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Diagnostic Cytopathology, 2nd edition
  1. S Boerner

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    Gray W, McKee T, eds. (£195.00.) Elsevier Science Limited, 2003. ISBN 0 443 06473 3.

    It is a daunting task to produce a contemporary and comprehensive textbook of cytopathology that adequately deals with the full expanse of the topic. This difficultly is compounded by the need to write a text that is not only appealing, but functional as a desktop reference for a diverse group of practitioners, from student cytotechnologists to expert cytopathologists. Yet, the second edition of Diagnostic Cytopathology manages to accomplish much of this task.

    This single volume book is organised into a systems based review of general cytopathology. The second edition maintains its focus on cytomorphology with minimal discussion of sampling and preparatory techniques. There is some attention paid to the impact on cytomorphology of exfoliative versus fine needle aspiration sampling; however, the effects of cytopreparation on the cytological features and interpretation are not frequently discussed. This is particularly evident in the differences in cytomorphology that occur as a result of liquid based preparations. The application of immunocytochemistry is covered in most sections, but again greater detail would be useful, and there is little discussion on the use of other ancillary studies. New technology is mentioned as overviews on liquid based processing, automated screening devices, and other modalities for screening for cervical cancer, in addition to newer sampling techniques, such as endoscopic ultrasonographically guided pancreatic fine needle aspiration.

    There is variability in the comprehensiveness of coverage of some topics, but particular strength is shown in the sections relating to the respiratory system, serous cavities, breast, and female genital tract. With some other chapters, the advanced reader may be left wanting for details when topics are rather briefly discussed. To compensate, the reader is at times directed to a chapter’s bibliography for further information, and in general these bibliographies are reasonably comprehensive, although inclusion of more recent references is inconsistent. Novice readers, in particular, may appreciate the use of bulleted lists of the pertinent cytological features of the major entities, which have been offset from the text by coloured headings and are followed by a discussion of the diagnostic pitfalls, review of the differential diagnoses, and often with a suggested approach to the separation of entities under consideration. These discussions could have been aided by the inclusion of tables to contrast and compare differential diagnostic entities. In addition, allusions to the limitations of cytomorphology to separate some entities could have been more clearly stated.

    The nomenclature and classification systems used in the book follow most standard schema, but there are some chapters in which the most recent classification system is not applied. Notable examples include the use of the 1973 World Health Organisation (WHO) classification for urothelial neoplasms rather than the 1998 WHO/International Society of Urological Pathology Consensus classification, and the use of the revised European–American classification of lymphoid neoplasms (REAL classification) rather than the 2001 WHO classification. The book does not address recent changes to histological classifications that have rendered definitive cytological diagnosis more difficult. This is illustrated by bronchioloalveolar carcinoma, which by the 1999 WHO histological definition must be a non-invasive lesion. Because invasiveness cannot be accurately assessed in exfoliative or fine needle aspiration specimens, a cytological diagnosis of bronchioloalveolar carcinoma may not correlate with the ultimate histological classification of the excised lesion; a dilemma that is not addressed within the discussion of this entity.

    The book is richly endowed with colour photomicrographs aptly demonstrating the pertinent cytological features of normal cellular constituents and pathological entities under discussion. The cytological images include air dried and alcohol fixed material with both May–Grünwald–Giemsa and Papanicolaou staining. Some illustrations of liquid based preparations are included, but most of the illustrations are of conventional cytological preparations. Occasional gross and histological photographs are used to good effect and the focus, clarity, and colour balance of most illustrations are good to excellent.

    Diagnostic Cytopathology demonstrates a number of strengths and is particularly useful as an introductory and general reference book. Further updating would be useful with regard to classification schemes and the impact of new technologies on cytological interpretation, but this does not detract from the wonderful illustrations and sound basis in cytomorphology with which the book is endowed.