SCREENING FOR CANCER 1055-3207/99 $8.00 + .OO ISSUES IN CYTOLOGIC SCREENING AND EVALUATION Diane D. Davey, MD THE ESSENTIALS: KNOW YOUR LABORATORY The key to getting helpful results from cytologic specimens is to know your laboratory and pathologist(s). Specimen submission requirements, processing, and terminology vary among laboratory settings. Similar to other anatomic pathology disciplines, there is also interobserver variabil- ity in diagnostic assessment, especially for low-grade malignancies, pre- cancers, and proliferative disorders.24 In this sense, cytologic evaluation differs from most clinical laboratory tests because the final diagnosis is the result of human judgment and the application of criteria that are al- most never "black and white." Surgeons should call the laboratory in advance with questions con- cerning specimen submission. Correcting problems later may be difficult, especially because cytologic specimens are often small and may be diffi- cult to replace. If estrogen receptors or other special stains are desired, the laboratory may need to make special cell preparations at the time of initial processing. Flow cytometry for lymphoma markers requires unfixed spec- imens, preferably submitted in cell culture media. Surgical oncologists may be required to use a number of cytology laboratories because of in- surance or managed care coverage. A manual that includes specimen in- structions, submission requirements, pathology telephone numbers, and cytology requisitions should be accessible to physicians and office staff. Clinical history is critical for proper interpretation. Prior chemother- apy or radiation may induce changes that mimic malignancy. Similarly, From the Department of Pathology and Laboratory Medicine, Division of Cytopathology, University of Kentucky Medical Center, Lexington, Kentucky SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA VOLUME 8. NUMBER 4. OCTOBER 1999 623