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CITOLOGIA EXFOLIATIVA DEL CITOLOGIA EXFOLIATIVA DEL TRACTO RESPIRATORIO TRACTO RESPIRATORIO
Dra. Himelda Chávez T.Dra. Himelda Chávez T.
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Citologia del tracto respiratorioCitologia del tracto respiratorio
EsputoEsputo Citología Bronquial Citología Bronquial
ASPIRADO BRONQUIAL ASPIRADO BRONQUIAL CEPILLADO BRONQUIALCEPILLADO BRONQUIALLAVADO LAVADO
BRONQUIOLOALVEOLARBRONQUIOLOALVEOLAR
Esputo PostbroncofibroscopìaEsputo Postbroncofibroscopìa
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Citologia del tracto respiratorioCitologia del tracto respiratorio
Detección de tumores Detección de tumores malignosmalignos
En el seguimiento de En el seguimiento de pacientespacientes
Infecciones oportunistasInfecciones oportunistasOtras lesiones benignasOtras lesiones benignas
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El CITODIAGNOSTICO REQUIEREEl CITODIAGNOSTICO REQUIERE
Buena conservaciónBuena conservaciónProcesado correcto Procesado correcto Células de todo el aparato respiratorioCélulas de todo el aparato respiratorioCélulas en cantidad suficienteCélulas en cantidad suficienteEstudio de tres días consecutivos.Estudio de tres días consecutivos.
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Características macroscópicas.Características macroscópicas.
AspectoAspecto
TraslúcidoTraslúcido
BurbujasBurbujas
PurulentoPurulento
MucopurulentoMucopurulento
MucohemorrágicoMucohemorrágico
Color Color
BlanquecinoBlanquecino
TransparenteTransparente
Amarillo – verdeAmarillo – verde
Amarillo – verdeAmarillo – verde
Estrías rojasEstrías rojas
Causas probables Causas probables
Bronquitis agudaBronquitis aguda
Edema de pulmónEdema de pulmón
Abscesos, infecciónAbscesos, infección
BronquitisBronquitis
BronconeumoníaBronconeumonía
BronquiectasiaBronquiectasia
Tuberculosis Tuberculosis Tumor,TBCTumor,TBCBronquitis, Neumonía Bronquitis, Neumonía
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Componentes celulares normales del arbolComponentes celulares normales del arbolrespiratorio.respiratorio.
Células escamosasCélulas escamosasCélulas caliciformesCélulas caliciformesMacrófagosMacrófagosCélulas cilíndricasCélulas cilíndricasCélulas cuboideasCélulas cuboideasLeucocitos Leucocitos
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ESCAMOSASESCAMOSAS
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CILINDRICASCILINDRICAS
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CELULAS BRONQUIOLARESCELULAS BRONQUIOLARES
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CELULAS DE RESERVACELULAS DE RESERVA
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METAPLASICASMETAPLASICAS
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REACTIVASREACTIVAS
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MACROFAGOSMACROFAGOS
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EOSINOFILOSEOSINOFILOS
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CRISTALES DE CRISTALES DE CHARCOT-LEYDENCHARCOT-LEYDEN
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ESPIRAL DE CURSHMAUNNESPIRAL DE CURSHMAUNN
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CELULA VEGETALCELULA VEGETAL
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CUERPO FERRUGINOSOCUERPO FERRUGINOSO
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CORPORA AMILACEACORPORA AMILACEA
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CANDIDIASISCANDIDIASIS
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CRIPTOCOCOCRIPTOCOCO
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ASPERGILLOSISASPERGILLOSIS
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ACTINOMICESACTINOMICES
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PneumocystisPneumocystis
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TUBERCULOSISTUBERCULOSIS
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PARASITOS PARASITOS
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CAMBIOS MALIGNOSCAMBIOS MALIGNOS
CARCINOMA ESCAMOSOCARCINOMA ESCAMOSO
QUERATINIZANTEQUERATINIZANTENO QUERATINIZANTENO QUERATINIZANTE
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CAMBIOS MALIGNOSCAMBIOS MALIGNOS
ADENOCARCINOMA ADENOCARCINOMA
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CAMBIOS MALIGNOSCAMBIOS MALIGNOS
CARCINOMA CARCINOMA BRONQUIOLOALVEOLARBRONQUIOLOALVEOLAR
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CAMBIOS MALIGNOSCAMBIOS MALIGNOS
CARCINOMA INDIFERENCIADO CARCINOMA INDIFERENCIADO DE CELULAS PEQUEÑAS DE CELULAS PEQUEÑAS
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CAMBIOS MALIGNOSCAMBIOS MALIGNOS
CARCINOMA INDIFERENCIADO CARCINOMA INDIFERENCIADO DE CELULAS GRANDESDE CELULAS GRANDES
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Resumen de condiciones para la adecuación del Resumen de condiciones para la adecuación del especimenespecimen EsputoEsputo
Numerosos macrófagos alveolaresNumerosos macrófagos alveolaresLa adecuación del espécimen en una muestra simple es La adecuación del espécimen en una muestra simple es
directamente proporcional al número de macrófagos directamente proporcional al número de macrófagos alveolares que contiene (Greeberg 1983).alveolares que contiene (Greeberg 1983).
Las células bronquiales son insuficiente evidencia de Las células bronquiales son insuficiente evidencia de adecuación.adecuación.
Aspirado y cepillado bronquialAspirado y cepillado bronquialNumerosas células bronquialesNumerosas células bronquiales
Lavado bronquioloalveolarLavado bronquioloalveolarAbundantes macrófagos alveolaresAbundantes macrófagos alveolaresLa presencia de células escamosas puede ser pequeña o La presencia de células escamosas puede ser pequeña o
pocapoca
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Citologia de EsputoCitologia de Esputo
VENTAJAS VENTAJAS Fácil de obtener si es Fácil de obtener si es
espontáneo.espontáneo. Extensa área muestreadaExtensa área muestreada Buena para tumores centralesBuena para tumores centrales Asequible para el diagnostico Asequible para el diagnostico
de tumores malignosde tumores malignos Buena eficacia de diagnóstico Buena eficacia de diagnóstico
especialmente para carcinoma especialmente para carcinoma escamoso y de células escamoso y de células pequeñaspequeñas
Es el mejor test de tamizajeEs el mejor test de tamizaje
DESVENTAJASDESVENTAJAS Difícil de obtener si no es Difícil de obtener si no es
espontáneoespontáneo No ayuda a localiza la lesiónNo ayuda a localiza la lesión Pobre para tumores periféricosPobre para tumores periféricos Los tumores benignos difíciles Los tumores benignos difíciles
de diagnosticarde diagnosticar Menos agudeza diagnóstica Menos agudeza diagnóstica
para adenocarcjnoma para adenocarcjnoma metástasis o linfomametástasis o linfoma
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CiTOLOGiA BRONQUIALCiTOLOGiA BRONQUIAL
VENTAJAS VENTAJAS Puede localizar lesiones, Puede localizar lesiones,
establecer diseminación y establecer diseminación y diagnóstico de enfermedad diagnóstico de enfermedad difusa.difusa.
Correcta precisión de tumores Correcta precisión de tumores malignosmalignos
Buena tanto para lesiones Buena tanto para lesiones centrales o periféricascentrales o periféricas
Tumores pequeños pueden ser Tumores pequeños pueden ser diagnosticadosdiagnosticados
DESVENTAJASDESVENTAJAS Consumo de tiempo, Consumo de tiempo, No para tamizajeNo para tamizaje Tumores benignos menos Tumores benignos menos
accesibles para el diagnosticoaccesibles para el diagnostico Lesiones muy periféricas no Lesiones muy periféricas no
pueden ser diagnosticadaspueden ser diagnosticadas Área limitada para muestreoÁrea limitada para muestreo
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Sensitivity and Specificity of the Three Diagnostic Sensitivity and Specificity of the Three Diagnostic Cytologic Procedures*Cytologic Procedures*
Method Method Most Sensitive to Most Sensitive to Most Specific forMost Specific for
Sputum Sputum Squamous, small cell Squamous, small cell Squamous cells Squamous cells
carcinomascarcinomas carcinomascarcinomas
Bronchial washingBronchial washing Squamous cells Squamous cells Squamous, small cell Squamous, small cell
carcinomascarcinomas carcinomascarcinomas
Bronchial brushingBronchial brushing Squamous cells Squamous cells Small cells Small cells carcinomas carcinomas adenocarcinomaadenocarcinoma
** The sensitivity of the three procedures for the diagnosis of The sensitivity of the three procedures for the diagnosis of adenocarcinoma is about equal. In fact, the overall performance of adenocarcinoma is about equal. In fact, the overall performance of sputum cytology, bronchial washing, and bronchial brushing are about sputum cytology, bronchial washing, and bronchial brushing are about equal, but complementary.equal, but complementary.
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