Biomedical Engineering Reference
In-Depth Information
if it is deeper, and there are intermediate cells in it, and also superfi cial
cells, then it is CIN II. This is very simplifi ed this here, what I am saying
(…) and then if it is
even deeper
down, so that there are
basal cells
in
the sample too. First it is superfi cial cells and intermediates, and basal
cells. Then there are parabasal cells (…) and if those cells that sit in the
basement layer are changed, then it is CIN III. And then there's also
cancer in situ that is more like the whole chunk then. And there are also
changes in glandular cells. Then there is cancer, it is diffi cult to say then,
if
there are glandular cells or squamous cells. Yes, of course you learned
that once. How it should be. There are always textbook examples. Like
that, like that, like that so, of course there are simple rules to follow.
(Olivia, Cyto lab)
The diagnosticians talked about typical and exceptionally clear cases, for
example in regard to cells, bacteria, or indications of virus effect
on the cells.
Such cases were often referred to as 'clear-cut' or 'classic', for example 'a
classic CIN I' or 'clear-cut CIS'. For example, Filippa at Cyto lab described
how some viruses, like HPV, could display a very distinct and typical picture
of cells:
… you see it, you call it 'birds' eyes' in English. You see clearing around
the nucleus in the cytoplasm, which almost looks like a bird's eye,
you could say and that is the fi rst sign, that there is clearing around
the nucleus. It is often orange cytoplasm. It is a little clear around the
nucleus. It has a special appearance.
This may have been the kind of picture that the cytologist saw during
the demm in the second of the introductory examples, when he wanted
to take a picture of the 'crystal clear HPV'. But how did aesthetic notions
such as 'beautiful' relate to this? The easy accessibility and interpretability
of the relatively scarce classical samples seemed to have an aesthetic value in
themselves - they were deemed 'beautiful' samples. The cytodiagnostician
above also talked about the importance of 'seeing it'. A core feature of
cytological assessments is that it is quintessential to have visual evidence for
one's assessment. The pivotal role of visual evidence was also clear when
visual evidence was lacking. At times, the effect
on the cells by bacteria, virus
or candida was more diffuse. Sometimes a particular classifi cation could be
suspected without fi nding any visible evidence:
Maybe sometimes you don't see it, but you see that it must basically be
condyloma. If you see it you are a hundred percent certain that it is that.
But sometimes you can maybe get a feeling. It
can
be koilocytes, those
changes are called koilocytes …
(Filippa, Cyto lab)
