Cytology and FISH

Cytology

Cytology is defined as the study of cells. In cytopathology, it is a random sampling of cells used as a tool for the diagnosis of benign, atypical, dysplastic or cancerous cells. The advantages of utilizing cytology testing are that sampling is less invasive for the patient and sample size needed for testing is minimal.


Gastrointestinal Cytology

Diagnostic cytology of the gastrointestinal tract is composed of the esophagus, stomach, small and large intestine. Cytologic samples may be submitted fixed in 95% ethanol or rinsing medium such as Cytolyt.


Smears and/or liquid based preparations are made and stained for screening and diagnostic purposes performed by certified cytotechnologists and pathologists.

  • Example of normal squamous cells within esophageal brushing sample.
  • Example of Positive Gastric brushing with pap stain.

Barrett's Esophagus FISH

Fluorescent In-Situ Hybridization (FISH) is performed on samples of Barrett's epithelium of the esophagus, determining the risk of developing dysplasia and malignancy in patients with known Barrett's Esophagus.

This Assay is tested using cytology brushings from known Barrett's esophagus (BE) patients and/or suspected BE nodules to help determine the risk of developing dysplasia and adenocarcinoma. Cytology specimens collected via endoscopic brushing result in more comprehensive and Wide Area Tissue Sampling (WATS) than biopsies alone. FISH testing is performed on the cytology sample as an adjunct to the four quadrant biopsies. Studies have shown progression to High Grade Dysplasia & Esophageal Adenocarcinoma in spite of no dysplasia being seen on traditional biopsies within 33 months of significant genetic abnormalities and if polysomy are seen on the FISH testing. (1) Barrett's FISH uses probes that help identify genes to include: MYC, p16, HER2 and ZNF217.


References:

  1. 1. Fritcher, E. G., Brankley, S. M., Kipp, B. R., Voss, J. S., Campion, M. B., Morrison, L. E., . . . Halling, K. C. (2008). A comparison of conventional cytology, DNA ploidy analysis, and fluorescence in situ hybridization for the detection of dysplasia and adenocarcinoma in patients with Barretts esophagus. Human Pathology, 39(8), 1128-1135. doi:10.1016/j.humpath.2008.02.003

HER2 FISH

The Human Epidermal growth factor receptor 2, known as HER2, is frequently recognized with being overexpressed in gastroesophageal cancers. With the molecular abnormalities identified utilizing our HER2 FISH panel, we are able to provide clinicians with additional options for treatment for advanced gastric cancer.

  • HER2 FISH Assay

Standard Diagnostic Procedures

Urinary cytology screening is used for inflammatory diseases, precancerous conditions, and cancer. Cytology has a high specificity of 98% in the diagnosis of bladder cancer.
Implementation of The Paris System for Reporting Urinary Cytology was adopted and used primarily to lower atypical diagnostic rates, focus on high grade screening and provide our clinicians with a more efficient and diagnostic way of reporting and treating a patient.

Enhanced Cytology Testing

hTERT Antibody ICC - To enhance our highly specific cytology testing we have added a FDA approved biomarker that aids in the detection in bladder cancer.

  • Anti -hTERT Antibody (RNA component/ telomerase reverse transcriptase) contains a cancer-related biomarker known as telomerase. The addition of Anti-hTERT ICC is crucial in patient care with the knowledge that 90% of bladder cancers use telomerase. When this antibody stains positive, it indicates an increased chance of urothelial cancer (including pre-invasive urothelial proliferation and invasive cancer).
  • Positive hTERT slide
  • Anti -hTERT Antibody (RNA component/ telomerase reverse transcriptase) contains a cancer-related biomarker known as telomerase. The addition of Anti-hTERT ICC is crucial in patient care with the knowledge that 90% of bladder cancers use telomerase. When this antibody stains positive, it indicates an increased chance of urothelial cancer (including pre-invasive urothelial proliferation and invasive cancer).

Flourescent In- Situ Hybridization (FISH)

UROVYSION FISH

Urovysion FISH is FDA approved for detection of bladder cancer in voided urine. This FISH assay is used for chromosomal abnormalities associated with the development and recurrence of bladder cancer. The detection of chromosomal abnormalities such as aneuploidy in chromosomes 3, 7, 17 & the loss of 9p21 locus. The UroVysion® assay is designed to detect these abnormalities in patients with recurring Bladder Cancer and is a useful test for detecting Bladder Cancer in patients with persistent microcytic hematuria. Used in conjunction with urine cytology and cystoscopy, the UroVysion® assay produces a 97% sensitive rate of detection of recurrent Bladder Cancer.

Enhanced Cytology Testing

As part of The CytoGen Complete Study, Urovysion FISH analysis testing increases the sensitivity for the detection of bladder cancer.

  • Normal transitional cell by Urovision
  • Abnormal transitional cell by Urovision

PTEN/ ERG FISH

Phosphatase and Tensin Homolog, also known as PTEN, is a tumor suppressor gene that is associated with a deletion in about 50% of prostate cases. Various deletion combinations may be reported with this FISH assay to include: the loss of the PTEN gene and whether it is hemizygous, where one allele is absent, or homozygous, in which both alleles are absent.

The Erythroblast transformation specific Related Gene or ERG has been linked to be involved with prostate cancer through another gene identified as TMPRSS2. An ERG deletion, increased copy number and/ or rearrangement on FISH could furthermore correlate with cancer prognosis and reoccurrence.

PTEN and ERG FISH results will ultimately benefit patients diagnosed with prostate cancer to assess the aggressiveness of treatment.

  • Normal ERG FISH

Urinary STI Testing

Urine specimens may be submitted to test for sexually transmitted infections. Our testing method is through Transcription Mediated Amplification or (TMA) PCR. We currently offer STI testing to both males and females to include:

  • Chlamydia trachomatis
  • Neisseria gonorrheoa
  • Trichomonas vaginalis
  • Mycoplasma genitalium

Women's Health Gynecology

The Pap smear is used for diagnosing inflammatory diseases, precancerous lesions as well as cervical/vaginal cancer.

The Thin Prep Pap test is used for our gynecological screening. Additional molecular testing may be run from the original Pap test vial. Co-testing with Human Papillomavirus (HPV) testing may be performed with FDA approved Aptima® HPV assay. There are 14 types of the most common HPV High-risk types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 detected through E6/E7 viral mRNA. If positive, HPV high-risk genotyping will be performed for 16, 18/45, and reported.

Additional testing for chlamydia trachomatis (CT), Neisseria gonorrhea (NG) & Trichomonas vaginalis (TV) may be performed using FDA approved Aptima® Combo 2 Assay & Aptima® assay respectively.

Herpes Simplex Virus 1 & 2 (HSV 1&2) testing is provided via collection by anogenital swab and performed with the Aptima® HSV 1 &2 test assay.

Mycoplasma genitalium (M. gen) testing is another STI test that may be run off the Aptima multi-test swab.


  • ThinPrep® Pap Vial
    Pap Test
    HPV HR
    HPV genotyping
    CT/ GC
    Trichomonas
  • Aptima® Multitest swab
    CT/ GC
    Trichomonas
    HSV 1&2
    Mycoplasma genitalium