the cells in a tissue sample which allowsmuch greater magnification, enabling the visualization of organelles within the cells Lab TestsOnline UK, 2018.
Molecular TechniquesMolecular pathology focuses on the diagnosisand study of disease through the examination of molecules within bodily fluids,tissues or organs Harris TJ., 2010. First is Polymerase chain reaction (PCR)which enables the amplification of specific sequences of nucleic acids from anextremely small amount of genetic starting material which usually performed ona variety of fresh specimens Bethesda, 2004. Second is Real-time PCR which detects pathogens in the research setting and diagnostic settings. It combines PCR chemistrywith either a fluorescent probe or DNA detection dyes such as Sybr green Sumathi,S., 2012.
Third is Spectralkaryotyping which uses 23 sets ofchromosome-specific “painting” probes to identify chromosomal abnormalities George, J., 2003. Next is Microdissection of tissue sections andcytological preparations which has been used increasingly for the isolation ofhomogeneous since it allows precise examination Fend, F.
, 2000. Lastly is Forensic pathology focuses on the causes of death as opposed toillnesses and their cures or treatments. A forensic pathologist must remove anextremely thin section of the tissue for an autopsy to study the areas ofbody tissue Mary Hannon, 2009. Advanced Techniques in Diagnostic Cellular PathologyFor the past recent years, manybasic techniques for cellular pathology diagnosis have been replaced withadvanced techniques which have many benefits.
First technique is Virtual microscopy which is the newtechnique which replaces telepathology system. It utilizes digitization ofwhole-microscopic glass slides via computer-aided systems to produce virtualmicroscopic slides for the interpretation of tissue sections Mary, H., 2009. The advantages are ease of navigation while maintaining orientation, produce better image quality, greater time efficiency and can view anypart of the tissue section at any magnification Ngozi, N., 2017. Equipments of virtual microscopy are automated microscopes which is a High-specificationmicroscopes combine imaging and computational technology to produce the device Mary, H., 2009.
Figure 1: AutomatedMicroscope Mary, H., 2009. Besides that is Scannerssuch as Progressive scan CCD systems which has capability for slide observation and allows digital imagecapture.
It additionally has Internet communications capabilities which are themajor feature. Samples can be viewed on networked PCs at remote locations Mary, H., 2009. Figure 3: Scan CCD system LabWrench, 2018 Next is Aperio ScanScope system which offers aslide capacity of 120 slides and is suitable for environments such ashospitals, labs and research organizations. Itcreated an alternative way to tiling, termed ‘line scanning’ which accuratelymoves the slide under a line-scan camera to acquire the image Mary, H., 2009.
Figure 5: Aperio ScanScope scanning system Mary, H., 2009. Applications ofvirtual microscopy in diagnosis ofdisease is that it has very high interest, forexample, in cancer biomarker expression quantification (e.g. HER2/NEU) whichimportant for both patient health and financial considerations Mary, H.
, 2009. For education, traditionally it has been based onprinted micrographs and projection slides. Now, modern textbooks provide asupplemental CD with digital images.
This enables viewing of any part of aspecimen at any magnification Mary, H., 2009. Lastlyare research studies.
All studies generallyshow ‘proof of concept’ with small images captured from a traditional CCDcamera. In molecular pathology research, virtualmicroscopy could provide the entire study material viewable and it would bevaluable for authors, journals, and readers. Lundin, M., 2004 Secondtechnique is Liquid-Based Cytology. In an attempt to improve the traditional Pap smear,Liquid-Based Cytology has been introduced.
The aim is to improve both thesensitivity and specificity of the cervical smear. One difference between LBCand traditional technique is that the cells are rinsed into a vial of fixative,which allows better preservation of cells so, clearer nuclear staining which isthe main principle for this techniqueMary, H., 2009. Figure 8: CellProcessing Using LBC Mary, H., 2009. Advantages ofthis technique is that the Cellularmaterial evenly distributed and spread on the slide, cellular materialwell-preserved, reduces mucus, blood, and exudates on slide, and reducesscreening time Mary, H., 2009.
Figure 9: Conventional Smear vs.Liquid Based Michael, A., 2006 Applications for this technique in Cervical Screening is that it reduces the number of false-negative test results, invasivecancer incidence, make diagnosis accurately and decrease in time taken to obtainthe smear Mahboobeh, S.
, 2007. For oral brush, it improves cytodiagnostic accuracy and providesan adequate sample of oral epithelium. LBC also removes most mucus, protein andred cells from the microscope slides, distributes cells evenly, maintainsdiagnostic clusters, reduces scanty preparations and eliminates air-dryingartifacts in oral samples Shwetha, N., 2016