ABPath Cytopathology flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

ASC-US management

Atypical squamous cells of undetermined significance: reflex HPV testing preferred; if HPV positive, colposcopy; if negative, repeat screening in 3 years (age-dependent).

HSIL cytology features

High-grade squamous intraepithelial lesion shows high N:C ratio, irregular nuclear membranes, coarse chromatin, and loss of polarity; warrants colposcopy with excision or ablation.

LSIL definition

Low-grade squamous intraepithelial lesion corresponds to HPV effect (koilocytosis): enlarged nucleus, perinuclear halo, and raisin-like chromatin; most regress spontaneously.

AGC management

Atypical glandular cells require colposcopy with endocervical sampling; endometrial sampling added if age ≥35 or risk factors; AIS warrants excisional procedure.

Endocervical AIS cytology

Adenocarcinoma in situ shows hyperchromatic crowded groups, rosettes, feathering, and nuclear pseudostratification with apoptosis; distinct from HSIL by glandular features.

Anal cytology HSIL

Anal HSIL in high-risk populations (HIV-positive MSM) warrants high-resolution anoscopy; anal cytology has limited sensitivity and requires careful screening.

Bethesda adequacy criteria

Conventional and liquid-based cervical preparations require approximately 5,000 well-visualized squamous cells; obscuring blood or inflammation must be documented.

HPV cotesting algorithm

Negative HPV with NILM permits 5-year interval; HPV16/18 positive with NILM warrants immediate colposcopy; other high-risk HPV positive triggers repeat testing.

Koilocyte features

Enlarged nucleus with raisin-like chromatin and a sharply demarcated perinuclear halo; hallmark of HPV cytopathic effect and LSIL.

Thyroid Bethesda VI

Malignant category carries ~97-99% malignancy risk; includes papillary carcinoma, medullary carcinoma, and anaplastic carcinoma; usually prompts surgery.

Papillary thyroid carcinoma FNA

Shows papillary clusters, nuclear grooves, intranuclear pseudoinclusions, and powdery chromatin; psammoma bodies may be present; high specificity for malignancy.

Follicular neoplasm category

Bethesda IV: cellular follicular proliferation with scant colloid; cannot distinguish adenoma from carcinoma on cytology; requires surgical excision for diagnosis.

Pleomorphic adenoma FNA

Shows fibrillary chondromyxoid stroma with plasmacytoid and myoepithelial cells; benign salivary gland neoplasm with characteristic biphasic appearance.

Small cell carcinoma cytology

Shows nuclear molding, salt-and-pepper chromatin, scant cytoplasm, and crush artifact; high N:C ratio; immunostains confirm neuroendocrine origin (synaptophysin, chromogranin).

Lung adenocarcinoma markers

TTF-1 and Napsin A positive; p40 and p63 negative; distinguishes adenocarcinoma from squamous cell carcinoma in lung FNA.

Squamous cell carcinoma markers

p40 and p63 positive; TTF-1 and Napsin A negative; used to distinguish squamous from adenocarcinoma in lung and head/neck FNA.

Mesothelioma immunostains

Calretinin, WT1, and CK5/6 positive; MOC-31, Ber-EP4, CEA, and TTF-1 negative; distinguishes mesothelioma from adenocarcinoma in pleural fluid.

CSF malignant cells

High N:C ratio, prominent nucleoli, and clustering suggest malignancy; normal adult CSF has 0-5 mononuclear cells/µL; flow cytometry aids lymphoma diagnosis.

ROSE in FNA

Rapid on-site evaluation improves adequacy and triage for ancillary testing (flow cytometry, cell block, molecular); reduces nondiagnostic rates.

Pancreatic FNA adenocarcinoma

Crowded overlapping clusters with nuclear contour irregularity, necrosis, and loss of honeycomb architecture; Papanicolaou Society categories guide risk stratification.

CLIA cytology workload limit

No cytotechnologist may examine more than 100 slides in 24 hours; screening limited to 7.5 hours per day; enforced under CLIA '88.

10% rescreen rule

CLIA mandates random rescreen of 10% of negative Pap tests plus high-risk cases; results tracked for quality assurance.

ASC-US/LSIL ratio

Quality metric target approximately 2:1 to 3:1; elevated ratios may indicate overdiagnosis and prompt review.

Levey-Jennings chart

Plots QC values over time; ±2SD warning and ±3SD rejection rules; Westgard rules flag systematic and random error.

FTE calculation

Total paid hours divided by 2,080 annual hours per FTE; productivity measured as slides or tests per FTE per year.

Budget variance

Variance equals actual minus budgeted; favorable expense variance means actual is less than budgeted; unfavorable means actual exceeds budget.

Root cause analysis

Reactive method identifying system failures after an adverse event; FMEA is the proactive counterpart used for risk anticipation.

Turnaround time monitoring

Track from specimen receipt to report; CAP requires documented TAT benchmarks for critical results and quality improvement.

Cytology slide retention

CLIA requires 5-year retention of negative cytology slides and records; positive slides retained longer per institutional policy.

Proficiency testing cytology

Cytotechnologists undergo 10-slide/10-minute locator and 20-slide proficiency tests; laboratories enroll in approved PT programs.

Incident reporting

Non-punitive reporting of adverse events; supports quality improvement and system-based learning rather than individual blame.