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ABPath Cytopathology study materials
ABPath Cytopathology study resources

ABPath Cytopathology: Non-Gynecologic and Fine Needle Aspiration Cytopathology

ABPath Cytopathology · Work through your exam, one topic at a time.

All guide sections

Non-Gynecologic and Fine Needle Aspiration Cytopathology

Key Concepts

  • Thyroid FNA: Bethesda System for Reporting Thyroid Cytopathology (I–VI); understand risk of malignancy and management.
  • Salivary Gland FNA: Milan System categories; differentiate pleomorphic adenoma, Warthin tumor, mucoepidermoid carcinoma.
  • Lymph Node FNA: Recognize reactive hyperplasia, granulomas, lymphoma, metastatic carcinoma.
  • Body Fluid Cytology: Distinguish reactive mesothelial cells from adenocarcinoma; use ancillary tests (immunocytochemistry).
  • Pancreaticobiliary and Lung FNA: Apply criteria for adenocarcinoma vs. reactive; molecular testing.

Common Traps

  • Thyroid Bethesda III/IV: Atypia of undetermined significance (AUS) and follicular neoplasm have overlapping features; avoid overdiagnosis of malignancy.
  • Salivary Gland Mimics: Mucoepidermoid carcinoma can mimic mucocele; look for intermediate cells and mucin.
  • Mesothelial vs. Adenocarcinoma: Use panel (calretinin, CK5/6, WT1 vs. MOC-31, Ber-EP4, CEA).
  • Lymphoma vs. Reactive: Monoclonality by flow cytometry is key; cytology alone may be insufficient.
  • Lung FNA: Distinguish small cell from non-small cell; use immunocytochemistry (TTF-1, p40).

Rule of Thumb

For thyroid FNA with Bethesda IV (follicular neoplasm), diagnostic lobectomy is standard; repeat FNA is not recommended. For Bethesda III, repeat FNA or molecular testing.

Worked Example

Thyroid FNA shows microfollicles with scant colloid, Bethesda IV. Management: diagnostic lobectomy. If Bethesda III, consider Afirma or ThyroSeq to guide surgery.