fundamental to this , however , is a reliable , quick , inexpensive , and accurate diagnosis .
surgical histopathology remains the gold standard for diagnosis , but is generally unavailable in most developing countries and comes with challenges of equipment , expertise , and cost to facilities and patients at large .
it involves obtaining tissue diagnosis of subcutaneous and other tumors with the aid of a special needle that with imaging techniques may allow its use in a wider scope .
the procedure is regarded as inexpensive , requiring simple equipment , less time consuming , and can be applied to a wide range of diseases .
detailed explanation of the procedure and how it can be applied throughout the body has been documented and has been adopted in clinical practices , especially for quick bedside diagnosis of various malignancies .
the dangers of false positives and the inevitability of false negatives can not be overemphasized because a negative cytology report is not definitive , especially when there is a mass .
a good cytopathology practice also requires access to surgical pathology to clarify cases for which cytopathology gives uncertain or no diagnosis and for validation and quality control purposes .
fine needle aspiration cytology ( fnac ) clinics and cytology practices have been running in the pathology department of our hospital since 2010 . after brief closure of the department in 2004 ,
much assistance in re - establishing the department to include a cytology unit came from the breast health global initiative .
there was also collaboration between our hospital and a teaching hospital in europe to train pathologists and technologists in 2005 . in this article
, we present a detailed retrospect of experience in running cytopathology services in kumasi , ghana after its establishment .
this will provide a clear picture on the performance with respect to this service as offered by the department .
this was a retrospective study conducted using reports on all cytology procedures performed in our department from january 2010 to december 2011 .
this retrospective study was approved and supervised by the research and development unit ( ethics committee ) of our institution with approval from the department .
participant informed consent was not obtained ; hence , patient records / information was anonymized and de - identified prior to analysis . in routine cytology practice in our centre , pathologists performed fine - needle aspirations with the assistance of biomedical scientists .
the method applies to various body sites and its interpretation was documented by a previous documented review of the methodology .
fluid specimens ( urine and pleural effusions ) are centrifuged to obtain the sediment , which is then used to prepare direct smears .
wet mounted smears are stained with papanicolaou stain , giemsa , and sometimes hematoxylin and eosin .
neelsen ( zn ) staining was performed on smears when tuberculosis was clinically suspected or if granulomatous inflammation was noted on the routine stains .
no gynecological smears were , however , received in the department during the period under review .
this was due in part to the unavailability of cyto - screeners to assist in the anticipated workload at the time .
data from the reports were entered into an excel spreadsheet and analyzed using the statistical package for social scientists , version 16.0 ( spss , il ) .
this was a retrospective study conducted using reports on all cytology procedures performed in our department from january 2010 to december 2011 .
this retrospective study was approved and supervised by the research and development unit ( ethics committee ) of our institution with approval from the department .
participant informed consent was not obtained ; hence , patient records / information was anonymized and de - identified prior to analysis .
in routine cytology practice in our centre , pathologists performed fine - needle aspirations with the assistance of biomedical scientists .
the method applies to various body sites and its interpretation was documented by a previous documented review of the methodology .
fluid specimens ( urine and pleural effusions ) are centrifuged to obtain the sediment , which is then used to prepare direct smears .
wet mounted smears are stained with papanicolaou stain , giemsa , and sometimes hematoxylin and eosin .
neelsen ( zn ) staining was performed on smears when tuberculosis was clinically suspected or if granulomatous inflammation was noted on the routine stains .
no gynecological smears were , however , received in the department during the period under review .
this was due in part to the unavailability of cyto - screeners to assist in the anticipated workload at the time .
data from the reports were entered into an excel spreadsheet and analyzed using the statistical package for social scientists , version 16.0 ( spss , il ) .
a total of 836 cases were reviewed , an average of approximately 418 cases were performed a year .
this accounted for approximately 5.7% of the total workload of the department including surgical pathology , cytopathology , and autopsy .
approximately one - fifth ( 19.4% ) of the cases reviewed , however , had no age specified .
more than half ( 58.0% ) of the cases received had no clinical diagnosis indicated on the forms .
although a number of cases had no indicated gender , this formed only 4.3% of the total cases [ table 1 ] .
characteristics of cytological cases received at the department relative to gender the most aspirated sites in decreasing order was the breast ( 20.2% ) , lymph nodes ( 20.0% ) , thyroid ( 12.0% ) , soft tissue ( 9.6% ) , salivary glands ( 4.7% ) , ascitic fluid ( 4.1% ) , pleura ( 5.1% ) , csf ( 0.7% ) , liver ( 0.6% ) , and other miscellaneous sites , which accounted for 23.0% of the total .
more females had samples aspirated from the breast ( 27.9% ) and thyroid ( 13.4% ) than males ( 5.6% and 8.8% , respectively ) .
there were more benign than malignant cases with respect to all sites aspirated except the breast ( 18.3% ) , lymph nodes ( 35.0% ) , and soft tissues ( 11.7% ) where the reverse occurred [ table 2 ] .
site distribution of cases according to age , sex , and nature of diagnosis in table 3 , the age and sex distribution of cases received relative to cytological diagnosis is shown .
there was an equal distribution ( 40.5% ) of reported benign and malignant cases among those aged 5 years and below .
there was an almost equal distribution of malignant ( 38.0% ) and benign ( 35.0% ) cases among males .
diagnosis , however , could not be ascertained in 28 ( 3.3% ) of the cases .
reasons for this included inadequate smear , inadequate cellular material , and no palpated lumps for aspiration .
cytopathology is a relatively inexpensive , quick , and reliable method of diagnosis in pathology settings , especially in developing countries .
, we sought to evaluate the frequency of cases , efficacy of diagnosis , its impact , and relevance to referring clinicians .
most of the fnacs performed were aspirates from the breast ( 20.2% ) , followed by that from the lymph nodes ( 20.0% ) .
our findings show that the use of cytopathology for the diagnosis of the abovementioned conditions is very important , in the triage of such patients and the provision of a quick diagnosis for prompt attention by referring clinicians .
in contrast to our findings , a study conducted in cameroon showed that lymphadenopathy was the most common indication for fnac followed by breast . in most of the cases under review , cytopathology was very useful in distinguishing benign and malignant cases .
benign cases were , however , more than malignant cases , a reassurance that with the right treatment patients are likely to have a very good prognosis .
this is contrary to a finding by spillane et al . , who found a high percentage of malignant lesions being diagnosed by fine - needle aspiration biopsy ( fnab ) .
however , this was of benefit by reducing the number of corresponding open biopsy rates .
the percentage of the total workload accounted for by cytopathology was relatively small . because pathology practice in ghana is still in its infancy with high rate of autopsy practice , cytopathology is usually not considered by clinicians , especially those in peripheral hospitals .
laboratory request forms , which provide detailed information about the patient and clinical history , were not properly filled or completed by referring clinicians .
approximately one - fifth of all the forms received did not specify sex , and more than half ( 58.0% ) of the cases did not have any clinical diagnosis indicated by referring clinicians .
this could lead to a possible delay in diagnosis as well as reliability of the diagnosis .
a similar finding was also reported in a study conducted in ghana on the evaluation of request forms received in a hematology laboratory , and seems to be the trend in most hospitals in ghana .
seventy - seven percent of the time , a working diagnosis was achieved with a definite diagnosis in 73.4% of cases
. however , there is a limitation in determining the specificity and sensitivity of diagnosis .
poor requests from referring clinicians , varied sampling techniques by pathologists and biomedical scientists may account for the high rate of nondiagnostic cases .
going forward , histology and cytopathology correlation may be necessary to reduce the high rate of non - diagnostic cases and to ascertain unclear cases .
it has been suggested that having a pathologist on site for fnac improves sampling and enables assessment of clinical signs and symptoms to enhance diagnostic accuracy .
this was a major advantage in this setting , as seen in the percentage of diagnosis obtained
. more work , however , needs to be done to improve efficiency and diagnosis rate .
cytopathology practice in our centre has improved and is promising . improving and expanding on the current practice will ensure that pathologists in practice sustain and improve diagnostic cytopathology , as well as provide materials for training young pathologists . as the number of pathologists on site increases , sub - specialization in cytopathology may be necessary to enhance the diagnostic capability of the department .
 aim : surgical pathology service is generally unavailable in most developing countries and comes with challenges . 
 cytopathology is a reliable , inexpensive adjunct to surgical histopathology . 
 we present a retrospective review of the various cytopathology cases received at the department.materials and methods : a retrospective review of 836 cytopathology cases from january 2010 to december 2011 at the department of pathology of our hospital was conducted . 
 all cytopathology reports and records from the department were retrieved and analyzed using the statistical package for the social sciences version 16 for windows.results:a total of 836 ( mean age 38.18  22.18 ) cases were reviewed , at an average of approximately 418 cases performed a year ( 5.7% of the total workload ) . 
 more than half ( 58.0% ) of the cases received had no clinical diagnosis indicated on request forms . 
 seventy - seven percent ( 77% ) of the cases were diagnosed as either definite or nondefinite . 
 the breast was the most aspirated specimen site ( 20.2% ) . 
 benign cases formed 45.0% of all the cases and 29.0% were malignant . 
 there were more benign than malignant cases with respect to all sites aspirated except the breast ( 18.3% ) , lymph nodes ( 35.0% ) , and soft tissues ( 11.7% ) where the reverse occurred.conclusion:patronage of cytopathology in kumasi is increasing and serves as a quick , cheap , and effective alternate means for diagnosis . improving and expanding on the current practice will ensure that pathologists in practice sustain and improve diagnostic cytopathology and provide material for training young pathologists . 
Introduction
Materials and Methods
Design/Site
Ethical consent
Sample collection and reporting
Data handling
Results
Discussion
Conclusion
Financial support and sponsorship
Conflicts of interest