The CYTOLOGIC RESEARCH (Greek kytos a receptacle, here — a cell + logos the doctrine) — the research based on studying by means of a microscope of features of structure of the cells, cellular structure of bodies, fabrics, liquids of a human body and animals is normal also at pathological processes. C. and. it is widely applied in biology to studying of patterns of a structure and cell activity and in medicine — to diagnosis of various diseases. Methods C. and., used in forensic medicine, allow to find cellular elements of the damaged fabrics on various tools, vehicles, etc. (see. Medicolegal laboratory researches).
Diagnostic C. and. it is similar with gistol. a research of biopsy material (see. Histologic methods of a research) on the purpose (intravital recognition patol. process), methodical basis (morfol. analysis), to an object of a research (components patol. sites of body and fabric), to methods of coloring of a kernel, cytoplasm and other structural elements of a cell. However at a cytologic research, unlike histologic, it is required the smaller amount of material (separate cells, their complexes) is considerable, from to-rogo it is possible to prepare tsi-tolite within several minutes. drug (a smear, a print), as a rule, without long pretreatment and without resorting to the help of the special equipment. At the same time the material subjected to C. and., allows to estimate changes only on the limited site. Besides, in the course of preparation of a smear the space relationship of components of fabric remaining in gistol is broken. a cut (only occasionally in tsitol. drug small fragments of fabric are found). Thus, when it is required to reveal a relative positioning of cells and intercellular substance in the studied fabrics, C. and. concedes gistol. to a research.
C. and. more preferably when the biopsy (see), in need of detailed studying of features of structure of cells, bystry obtaining result is impossible or undesirable (e.g., at inspection of the patient in the conditions of policlinic, mass prof. surveys of the population).
Distinguish C. and. so-called exfoliative material (a phlegm, urine, juice of a prostate, washouts from various bodies during endoscopy, and also from a neck and a cavity of the uterus, allocation from mammary glands, scrapings and prints from erozi-rovanny or ulcer surfaces, fistulas, wounds, liquid from joint and serous cavities, a cerebrospinal and amniotic fluid); punctates (the material received at an aspiration diagnostic puncture, preferential fine needle) and prints from remote fabrics, napr, surfaces of a fresh section quickly remote or taken for gistol. researches of fabric.
By means of a cytologic research estimate a condition of an epithelium, a mesothelium and extent of its proliferation; hormonal activity at women; control a damage rate of tumor cells at treatment of malignant tumors, change of the hormonal status under the influence of hormonal therapy, watch dynamics of healing of wounds, etc.
C. and. widely apply during operation to the urgent solution of diagnostic tasks (establishments of the nature patol. process, identification of metastasises of a tumor or its germination in surrounding fabrics, existence of cells of a tumor in edges of an operational section, etc.). Value of such research is especially big in need of the analysis of the friable, crumbling masses, the bone and calciphied tissues or very small centers not suitable for an urgent gistol. researches.
At diagnosis of diseases of various bodies apply algorithms tsitol. researches. At this C. and. consider as an integral part of the general complex of diagnostic actions. The problem of an algorithm (see the Algorithm diagnostic) consists in receiving maximum objective tsitol. information in the shortest possible time, without harm for the patient, at the minimum number of researches. The algorithm provides need of first-priority use of the safest and effective ways of receiving material, preference of single-step complex researches at the obligatory accounting of features of a current patol. process, respect for the principle of succession of information. The expected result of C. and. depends on that, material is how correctly received (directly from the site of defeat or near it, from the site of a necrosis, hemorrhage etc.). In many cases the doctor-cytologist personally participates in carrying out the punctures and other manipulations directed to receiving material for C. and.
Character and a way of receiving material for C. and. is defined by localization patol. process in this or that body (fabric).
At diseases of skin (see) by means of C. and. study scrapings and prints from an ulcerated surface, punctates from patol. educations.
At defeats of soft tissues and bones, diseases of a thyroid gland (see) and bodies of a hemopoiesis (see) an object C. and. punctates from sites of defeat are. At diseases of a nervous system of C. and. subject cerebrospinal liquid (see), at diseases of an eye (see) — scrapings from a surface of a conjunctiva (see Conjunctivitis), punctates from a vitreous.
At diagnosis of diseases of a respiratory organs tsitol. the phlegm is subject to a research (see), including and a phlegm, allocation a cut it is induced by inhalation of trypsin; the material received by scraping, aspiration (see), washout, a puncture (see), including limf, nodes of a mediastinum (see) during a bronkhoskopiya (see) and transthoracic puncture.
On purpose tsitol. diagnoses of diseases of the digestive system investigate washouts from a gullet (see), a stomach (see), a duodenum (see), sigmoid and a rectum (a «blind» way); the washouts received under direct vision through the catheter brought to the site of defeat; scrapings about the help of a nylon brush during an ezofagoskopiya (see), gastroscopies (see), duodenoskopiya (see), sigmosko-piya, rektoskopiya (see Rektoromano-skopiya); scrapings and the aspirated material from the general bilious and main pancreatic channels during a retrograde endoscopic pankreatokholangiografiya (see Ban-kreatokholangiografiya retrograde); punctates from sialadens (see), a liver (see); punctates, scrapings and prints from various abdominal organs at a laparoscopy (see Peritoneoskopiya); the ascitic liquid received at a laparocentesis (see).
At diagnosis of diseases of a mammary gland (see) study allocations from a nipple and the punctates palpated and revealed by means of mammography (see) and termografiya (see) not palpated educations.
At diagnosis of diseases of men's generative organs of C. and. subject punctates from a small egg (see) and a prostate (see).
Tsitol. diagnosis of diseases of bodies of urination is based on a research of the emitted urine (see); the residual urine received from a bladder by a catheter; washouts, scrapings, the aspirated material, the received at a tsistoskopiya (see) and retrograde catheterization of an ureter and a renal pelvis (see Catheterization of uric ways); punctate from a kidney (see Kidneys, methods of a research).
Methods of processing of material and coloring tsitol. drugs are various and depend on a research objective. As the result of a research often is based on identification of thin damages of nuclear and cytoplasmatic structures, confidence is necessary that these changes are not the artifacts connected with disturbance of a technique of processing and coloring of material. On the basis of a research of adequate and representative material establish tsitol. diagnosis. At the same time consider the overall picture found in tsitol. drug, and not just changes of separate cells, take anamnestic, radiological, endoscopic and other data into account.
As well as at any morfol. research, reliability of C. and. depends on sensitivity and specificity of a method, correctness and reproducibility of results. In a crust, time increase in reliability tsitol. the diagnosis it is provided by means of a number of objective methods. Cytochemical methods of a research concern to them (see) including cyto-spektrofotometriyu (see Cytophotometry) and immunocytochemistry tests (see Immunochemistry); morphometric methods (kario-and tsitometriya), mathematical methods (calculation of informational content and weight coefficients tsitol. signs). For carrying out diagnostic C. and. often use polarization microscopy (see the Microscope), fazovokontrastny microscopy (see), luminescent microscopy (see). In nek-ry cases received for C. and. cells with success cultivate as a part of fabric culture (see Cultures of cells and fabrics); at the same time they form these or those structures characteristic of a certain fabric that quite often facilitates the solution of differential and diagnostic tasks.
250 CYTOLOGIC RESEARCH
are important unification and standardization of criteria tsitol. diagnosis. It can be affirmative with accurate definition of nature of a disease, presumable that shall be considered as the instruction on need of additional diagnostic testings, and negative. The last does not exclude the estimated diagnosis, especially in the presence of these other diagnostic methods testifying in advantage a wedge, the diagnosis. By an important method of assessment of these C. and. also dynamic overseeing a wedge, disease after establishment tsitol is. diagnosis. Standard of correctness tsitol. the diagnosis results gistol in most cases are. researches. At complex use tsitol. and gistol. researches it is possible to achieve the most high level of reliability morfol. diagnosis.
In a crust, time of C. and. even more often is an independent diagnostic method in many fields of medicine. Below the short characteristic of features tsitol is given. researches in oncology, obstetrics and gynecology, surgery.
The cytologic research in oncology allows to establish belonging of cells to a malignant tumor (see) on the basis of detection of the majority of signs of a zlokachestvennost in them (polymorphism of cells, kernels, kernels, atypia of kernels, increase of number of mitoses, etc.). Tsitol. the picture usually reflects features gistol. structures of a tumor, degree of its differentiation, and sometimes and gistogenetiche-sky features. Tsitol. verification of new growths is based on modern gistol. classifications of tumors taking into account opportunities tsitol. method.
Being an effective diagnostic method at any stage of a progression of a tumor (see), C. and. allows: 1) to define character and extent of proliferation of an epithelium, a mesothelium, and also to watch in dynamics the nature of cellular changes; 2) to diagnose malignant tumors practically of any localization and a wedge, stages (it is promoted by development of the endoscopic equipment allowing to make a purposeful research of the bodies earlier unavailable the extra opera-tsionnomu morfol. research); 3) to establish gistol. a form of benign and malignant tumors, and also degree of a differentiation of a malignant tumor that matters for the choice of a rational method of treatment and assessment of the forecast of a disease; 4) to define prevalence of a malignant tumor, stating its germination in the next bodies, distinguishing metastasises in limf, nodes and other bodies; 5) to estimate sensitivity of a tumor to lay down. to influences (radiation therapy, chemotherapy, an immunotherapy) that is important during the development of rational methods of treatment and dynamic control of its results.
C. and. it is applied at mass prof. surveys of the population for the purpose of early detection of pretumor diseases (see) and tumors. For more effective use of C. and. in this area the statistical and flowing scanning systems automated connected with the COMPUTER are developed. The automated analysis tsitol. drugs promotes objectification and standardization of criteria tsitol. diagnoses.
C. and. for establishment of the exact diagnosis of a tumor it is carried out preferential in onkol. institutions (see. Oncological service). At a biopsy of tumors of various localization it is rational to conduct in parallel with histologic a cytologic research of a biopsi-rovanny piece that improves results morfol. researches of tumors.
Reliability of C. and. at a carcinoma of the stomach, a lung, milk and thyroid glands, a neck of uterus, a bladder, a rectum, at malignant tumors of skin, soft tissues and bones more than 80% make. Tsitol. the research allows to solve differential and diagnostic problems not only at tumors, but also at hyperplastic, metal astichesky, dysplastic changes of an epithelium, reactive and proliferative changes of not epithelial fabrics, to establish the nature of various not tumoral diseases.
The cytologic research in obstetrics and gynecology is conducted for the purpose of studying of cells of an epithelium of a vagina (kolpotsito-logical researches), a vulval part of a neck of uterus, the channel of a neck of uterus and a mucous membrane of a body of the womb, a research of punctate (or aspirirovanny material) from tumors of female generative organs for the purpose of detection of features of the hormonal status, pretumor diseases and cancer of female generative organs. Material for C. and. vulval smears, smears prints, washouts from a vagina, superficial scrapings from a mucous membrane of female generative organs, aspiri-rovanny material from an endometria and fabric punctates serve (from tumors of ovaries, etc.). Most often use a kolpotsitologichesky research of vulval smears (Papanikolau's method). Indications to its use are various diseases of female generative organs, at to-rykh assume these or those hormonal disturbances. Besides, a kolpotsitologichesky research diagnoses of pregnancy (see), control of its dynamics use for establishment of phases of a menstrual cycle (see), identifications of threat of interruption and a perenashivaniye of pregnancy (see).
Tsitol. the picture vulval separated (smears or washouts) depends on the sum of hormonal influences (oestrogenic, gestagenny, androgenic). The vulval smear consists of cells of various layers of an epithelium of a mucous membrane of a vagina (see). In it also endocervical, endometrial cells, erythrocytes, multinucleate cells, products of enzymatic activity of cells (esterases, acid phosphatase, to a beta glitch of a ronidaz, etc.), leukocytes, Dederleyn's sticks, a cellular detritis sometimes meet.
Smears take from a back or posterolateral vault of the vagina by means of the wooden pallet, a wadded or gauze ball, a branch of tweezers or a glass pipette with a rubber bulb. At children and virgins use a fluted probe for this purpose, it is possible to use also ear spoon. One day before capture of a smear inspected shall not make any vulval manipulations and have the sexual intercourses. The smear is applied on glass together with a drop of isotonic solution of sodium chloride, and then by means of other glass smear it a thin coat. Fixing is made dehumidification in mix of equal parts of 96% of alcohol and ether. For polikhromny coloring the smear is better to fix mix 97% of isopropyl alcohol (V2 of h) and ice acetic to - you (2V2 h).
There are simple and difficult methods of coloring of a smear. Refer coloring to simple methods hematoxylin-eosine, solution methylene blue, fuchsin and across Romanovsky — to Gimza (see Romanovsky — Gimza a method). To difficult — polikhromny coloring (the modified Papanikolau's method — Shora), the combined methods of coloring, coloring cresylic violet.
For the characteristic of a vulval smear consider a quantitative ratio of cellular elements by means of special indexes. Most often use a @-riopiknotichesky index — the relation of the keratosic cells with a pikno-tichny kernel to total number of cells; an acidophilic (eosinophilic) index — percent of acidophilic (eosinophilic) cells in relation to all counted; a basal index — percentage in a smear of basphilic cells and some other indexes.
Kolpotsitogramma — aggregated data about character of a vulval smear with the indication of its reaction, percentage of cells of different layers of a vulval epithelium and existence of other elements, napr, erythrocytes, histiocytes, leukocytes, etc. At newborns in the first
5 days of life under the influence of estrogen of mother vulval smears consist preferential of intermediate and basphilic cells, from the 5th to the 8th day when oestrogenic stimulation from mother weakens, there is desquamation of cells, and in a smear erythrocytes can appear, from the 8th to the 14th day smears gain atrophic character, to-ry remains to 8 — 9-year age when single superficial basphilic and acidophilic cells appear.
In the prepubertatny period in a smear superficial cells appear already in bigger quantity. Increase in an acidophilic index — a sign of fast approach of the first periods. Tsitol. the picture of a vulval smear undergoes changes also according to phases of a menstrual cycle.
Characterizing influence of hormones on tsitol. a picture of a vulval smear, one may say, that are oestrogenic (see) have the proliferative effect which is shown in emergence of the flat isolated cells of a superficial epithelium. Progesterone (see) promotes involution tsitol. pictures (desquamation, emergence of intermediate cells and their accumulations). Androgens (see) cause «aging» of a smear — proliferation basal and partly a medine. On tsitol. a picture of a vulval smear also non-hormonal factors exert impact (keratinization of a vagina, a tservitsita, colpitises, syringings,
especially with use of chemical
means, vaginal use
of medicines, rings, intrauterine contraceptives). There is a dependence
between gistol. picture of a mucous membrane of a vagina and tsitol. picture of a vulval smear. There is also certain
(not less expressed) communication tsitol. pictures of a vulval smear with changes in an endometria. However nek-ry researchers note the known discrepancies between a picture of a vulval smear and the nature of changes in an endometria, especially at disturbances of a menstrual cycle. In need of a kolpotsitogramm it can be replaced urotsitogrammy since the mucous membrane of a bladder undergoes vaginas of change, similar to a mucous membrane (owing to a community of development from an urogenital sine).
The cytologic research in surgery is applied more often for the purpose of studying in dynamics of wound exudate (see). At the same time it is possible to establish character of a wound process (see Wounds, wounds), to track efficiency of processing of a wound and dynamics of its healing, to estimate, to a certain extent, immune properties of an organism, its local regenerator opportunities. At trophic ulcers (see) emergence in contact preparations of lymphocytes (see) and monocytes confirms efficiency of the carried-out treatment, the good forecast; existence in exudate of a large number of plasmocytes (see) points to the long course of process. Criteria are developed for interpretation tsitol. data at the posttraumatic and complicated postoperative wounds, actinomycotic fistulas, syphilitic ulcers.
Bibliography: Abramovm. G. Klinich
of Skye cytology, M., 1974; Arsenyev M. G. Kolpotsitologicheskiye of a research in diagnosis and therapy of endocrine gynecologic diseases, M., 1977; Gynecologic endocrinology, under the editorship of K. N. Zhmakin, page 82, M., 1980; Degrell. The atlas of diseases of a mammary gland, the lane with Wenger., Budapest, 1977; Miller A. N. Tsitomorfolo-gicheskaya diagnosis of tumors, Kiev, 1983; The Guide to cytologic diagnosis of tumors of the person, under the editorship of
A.S. Petrova and M. P. Ptokhov, M., 1976; T and sh to e To. Introduction to quantitative cyto-histologic morphology, the lane from Romanians., Bucharest, 1980; Cytologic diagnosis of pretumor processes and malignant new growths, under the editorship of. I. Ya. Yakovleva, Chisinau, 1976; Chentsovyu.S. General cytology, M., 1984; I to about in l e in and I. Ya. ikukute B. G. Morphological diagnosis of pretumor processes and tumors of a uterus on biopsies and scrapings, Chisinau, 1979; G about m r e 1 C. Atlas of diagnostic cytology, N. Y. and. lake, 1978;
Gynecological cytopa-thology, ed. by M. J. Ayala a. F. N. Ortiz, St Louis, 1978; To o s s L. G. Diagnostic cytology, v. 1 — 2, Philadelphia — Toronto, 1979; To o s s L. G. ampere-second about 1 e m a n D. V. Advances in clinical cytology, L. a. o., 1981; Schneider M.L, u. S t an e m-m 1 e r H. - J. Atlas der gynakologischen Differentialzytologie, Stuttgart — N. Y., 1976; S with h n e 1 1 J. D. Zytologie und Mik-robiologie der Vagina, Basel, 1975; Z i m-mer S., N e u s e r D. u. Kuhndel K. Vaginale und zervikale Zytodiagnostik, Lpz., 1978.
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