exfoliated cell examination

The cancer tissue has high metabolism, and the surface of the cancer cells lacks calcium and hyaluronidase, and the adhesion to each other is lower than that of normal cells, and it is easy to fall off. Suspected of oral cancer, should be sampled in any nodules in the mouth and ulcers that have not healed. When suspected of nasopharyngeal carcinoma, the suspicious part of the nasopharynx is sampled. When you are highly suspected of lung cancer, you should take the fresh sputum coughed up by the bronchus, or take the secretions of the lesions under the direct view of the fiberoptic bronchoscope. Basic Information Specialist classification: growth and development check classification: microscopy Applicable gender: whether men and women apply fasting: not fasting Analysis results: Below normal: Normal value: no Above normal: negative: Grade I: negative. Non-nuclear heterogeneous cells, which are normal cells or generally degenerative cells in the smear. Positive: Grade IV: Positive. Typical cancer cells are found in smears, and are sometimes classified according to their morphological characteristics and distribution. Tips: When using 2% procaine for local anesthesia, a skin test should be routinely performed. Normal value The grading standard for cytological diagnosis is based on the Pap five-level method. normal: Grade I: negative. Non-nuclear heterogeneous cells, which are normal cells or generally degenerative cells in the smear. abnormal: Class II: Nuclear heterogeneity. A small amount of nuclear heterogeneous cells were found in the smear, which was caused by a high degree of inflammatory hyperplasia. Level III: Suspicious. Severe nuclear heterogeneous cells are seen in the smear, and their morphology is basically consistent with the malignant tumor cell standard. However, the number is too small, and the possibility of precancerous lesions or high-inflammation graves cannot be completely excluded. It is recommended to repeat the clinical examination. Grade IV: Positive. Typical cancer cells are found in smears, and are sometimes classified according to their morphological characteristics and distribution. Clinical significance Suspected of oral cancer, should be sampled in any nodules in the mouth and ulcers that have not healed. When suspected of nasopharyngeal carcinoma, the suspicious part of the nasopharynx is sampled. When you are highly suspected of lung cancer, you should take the fresh sputum coughed up by the bronchus, or take the secretions of the lesions under the direct view of the fiberoptic bronchoscope. Suspected breast cancer can be taken by nipple smear examination, or the removal of breast mass for pathological examination. Suspicious esophageal cancer should be taken at the x-ray prompt site for esophageal pull-net method, or by wiping the lesion at the esophagus for direct observation. When the gastric cancer is to be diagnosed, the gastric lavage fluid or gastric juice should be taken as a sediment sample, or the lesion should be sampled under the direct view of the fiber endoscope. In the duodenal drainage fluid, if cancer cells are found, it is helpful for the diagnosis of duodenal cancer, biliary cancer, and pancreatic cancer. If the sample is examined suspiciously in the duodenum under endoscopic direct vision, it is effective for the detection of cancer in the visible range. Retrograde cholangiopancreatography (ERCP) can be used to sample the suspicious tumors of the ampulla. In the case of suspected rectal cancer, the lesion can be sampled under direct vision of the proctoscope. For high colon cancer, sampling under fiberoptic colonoscopy can increase the detection rate of cancer cells. When suspected meningeal cancer or leukemia, lung cancer metastasis, attention should be paid to the examination of cancer cells in cerebrospinal fluid. Suspected to be metastatic chest and ascites, it is necessary to find cancer cells. Suspected ureteral cancer, bladder cancer, should take morning urine to find cancer cells. Suspected for prostate cancer, should be taken from the prostate secretion smear, check. For patients with cervical erosion, cervical smear or scraping can be used to find cancer cells. As a main method for screening cervical cancer, if there is "cervical inter-variation", it should be followed up. Use the intrauterine pipette to absorb secretions, look for cancer cells, and help diagnose the endometrial cancer. Positive results may be diseases: postmenopausal cervical cancer, rectal cancer, follicular dysplasia, middle ear cancer, ureteral tumor, neurogenic bladder, liver tumor, Barrett's esophagus matters needing attention Oral biopsy notes: 1, detailed medical history before surgery, blood routine examination, to rule out serious diseases that can not tolerate surgery. 2. Preoperative talks should explain the meaning of surgery, the risk of surgery, and the consent of patients and their families to patients and their families. 3. The patient cannot undergo surgery under fasting conditions. 4, when using 2% procaine for local anesthesia should be routine skin test. 5, for lesions that can not be removed at a time should not be reluctantly removed. 6, surgery must be treated, and preoperative biopsy treatment of the disease itself should be avoided biopsy (such as malignant melanoma, carotid body tumor, hemangioma, etc.). Breast cancer biopsy notes: l If the volume of the tumor is small (less than 2.5 cm) and there is no adhesion to the surrounding tissue, it should be completely removed as much as possible, and then fixed with 10% formalin, and immediately sent to the pathology department for biopsy. 2. If the tumor adheres to the skin, the skin should be removed by diamond in the biopsy to facilitate postoperative suture. 3. If the volume of the tumor is large and adheres to the periphery, the complete resection is difficult, and the malignant is suspected. When the specimen is removed, 2 to 3 pieces of the lesion and the different parts of the lesion should be removed as much as possible. slice. 4. If the lump is far away from the nipple, when the biopsy specimen is cut, the skin should be made with a radial incision around the nipple, which can reduce the number of cut off the milking camp without affecting the radical resection. 5. If the lump is close to the nipple, make an annular incision along the junction of the areola and the breast skin as much as possible, so that the mark is not obvious. 6. When the suspicious tissue of the breast is cut, it must reach a sufficient depth so as not to take only the necrotic tissue on the surface of the cancer or only a few cells, and it is difficult to make a histopathological conclusion. 7. Anyone who suspects a cancerous mass should never cut through the cancerous tissue when it is removed. Otherwise, it will easily cause the spread and pollution of cancer cells. Nasopharyngeal cancer biopsy notes: 1. The following conditions should be explained to the doctor or suspended: fever, high blood pressure, bleeding disorders, women's menstruation, etc.; 2. The relevant laboratory test results, CT or MR films should be carried during the examination for reference by doctors; 3. Before the examination, the nurse used 2% ephedrine to spray the bilateral nasal cavity to contract the inferior turbinate, and used 1 to 2% of the cain spray to spray the bilateral nasal cavity and inhale the nasopharynx for surface anesthesia; 4, the patient lying on the bed in the operating room, do not move the head and hands, there is discomfort; 5. If there is suspiciousness in the examination, a biopsy is needed. This is a less invasive examination. It is not necessary to be too nervous. After the biopsy, there may be a brief amount of bleeding. Do not suck and rub your nose vigorously for about half an hour. You can go home to rest without active bleeding, and avoid eating too hot and irritating diet. Gastrointestinal biopsy notes: 1, the application of low-tension drugs: 654-2, adult dose of 15 ~ 20mg, after 10 minutes of intramuscular injection. For those who are allergic to 654-2, glucagon can be used. 2, should pay attention to contraindications before the examination, indications, suspected gastrointestinal obstruction, perforation. A history of bleeding within 1 week or an endoscopic biopsy within 1 week is banned. 3, gas production powder should be quantified 3 ~ 6g, can not be snoring during the inspection process, so as not to affect the double contrast effect of gas discharge. 4, segmentation of the cardia, stomach, stomach and antrum; supine position, prone position and filling phase, mucosal pressure is indispensable, otherwise it is easy to miss diagnosis. 5, gastrointestinal examination should pay attention to changes in the contour of the gastrointestinal tract such as: liver left lobe occupying lesions pressing the stomach and upper part of the stomach (the author has found in the past 2 years 4 cases of left hepatic lobe occupy the stomach caused by the stomach The bottom left edge of the indentation, by B-ultrasound, CT diagnosed as liver cancer), pancreatic occupying oppression of the gastric antrum. Bone marrow examination notes: 1. Strict aseptic operation is required to prevent bone marrow infection. 2, the initial diagnosis of patients with bone marrow puncture should be before treatment. 3, the amount of bone marrow fluid is preferably 0.1 ~ 0.2ml. 4. It is advisable to perform a bone marrow examination for a death case within half an hour after death. 5. The syringe and puncture needle must be dry to avoid hemolysis. 6. After the puncture needle enters the bone, avoid swinging too large to avoid breaking. 7. Sap should be smeared immediately after the marrow fluid is withdrawn to avoid coagulation. 8, patients with bleeding tendency should be appropriate to extend the compression time of the puncture site, and pay attention to the presence or absence of postoperative bleeding. Inspection process Smear production method: (1) Preparation before smear and smear method 1. Preparation before smear (1) Ensure that the specimen is fresh and prepare as soon as possible after taking the material. (2) The coating operation should be light and avoid squeezing to prevent damage to the cells. The smear should be even, the thickness should be moderate, the cells should be too thick, and the cells should be too thin, which will affect the diagnosis. (3) The slide should be clean and free of oil stains. Soak it with sulfuric acid washing solution and then soak it with 75% acetic acid. (4) Specimens containing protein can be directly smeared, specimens lacking protein, and a thin layer of adhesive is applied to the slide before smear to prevent cell detachment during dyeing. The commonly used adhesive is protein glycerin, which is equalized. Chicken protein and glycerin are mixed. (5) Apply at least two slides to each patient's specimen to avoid missed diagnosis. Immediately after smear, number one end of the slide. 2. Smear preparation method (1) Push method: used for thin specimens such as blood, chest, ascites, etc. After centrifugation, a small drop of the specimen is placed on the right side of the slide, and the test solution on the slide is gently pushed to the left with a 30-degree angle. (2) Smear method: suitable for a slightly thick test solution, such as nasopharynx specimens. Apply the bamboo swab on the slide, and rotate it from the center of the slide in a clockwise direction; or apply it in parallel from the end of the slide. The application should be uniform and should not be repeated. (3) Pressure smear method: The specimen is sandwiched between two slides that are horizontally and vertically crossed, then the two slides are moved to overlap, and then pulled and pressed to obtain two smears. This method is applicable to more viscous specimens such as sputum. (4) Sucker push method: use the suction and drop the specimen on one end of the slide, then place the front end of the dropper parallel on the specimen drop, and move the dropper at the same speed parallel to the other end to push out the uniform film. This method is also applicable to chest and ascites specimens. (5) Spraying method: The specimen is repeatedly sprayed uniformly from left to right on a slide with a syringe with a fine needle, and the method is applicable to various sucked liquid specimens. (6) Printing method: cut the diseased tissue by surgery, immediately place the cut surface on the slide, and gently press the print. This method is an auxiliary method for biopsy. (2) Fixation of smear The purpose of fication is to maintain the natural morphology of the cells and prevent cell autolysis and bacterial spoilage; the fixative can precipitate and coagulate intracellular proteins and break down intracellular lysosomal enzymes, so that the cells not only maintain their natural morphology, but also Clear structure and easy to color. Therefore, the fresher the specimen, the more timely the fixation, the clearer the cell structure, and the better the staining effect. 1. Fixative solution: There are three kinds of fixatives commonly used in cytological examination: the first type of ether wine clearing solution: the fixed liquid has strong penetrability and good fixation effect, which is suitable for general cytological routine dyeing; Chloroform alcohol fixative: Also known as Carnot's fixative. Its advantages are the same as above; the third 95% alcohol fixative: suitable for large-scale anti-cancer screening. The preparation is simple. However, the penetration is slightly worse. 2. Fixed method (1) With wet fixation: the method of fixing after the smear is not dried after the specimen is dry is said to be wet. This method is clear due to the clear cell structure and fresh staining. Suitable for pasteurization or HE staining. This method is commonly used for sputum, vaginal secretions and esophageal smear. (2) Drying factor: After smear, it is not dried naturally, and then fixed. Suitable for thin specimens such as urine, gastric lavage, etc., also suitable for Reiter staining and Giemsa staining. 3. Fixed time: generally 15-30min. More specimens containing mucus, such as sputum, vaginal secretions, esophageal pull nets, etc., are prolonged due to the fixed time; urine, chest, ascites and other smears do not contain mucus, and the fixed time can be shortened as appropriate. (3) Staining of smears 1. Purpose and principle of dyeing: The day of dyeing is to make the tissue and the intracellular structure differently dyed by means of one or more dyes, so that the internal structure of the cells can be clearly observed under the microscope and the correct judgment can be made. The principle of tissue cell staining has not been satisfactorily explained, and may be a physical effect, a chemical action, or a combination of both. The physical function of dyeing is to use capillary phenomenon, permeation, absorption and adsorption to make the pigment particles of the dye firmly enter the tissue cells and make them color. The chemical action of staining is that the dye that penetrates into the tissue cells chemically reacts with its corresponding substance to produce a colored compound. Each dye has two properties, namely the production of color; the collection is organized to form affinity. These two properties are mainly produced by chromogenic genes and helper genes. Chromophore group: A derivative of benzene has an absorption band in the visible region. The apparent absorption bands of these derivatives are related to the instability of their valence bonds. For example, hydroquinone is colorless, and when it oxidizes, it loses two hydrogen atoms, and its molecules become yellowish. The enamel ring that produces the color is called a chromophoric group. If a compound contains several rings, as long as one of the oxime rings emits a color, the chromophore is called a chromogen. Auxiliary group: is a kind of auxiliary atomic group (acid-base group) which can make a compound ionize. It further deepens the color of the dye and gives it an affinity for the tissue being dyed. The nature of the coercive group determines that the dye is acidic and basic. The basic dye has an alkaline color-promoting group, and the colored portion produced in the solvent is a positively charged cation, and the kiss is combined with a negatively charged substance in the tissue cells to develop color. For example, the main chemical component of the nucleus, deoxyribonucleic acid, is easily stained with hematoxylin blue, which is called basophilic. Acid dyes have acidic chromophore groups, and the colored part in the lysozyme is an anion, which is easy to bind to the positively charged part of the tissue cells to develop color. This property is called eosinophilic, such as protein in the cytoplasm. It is easily red or orange in combination with eosin or orange. 2. Commonly used dyeing methods: The following three commonly used dyeing methods in clinical daily work: (1) Pap staining method: This method is characterized in that the cells have pleochroic colors and are colorful and colorful. The smear staining has good transparency, clear cytoplasmic granules and clear nucleus structure. For example, the cytoplasm of squamous epithelial hyperkeratotic cells is orange; keratinocytes are pink; and cells before keratinization are light green or light blue. Color, suitable for epithelial cell staining or to observe the effect of hormone levels on epithelial cells in vaginal smears. The disadvantage of this method is that the dyeing process is more complicated. (2) Hematoxylineosin (HE) staining method: The method has good staining transparency and a clear contrast between nucleus and cytoplasm. The dyeing step is simple and the effect is stable. It is suitable for sputum smear. The enamel core is purple-blue, the cytoplasm is pale reddish red, and the red blood cells are light vermilion. (3) Ritter-Gimsa staining method (wrightgiemsaatain); this method is mostly used for blood and bone marrow cytology examination. The intracytoplasmic granules and the nuclear safety structure show clearer. Easy to operate. Not suitable for the crowd Generally there are no people who are not suitable. Adverse reactions and risks Generally no adverse reactions.

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