ISSN: 2041-6792

Clinical Investigation

Cytopathology

Cytopathology specimens most appropriate for the diagnosis of TB are fine needle aspiration biopsies (FNABs). A presumptive diagnosis of TB may be suggested on other specimens such as pleural and pericardial effusion samples, ascitic fluid, cervicovaginal (Pap) smears, or sputum, but more effective methods such as fluorescent smear microscopy or culture are available to this end. These specimen types are more commonly submitted to the cytopathology laboratory to exclude or diagnose malignancy. In children the difficulty in obtaining a sputum specimen is well documented, and, although induced sputum may provide an adequate specimen, this requires skill and may be a source of nosocomial infection for health workers. Alternative specimens may be aspirates from the nasopharynx, trachea, and stomach, which may not be well tolerated. Hospitalized patients may undergo bronchoscopy and washings and brushings, and bronchoalveolar lavage (BAL) specimens may be submitted to the cytology laboratory. This is usually in addition to the specimens submitted to microbiology for direct microscopy and culture. Adequate clinical information including the origin of the specimen submitted, age and gender of the patient, and duration of symptoms greatly enhances the diagnosis proffered by the pathologist. The immune status of the patient is essential, if known to the clinician, as specimens from immunocompromised patients may show significantly altered cytomorphology compared with the classical cytomorphology of immunocompetent patients.    

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