Section 1 -

The Rise(s) and Fall(s) of FNAC Karin Lindholm Senior consultant Clinical Cytology University Hospital MAS, Malmö , Sweden

The Rise(s) and Fall(s) of FNAC FNAC is a Quick Simple Cheap Close to non invasive Bedside method and there will always be a need for such a method if it could answer the relevant questions in the preoperative/pre-treatment situation. Development of magnifying lenses and the microscope made it possible to see what had earlier been hidden for the human eye. Reports incl. drawings of unstained cell material from effusions, secretions and scrapings were presented already in the beginning of the 19th century and the first microphotographs in the middle of that century. The focus was on cells until methods for fixation, embedding and cutting provided material good enough for microscopy of tissues. Tissue pathology and especially the development in surgery with open surgical biopsies was a rise for histopathology and a fall for cytopathology. The introduction of frozen section for tissue biopsies preoperatively another drawback for cytology. Studies on cytological material – especially exfoliated material – continued however and in haematology where sampling and preparation was performed bedside by the haematologist there was never a fall. The second rise for cytology and the first for FNAC - however very short - was the presentation of needle aspirations of tumours from the Memorial Hospital in New York –Martin and Ellis and from Dudgeon and Patrick in UK around the 1930ths. The reason was the advantages of FNAC listed above and the opinion that tissue biopsy might not be that harmless The second rise for FNAC came in the 1950ths through the continuing use of the method by what Nils Söderström called the "professional hybrids" – clinicians with a direct need of the bedside method– most of them with knowledge in haematology; Nils Söderström in Lund and the group at the Karolinska being the first in Sweden. At that time there was, at least in Sweden, among clinicians and younger histopathologists a great interest in this new method and in the 60ths the university clinics and a few larger regional hospitals took over the increasing load of exfoliative and aspiration cytology. The knowledge and experience grew and the basic and continuing education of histopathologist and dedicated cytopathologist was good. "Cytology and its Histopathological Basis" was taught as Dr Koss coined it. The intense development of radiology with possibilities to make guided aspirations from deep sited lesions, mammography, ultrasound, CT and MR has given the cytopathologist more work the last decades. The introduction of CNB meant a sharp fall for FNAC. The development in molecular medicine has introduced among other things – prognostic and predictive factors to be analyzed; some in the preoperative situation. The minute amount of material from the FNA is a drawback which has to be meat with new technical methods in the laboratory. This growing amount of knowledge together with new claims from other specialities and the society as well as the introduction of treatment protocols, the team approach, the quality control etc has meant a lot of more work and a need of more personal! The team approach gives an excellent opportunity to continuing education - what is today called contextual education. It is often combined with introduction of sub specialities with claims of directed and longer education for the sub speciality. The teaching of cytopathology related to the sub speciality must be a rather easy task. The results of good team approach and the development and status of FNAC in soft tissue and bone will be presented in the following lectures in this session. The question of how to produce the "GP" – the general pathologist - the pathologist with good general knowledge in histopathology and cytopathology is a burning question. The more we specialize inside the hospitals and even worse between hospitals the more the patients are referred to the GP – the general practitioner – outside the hospital - for the first evaluation of the medical problems. If cytology and FNAC should be used as the excellent bedside method I listed in the beginning – the well trained cytopathologist has to be available otherwise we will be by passed.