Cytology

Analytic Cytology

The Analytical Cytology division of the Department of Cytology of the BC Cancer Agency provides an interpretive and consultative Cytometric service to the B.C Cancer Agency as well as all other Hospitals, Physicians, and Researchers throughout the Province of BC

The Laboratory is currently equipped with two Robotic Digital Image Microscopes which can be used interactively or trained for automated analysis/screening; as well as a Multiparameter , Sorting Flowcytometer.

This Laboratory is capable of processing most biological samples such as Paraffin embedded tissue, Formalin fixed tissue , fresh tissue, fresh frozen tissue, body cavity fluids and Fine Needle Aspiration Biopsies.

The results from these Laboratory tests are used in conjunction with other laboratory test and clinical observations for diagnosis, prognosis and treatment monitoring of Cancer patients throughout BC

Miscellaneous Cytology

The Miscellaneous Cytology division of the Department of Cytology of the BCCA provides an interpretive and consultative service for cytologic specimens obtained from all body sites with the exception of the uterine cervix. Commonly examined specimens include sputum, urine, pleural and ascitic fluid, cerebrospinal fluid and fine needle aspirates from breast, lymph nodes and lung. The Division also provides a fine needle aspiration service in which aspirates are both obtained and interpreted by Cancer Agency staff at the Vancouver Cancer Centre.

The Division is the largest Miscellaneous Cytology Laboratory in the province. In a year the laboratory will interpret over 20,000 specimens, the majority of them referred in from around the province. Our in house fine needle aspiration service handles over 1500 specimens a year.

Questions and Answers About:
Fine Needle Aspiration Biopsy (FNAB) at the BC Cancer Agency

What is FNAB?

FNAB is a safe, quick, and reliable way of diagnosing lumps that have been felt by you or your doctor. It is simple, requiring an appointment of only 10-15 minutes. Described more than sixty years ago, developed and refined in Sweden it is now practised worldwide.

What is the Purpose of FNAB?.

FNAB is used to obtain cells from a lump. Analysis of this tissue may lead to a firm diagnosis or a short list of possibilities. With this information your doctor will be able to advise you what the lump is and if further tests are needed or if surgery is advised.

What is the FNAB Procedure Like?

At the BC Cancer Agency, FNAB’s are done by Laboratory Physicians on the cytology team. We will ask for some history about the lump. When was it first noticed? Has it changed? Is it painful? Is there a personal or family history of concern? If you had other tests or treatment, what were the results? Often a short note from your doctor will include much of this information. This is very helpful! Finally we answer any questions you may wish to ask. As a memory aid, it is a good idea to note any questions before you arrive.

We examine the lump to confirm your own doctor’s findings and the target of biopsy. The actual biopsy takes only a few seconds. We use a very small disposable needle to obtain a reliable sample.

The skin is cleansed with alcohol and the needle inserted into the lump for about 5-10 seconds. Most lumps require two to four such samples to ensure reliable results.

After the biopsy you may return to your usual activities.

What are the Complications of FNAB?

No procedure, including FNAB, is completely without complications. A small bruise or slight swelling and tenderness may occur at the biopsy site. These require no special treatment and will resolve in a few days. Actual bleeding at the time of biopsy is usually limited to a few drops. Rarely complications, such as infection or significant bleeding may occur and may require treatment. Although the vast majority of aspirations are uncomplicated, if you have any concern, please notify the doctor who ordered the test or your family doctor immediately.

Will the Biopsy Spread Cancer?

Most of the lumps we sample are benign. Hundreds of thousands of needle biopsies have been performed on cancers worldwide, and only about two dozen instances of tumor being spread down the path of the needle have been reported. The use of very fine needles and improved technique has minimized this risk. Even if this rare complication were to occur it would not alter your chance of responding to treatment.

How are FNAB Results Obtained?

The physician who performs your aspirate will personally examine your biopsy sample with the microscope. In this way, the information gained from you, your doctor and the examination of the lump can add to what is seen in the microscope.

When Will You Know the Results?

Speed of reporting is one of the real advantages of FNAB. Usually we issue a report to your doctor’s office within 24 hours of the biopsy. If necessary, a verbal report may be issued sooner. We feel that your own physician is best able to explain what the results mean for you and what (if anything), should be done next.

What are the Limitations of FNAB?

Occasionally the sample is too limited to be helpful. When the specific cause remains uncertain, your doctor might recommend repeat FNAB, surgical biopsy or other studies. No medical test, including FNAB is 100% accurate. The chances of failing to find a cancer when one is present are 1- 5% . Therefore, after FNAB, a persistent lump should be observed. If any change occurs, further study is required. Your own physician is in the best position to advise you.

Division of Laboratory Medicine, Molecular Genetic Section

Preamble:

The Molecular Genetics Laboratories at the BC Cancer Agency, Vancouver Cancer Center, serves as a provincial referral laboratory for the diagnosis of lymphoma, leukemia, sarcoma, and hereditary breast cancer using DNA technology. The mandate of the laboratory includes; the detection of clonal and lineage-specific markers in B and T cell lymphoma, disease-specific chromosomal translocations in leukemia, lymphoma and sarcomas, the evidence of oncogene activation, deletion and amplification in solid tumors, and mutational analysis for the detection of inherited cancer susceptibility mutations asssociated with hereditary breast, ovarian and colon cancer. A combination of standard molecular genetic techniques including Southern blotting analysis, the polymerase chain reaction (PCR) and PCR from RNA are routinely used for this testing. The results of DNA studies are closely correlated with clinical, morphologic and phenotypic features.

Current research activities include the development of methods for: measurement of minimal residual disease; microsatellite analysis for the determination of loss of heterozygosity and DNA replication error repair defects; chromosome microdissection to produce custom DNA probes for studying chromosomal alterations associated with specific types of cancer, and mutational analysis for P53, BRCA1 and BRCA2.

There are no other laboratories of this size or experience in Canada with such a large menu of molecular genetic tests. This service is complemented by a large and experienced cytogenetic and FISH facility. Further details available on request.

The Tumour Marker Laboratory (TML) of the BC Cancer Agency

The TML acts as a province wide (and for some tests, nation wide) reference laboratory, and occasionally as a developmental laboratory, testing new assays for clinical usefulness.

Tumour markers are substances produced by a tumour, or by the body in response to a tumour. These substances, present in tumour tissue or cells, may be released into body fluids which can be detected by various means. The measurement of tumour markers should permit the detection of cancer and possibly identify the organ-source of the tumour. The result of the test should ideally correlate with tumour size, and the fall in level, with therapy, should correspond to positive response to treatment. Tumour markers may, however, be elevated in some benign diseases.

A tumour marker should aid in the detection of tumour, prediction of prognosis, monitoring of therapy, and prediction of recurrence. However, this is not the case with all tumour markers and patients. A patient may have extensive disease, yet show low ("normal") tumour markers, or a healthy person may have an elevated tumour marker, but no cancer. Tumour marker results can only be used in conjunction with other tests (X-rays, physicals) and the patients medical history. This is the reason that the TML does not recommend any tests for cancer screening of healthy people.

Tests done by the Tumour Marker Laboratory