Who reads CSF cytology?

[Enkidu]

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Who generally reads CSF cytology? Is it part of neuropathology training, or is it part of cytopathology training.

On a similar note, is reading peripheral blood smears part of clinical pathology or is it part of anatomic pathology? Is peripheral smear clinical, but bone marrow is anatomic?

 

[KeratinPearls]

Who generally reads CSF cytology? Is it part of neuropathology training, or is it part of cytopathology training.

On a similar note, is reading peripheral blood smears part of clinical pathology or is it part of anatomic pathology? Is peripheral smear clinical, but bone marrow is anatomic?

CSF is read by the cytopath service. Reading peripheral blood smears and bone marrows is done by the hematopathologist. Hematopathology is considered clinical pathology.

 

[BU Pathology]

At some institutions, CSF cytology is read by the hemepath people, with appropriate consultation with their cytologic colleagues.

 

[KCShaw]

Also depends on how it's been sent/ordered. Clinicians don't always know what they should be requesting, and may end up with no more than a technician's neutrophil count. If they're looking for tumor, however, it should be sent to the cytopathology service and the attending on would (where I have been, anyway) determine if it should be reviewed by other specialists such as hemepath.

Similar goes for peripheral smears -- a slide might be made and manual count performed by a technician on certain cases, and not reviewed by a pathologist unless it's been flagged by the tech or the test is appropriately ordered. If you -have- a hematopathologist, that person typically handles path review for smears, marrows, etc. If there is no hemepath, then it depends on how the institution/practice has decided how to do it.

Most clinicians, and certainly junior staff, are at risk for not knowing how or when to appropriately order these relatively uncommon (outside of certain settings) evaluations based on the question they're trying to answer.

Otherwise I basically agree with previous replies.

 

[pathstudent]

It is worth pointing out that the CSF is rarely involved by primary brain tumors. Usually you are looking at inflammation, leukemia, lymphoma. That is why Neuropathologists don't develop mastery in it.

 

[yaah]

CSF can be read as a cytology specimen. More commonly hemepaths review it as it is a fluid that is sent for cell counts and at most places gets a mandatory hemepath review particularly if there is a history or suspicion of malignancy. Some clinicians send it for cytology and cell counts, which doesn't usually add much in most cases. If it is sent for cytology it is usually to rule out metastatic carcinoma or involvmenet by leukemia/lymphoma.

 

[LADoc00]

Answer: everyone. I read them all the time. Doesnt require special training at all, routine general specimen. Nothing to worry about here, move along.

 

[deleted314957]

Who generally reads CSF cytology? Is it part of neuropathology training, or is it part of cytopathology training.

On a similar note, is reading peripheral blood smears part of clinical pathology or is it part of anatomic pathology? Is peripheral smear clinical, but bone marrow is anatomic?

When you are a solo general pathologist like me in a ~175 bed hospital YOU do. You recomend flow, send to your heme path or cytopath associates ( who are at a large central lab in my group) when you need help but 95%+ of it is a no brainer.

 

[yaah]

I always find cytology (i.e. pap stain) on CSF kind of useless. The heme slide they use for cell counts is usually enough. I usually just encourage clinicians to submit it for flow if they are worried about leukemia or lymphoma because cyto is unlikely to help unless there are tons of cancer cells.

 

[BierstiefelAndy]

I always find cytology (i.e. pap stain) on CSF kind of useless. The heme slide they use for cell counts is usually enough. I usually just encourage clinicians to submit it for flow if they are worried about leukemia or lymphoma because cyto is unlikely to help unless there are tons of cancer cells.

Agreed. I like air-dried, Wright-Giemsa stained preps better, especially if you're dealing with a lymphoma/leukemia patient (which need flow anyway). Hence, if it's a heme-y thing, send the CSF to heme. If it's a carcinoma thing, give it to cytology...carcinomas can be diagnosed easily on both pap stained and W-G stained preps.

 

[coomasie blue]

The secret to a good CSF is immediate processing. If a CSF sits around it becomes useless. Immediate processing using either a diff quick type stain is ideal. ThinPrep in general stinks for hematologic malignancies.
In any good lab, whenever a CSF hits the floor it needs to be processed ASAP. Preferably spun down (cytospun)....

If a hematologic malignancy is in the differential, an aliquot must be put aside for flow.

 

[yaah]

It always bugs me when they send flow for cell counts and cytology to rule out leukemia/lymphoma and there isn't enough left for flow. That's because you sent it for cytology!

 

[WhtsThFrequency]

The secret to a good CSF is immediate processing.

YES. I worked as an emergency tech in the veterinary clinical pathology laboratory for a year or so....and lord, its true .For CSF always did a glucose count, protein count, a cytospin, and a hemocytometer count with differential.

Hence why, as a resident, I was incredibly pissed when I drew an immediate postmortem sample on a neurologic sheep,and the attending pathologist said they'd run a specimen up to clin path right then...and lo and behold, I see it sitting in the fridge the next day *headdesk*. CSF is almost as bad as urine cytology - cells tend to degenerate so fast......