Cytodiagnostics in Pneumology - State of the Art 2019

Pulmonary cytology represents one of the basic diagnostic methods in pneumopathology. It is primarily focused on: 1) assessment of biologic nature of the pathologic process (recommended terminology and classification according to the The Papanicolaou Society of Cytopathology guidelines, 2016), 2) typing of malignant tumors (according to the WHO Classification of Tumours of the Lung, 2015), 3) assessment of mediastinal and hilar lymph nodes (including preoperative staging), 4) attaining adequate material for ancillary testing, 5) bronchoalveolar lavage (BAL) differential cell count and cytopathology studies. The need for sufficient amount of material especially in tumour diagnostics in the era of targeted therapy/personalized medicine is increasing. In pneumocytology, the diagnostic yield is greatly improved by endobronchial ultrasound-guided (EBUS) fine-needle aspiration accompanied by rapid on-site evaluation (ROSE) provided by a cytopathologist. This process gives the possibility to carefully handle and triage the specimen for diagnostic procedures as well as specific ancillary studies. When carcinoma is suspected, both cytology and biopsy specimens should be obtained whenever possible and reviewed together to achieve the highest specificity and diagnostic concordance. If no histology sample is available, attaining adequate material in the cell block becomes crucial, as it enables to carry out immmunohistochemical methods and molecular genetic testing from cytology material. For optimal acquisition, processing and testing of limited specimens in pneumocytology, as well as in pulmonary histopathology, the key issue is to establish and operate a multidisciplinary team including a cytopathologist/surgical pathologist, radiologist and pulmonologist.