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New visibility in the lab for cytotechnologists.

Picture a clinical laboratory. What do you see? Technologists performing tests, certainly. Pathologists examining tissue? Possibly. The cytotechnologist at the microscope? Probably not.

Cytotechnologists are the forgotten employee in many laboratories. They are a tiny minority, often numbering one per lab as in our hospital. They also lack visibility because they're usually anchored to the job of screening slides, rather than moving around. There's a tendency to dismiss their duties as very limited--just workig on Pap smears.

That's all starting to change, thanks to heightened emphasis on the most cost-effective and lowest-risk procedures to diagnose disease. Needle aspiration biopsy is rapidly becoming a popular alternative to open surgical biopsy for almost all mass lesions regardless of site, especially if the clinician suspects that diagnostic information can be obtained cytologically. But the clinician will consider that alternative only if the laboratory has a well-trained cytotechnologist and a pathology group that supprts both the procedure and the technologist's role in helping to carry it out.

In addition, sputum and urinary cytology specimens, easily obtained from patients, are becoming much more common for high-risk populations as an early means of detecting cancer. Fluids from any cyst or space are now routinely sent for cytology examination. Thus while the cervical-vaginal Pap smear remains a major part of the cytotechnologist's daily work, other procedures have greatly expanded the scope of practice.

That's certainly the case at our 440-bed hospital and 535-bed university hospital affiliate, as well as other hospitals around the country that view the cytotechnologist as a vital member of the health care team. Our cytotech has become more visible and better utilized in several ways.

To begin with, our cytotechnologist is directly involved in specimen procument. She obtains buccal smears from patients and, more frequently, assists clinicians with needle biopsy aspirations. In the latter role, she makes sure the specimen is adequate and properly preserved. For example, a clinician in radiology performing a difficult needle biopsy of a lung mass will rely on the cytotech to confirm that enough cellular material is collected before ending the procedure, thus sparing the patient a repeat biopsy. The technologist may also act to optimize preservation by fixing and staining the specimen immediately after it is taken.

The better the fixing and staining of specimens, the more reliable the diagnosis will be. Our cytotechnolgist works closely with the cytology technician, advising on proper staining techniques and lending a hand on difficult procedures. The cytology technician may want to know how many slides to prepare on a peritioneal fluid. To answer the question, the cytotechnologist makes a wet mount of the fluid and examines the cellularity.

We feel that one mark of a good cytophathologist is support by a good cytotechnologist. Our cytotechnologist is encouraged to evaluate slides fully before a pathologist reviews them. These evaluations include judgments on which special stains to use in investigating the possible types of malignancy or infectious agents. It's an independent study, based on the cellularity and uncolored by any of the additional information that a pathologist may have gathered from a biopsy and patient history.

This is a far cry from a few years ago, when cytotechnologists were expected merely to indicate a general diagnosis of "cancer." In one recent case involving malignant cells from a lung lesion, use of a mucin stain enabled the cytotechnologist to classify the malignancy as adenocarcinoma instead of large cell undifferentiated carcinoma.

We try to use the cytologist in all areas where expertise in microscopy is required, including frozen sections, other aspects of surgical pathology, and even evaluation of spermatozoa.

Our laboratory frequently receives surgical and cytology specimens from the same lesion. The biopsy may be so small that a tissue pattern is difficult to identify, while the cytology smears are adequate to make a diagnosis. These specimens are examined in concert by the pathologist and the cytotechnologist to insure agreement in deiagnosis.

The frozen section is often difficult for a pathologist to diagnose. A rapid determination of a disease process must be made from limited or distorted material, and that determination will affect the extent of surgery performed. Our cytotechnologist stands by, ready to make touch preps of the tissue to help in the valuation.

We recently had a difficult frozen section from a patient suspected of having cancer. The cells on the biopsy were badly distored, and no definite diagnosis could be made. On the other hand, minimal deformation on touch preps by the cytologist permitted us to make a diagnosis of lymphoma.

Many surgical specimens (lymph nodes, bladder, prostate, stomach, and adrenal gland, among others) received in the gross room are sent to the cytotechnologist for touch preps. She screens these slides as she would regular cytology specimens and discusses her opinion with the surgical pathologist who is evaluating the tissue slides. The cytology imprints often help in arriving at or confirming a diagnosis.

Finally, our cytotechnologist is a teacher, instructing in both the pathology resident and cytotechnology training programs at our VA hospital and university affiliate. Residents become familiar with cytologic evaluation and learn the value of a skilled cytotechnologist.

The two hospitals provide a diverse learning experience because of their different patient populations. The majority of the VA specimens are nongynecologic, just the reverse of the university specimens, and are frequencly more difficult to evaluate. Students and residents alike profit from the cytotechnologist's experience and skill in interpretation.

Our cytotechnologist program leads to a B.A., but many in the field have only two-year degrees plus one year of clinical training. The ASCP Board of Registry has concluded task analysis surveys and plans to make a bachelor's degree a prerequisite for its CT(ASCP) exampination, starting with the August 1988 exam. This requiremental recognizes the amount of expertise demanded of today's cytotechnologists.

We encourage our cytotechnologist to keep up to date in such expanding areas as needle biopsies by attending continuing education workshops whenever possible. It enhances her value to the lab and raises the level of patient care.
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Author:Heustis, Darryl G.
Publication:Medical Laboratory Observer
Date:Mar 1, 1985
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