Foundation of Diagnostic Cytology

The history of diagnostic cytology is like a winding road with many obstacles, but to the attentive traveler–the historian–brightly illuminated directional signs and familiar names are visible in the distance. Until the 19th century, microscopy was not respected in medicine. Such giants in pathology as the Italian Morgagni (1682-1771), the British Baillie (1761-1823), and the French Bichat (17711802), did not appreciate the utility of the microscope. There were four great technical advances that gave impetus to microscopic examination of tumor cells in smear preparations. It all began in the 1830s with imprint smears and continued with sporadic microscopic examination of sediments from body fluids. And finally, in the 1920s, aspiration and exfoliative cytology were introduced. Johannes Muller (1801-1858), a pathologist in Berlin (Fig. 1), was the first, in 1838, to show cancer cells as they appeared in the microscope on scrapings from the cut surface of surgically excised tumors. He illustrated, among other things, cells of mammary carcinoma and osteosarcoma [1]. In 1843, cancer cells were shown on scrapings from a uterine cervical cancer [2] and cytologic preparations were made from a fistulous parotid tumor believed to be malignant [3]. A year later, colored prints of tumor cells of breast carcinoma, sarcoma of the mandible, and soft tissue sarcomas of the leg were published [4]. In 1846, the same author described and illustrated cancer cells in blood-stained sputum of a patient with lung cancer and in the vomitus of another patient who had gastric cancer [5]. Lebert (1813-1878), a French pathologist, collected specimens for cytologic examination from effusions, tracheobronchial secretion, and urine. He prepared innumerable imprint smears from surgical specimens, including tumors and nonneoplastic lesions. His cytology atlas, published in 1845, contains more than 250 cytologic illustrations. The pictures were taken through the microscope by the newly-invented Deguerre technique [6]. Paget (1814-1879) prepared smears from needle aspirate of a breast carcinoma in 1853 [7]. Malignant cells were diagnosed in urine in 1856 [8] and in 1869 cancer cells were recovered from material passed by the urethra [9]. By the 1890s, diagnosis of bladder tumors by microscopic examination of urine had become a routine procedure [10]. Cytologic examination of sputum was soon introduced as routine laboratory procedure [11] and microscopic examination of ascitic fluid was Address correspondence to Steven I. Hajdu, M.D., 1759 Drumcliff Court, Westlake Village, CA 91361-1636, USA; tel 805 496-0691; fax 805 496-0620; e-mail sih15@aol.com. Fig. 1. Johannes Muller (1801-1858) made the first smears from tumors in 1838 [1].