Cytology: Diagnostic Principles and Clinical Correlates

Cytology
Copyright
Dedication
Contributors
Preface
Acknowledgments
1 - Cervical and Vaginal Cytology
The History of the Pap Test and Its Current Practice
Screening Guidelines
Guidelines for Managing Women with Abnormal Pap Results
HPV Vaccination
Sampling and Preparation Methods
Smears
Liquid-Based Cytologic Study
ThinPrep Pap Test
SurePath Pap Test
Automated Screening
Historical Overview
ThinPrep Imaging System
BD FocalPoint Slide Profiler and Guided Screening Imaging System
Accuracy and Reproducibility
Diagnostic Terminology and Reporting Systems
The Bethesda System
Specimen Adequacy
General Categorization
Interpretation and Results
The Normal Pap
Squamous Cells
Endocervical Cells
Exfoliated Endometrial Cells
Abraded Endometrial Cells and Lower Uterine Segment
Trophoblastic Cells and Decidual Cells
Inflammatory Cells
Lactobacilli
Artifacts and Contaminants
Organisms and Infections
Shift in Flora Suggestive of Bacterial Vaginosis
Trichomonas Vaginalis
Candida
Actinomyces
Herpes Simplex Virus
Cytomegalovirus
Chlamydia Trachomatis
Rare Infections
Benign and Reactive Changes
Benign Squamous Changes
Benign Endocervical Changes
Repair
Radiation Changes
Cellular Changes Associated with Intrauterine Devices
Glandular Cells Status Post Hysterectomy
Other Benign Changes
Vaginal Specimens in “Des Daughters”
Squamous Abnormalities
Squamous Intraepithelial Lesions
Grading Squamous Intraepithelial Lesions
Low-Grade Squamous Intraepithelial Lesion
Management
High-Grade Squamous Intraepithelial Lesion
Management
Problems in the Diagnosis of Squamous Intraepithelial Lesions
Avoiding Overdiagnosis of LSIL
Distinguishing LSIL from HSIL
Distinguishing HSIL from Invasive Carcinoma
Squamous Cell Carcinoma
Atypical Squamous Cells
Atypical Squamous Cells of Undetermined Significance
Management
Atypical Squamous Cells, Cannot Exclude Hsil
Management
Glandular Abnormalities
Endocervical Adenocarcinoma in Situ
Adenocarcinoma
Endocervical Adenocarcinoma
Endometrial Adenocarcinoma
Differential Diagnosis of Adenocarcinoma
Atypical Glandular Cells
Atypical Endocervical Cells
Atypical Endometrial Cells
Other Malignant Neoplasms
Small Cell Neuroendocrine Carcinoma
Malignant Melanoma
Malignant Lymphoma
Carcinosarcoma
Metastatic Tumors
Endometrial Cells in Women ≥45 Years of Age
References
2 - Respiratory Tract and Mediastinum
Normal Anatomy, Histology, and Cytology of the Respiratory Tract
Sampling Techniques, Preparation Methods, Reporting Terminology, and Accuracy
Sputum
Bronchial Specimens
Bronchial aspirations and washings
Bronchial brushings
Bronchoalveolar lavage
Transbronchial FNA (“Wang Needle”)
Endobronchial Ultrasound-Guided (EBUS) FNA
Transesophageal FNA
Percutaneous FNA
Benign Cellular Changes
Reactive Squamous Cell Changes
Reactive Bronchial Cell Changes
Bronchial Reserve Cell Hyperplasia
Repair
Type II Pneumocyte Hyperplasia
Noncellular Elements and Specimen Contaminants
Infections
Viral Infections
Herpes Simplex
Cytomegalovirus
Measles Virus and Respiratory Syncytial Virus
Adenovirus
Bacterial Pneumonias
Tuberculosis
Pulmonary Fungal Infections
Cryptococcosis
Histoplasmosis
Blastomycosis
Coccidioidomycosis
Paracoccidioidomycosis
Sporotrichosis
Invasive Fungi
Aspergillosis
Zygomycosis
Candidiasis
Pneumocystis Jirovecii
Parasitic Infections
Strongyloidiasis
Dirofilariasis
Echinococcosis (Hydatid Disease)
Nonneoplastic, Noninfectious Pulmonary Diseases
Sarcoidosis
Granulomatosis with Polyangiitis
Pulmonary Amyloidosis
Pulmonary Alveolar Proteinosis
Common Inflammatory Processes, Including Organizing Pneumonia
Benign Neoplasms of the Lung
Pulmonary Hamartoma
Langerhans Cell Histiocytosis
Sclerosing Pneumocytoma
Papillomas and Related Lesions
Inflammatory Myofibroblastic Tumor
Endobronchial Granular Cell Tumor
Precursor Lesions of the Respiratory Epithelium
Lung Cancer
Molecular Testing of Lung Cancers
EGFR
MET
ERBB-2 (HER2)
ALK
ROS1
RET
BRAF
PIK3CA
KRAS
PD-L1
Squamous Cell Carcinoma
Adenocarcinoma
Large Cell Carcinoma
Sarcomatoid Carcinoma
Neuroendocrine Tumors
Typical Carcinoid Tumor
Atypical Carcinoid Tumor
Large Cell Neuroendocrine Carcinoma
Small Cell Carcinoma
Uncommon Pulmonary Tumors
Lymphoepithelioma-Like Carcinoma
Adenoid Cystic Carcinoma and Other Bronchial Gland Tumors
PEComa (“Clear Cell Tumor,” “Sugar Tumor”)
Sarcomas
Lymphomas and Leukemias
Metastatic Cancers to the Lung
Tumors of the Mediastinum
Thymoma
Thymic Carcinoma
Mediastinal Lymphomas
Germ Cell Tumors
NUT Carcinoma
References
3 - Urine and Bladder Washings
Indications
Specimen Collection
Voided Urine
Catheterized Urine
Bladder Washings
Upper Tract Washings and Brushings
Ileal Conduits
Sample Processing
Adequacy Criteria
Reporting Terminology
Accuracy
Normal Elements
Benign Lesions
Infections
Noninfectious Findings and Conditions
Crystals
Casts
Nonspecific reactive urothelial cell changes
Effects of radiation and chemotherapy
Urothelial atypia associated with urinary calculi
Other Benign Lesions
Nephrogenic adenoma
Müllerianosis
Urothelial Neoplasms
High-Grade Urothelial Carcinoma and Carcinoma in Situ
Atypical Urothelial Cells
Other Malignant Lesions
Other Primary Cancers of the Urinary Tract
Squamous cell carcinoma
Adenocarcinoma
Clear cell carcinoma
Small cell carcinoma
Melanoma
Paraganglioma
Sarcoma
Metastatic Cancers
Renal cell carcinoma
Prostatic carcinoma
Colonic carcinoma
Other metastatic tumors
Ancillary Techniques
Summary
References
4 - Pleural, Pericardial, and Peritoneal Fluids
Specimen Collection, Preparation, and Reporting Terminology
Accuracy
Benign Elements
Nonneoplastic Conditions
Acute Serositis
Eosinophilic Effusions
Lymphocytic Effusions
Rheumatoid Pleuritis
Lupus Pleuritis
Other Nonneoplastic Conditions
Malignant Effusions
Primary Tumors
Diffuse Malignant Mesothelioma
Mesothelioma versus Reactive Mesothelial Cells
Mesothelioma versus Adenocarcinoma
Mesothelioma versus Squamous Cell Carcinoma
Mesothelioma versus Vascular Tumors
Primary Effusion Lymphoma
Metastatic Tumors
Adenocarcinoma
Immunohistochemistry for ER, PR, and HER2
Molecular Testing of Effusions with Metastatic Lung Cancer
Squamous Cell Carcinoma
Small Cell Carcinoma
Melanoma
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Multiple Myeloma
Acute and Chronic Leukemias
Myeloproliferative Neoplasms
Sarcomas
Germ Cell Tumors
References
5 - Peritoneal Washings
Specimen Collection, Preparation, and Reporting Terminology
Accuracy
The Normal Peritoneal Washing
Benign Conditions
Endosalpingiosis and Similar Benign Proliferations
Endometriosis
Malignant Tumors
Ovarian and Fallopian Tube Cancers
Endometrial Cancer
Cervical Cancer
Pancreatic and Gastrointestinal Malignancies
Pancreatic Cancer
Gastric Cancer
Colorectal Cancer
Monitoring Response to Treatment (“Second-Look Procedures”)
References
6 - Cerebrospinal Fluid
Anatomy and Physiology
Obtaining and Preparing the Specimen
Reporting Terminology
Accuracy
Normal Elements
Abnormal Inflammatory Cells
Nonneoplastic Disorders
Acute Bacterial Meningitis
Aseptic Meningitis
Cryptococcal Meningitis
Toxoplasmosis
Cysticercosis
Angiostrongyliasis
Primary Amebic Meningoencephalitis
Neoplasms
Metastatic Solid Tumors
Carcinoma of the lung
Carcinoma of the breast
Melanoma
Leukemia
Acute lymphoblastic leukemia
Acute myeloid leukemia
Chronic lymphocytic leukemia
Myeloproliferative Neoplasms
Malignant Lymphoma
Primary CNS Tumors
Primary central nervous system lymphoma
Medulloblastoma
Anchor 513
Astrocytomas and oligodendroglial tumors
Ependymoma
Atypical teratoid/rhabdoid tumor
Choroid plexus tumors
Pineal tumors
Germ cell tumors
Other tumors of the central nervous system
References
7 - Gastrointestinal Tract
Clinical Indications
Sampling a Wider Area and Reaching Deep Organs
Better Recognition of Lymphoid Cells
Less Invasive
Shorter Turnaround Time
Sample Collection and Processing
Sample Collection
Processing the Sample
Accuracy
Review of Morphologic Findings
Esophagus
Infections
Epithelial Repair and Reactive Changes
Barrett’s Esophagus
Dysplasia in Barrett’s Esophagus
Adenocarcinoma
Squamous cell carcinoma
Uncommon Tumors of the Esophagus
Stomach
Infections
Epithelial Repair
Dysplasia and Gastric Adenomas
Adenocarcinoma
Neuroendocrine Neoplasms
Non-Hodgkin Lymphoma
Gastrointestinal Stromal Tumor
Duodenum
Infections
Adenoma and Adenocarcinoma
Colon
The Anal Pap Test
References
8 - Fine Needle Aspiration Biopsy Technique and Specimen Handling
Introduction
Materials and Supplies
Procedure for Performing FNA of a Palpable Mass
Determining Whether FNA Is Warranted
Obtaining Patient Consent
Sample Explanation of the Procedure
Readying the Equipment
Positioning the Patient and Immobilizing the Lesion
Sampling the Lesion
“Feeling With the Needle”
Preparing the Sample
Making Smears
The “one-smear” method (Fig. 8.2A–D)
The “two-smear” method (Fig. 8.3A–C)
Splitting Material for Multiple Smears
Method 1 (Fig. 8.4A–F)
Method 2
Fixing the Smears
Handling Cystic Masses
Retrieving Material from the Needle Hub
Rinsing the Needle and Reserving Material for Ancillary Studies
Making a Cell Block from a Smear
Postprocedure Information for the Patient
Variations on Biopsy Technique
Ultrasound-Guided Techniques
Perpendicular Technique
Parallel Technique
Complications
Management of Adverse and Unexpected Events
Acknowledgments
References
9 - Breast
Specimen Types
Fine-Needle Aspiration
Nipple Discharge
Sample Preparation
Reporting Terminology
Evaluation of the Specimen
The Normal Breast
Benign Conditions
Cysts
Fibrocystic Changes
Nonproliferative Fibrocystic Changes
Proliferative Fibrocystic Changes
Fibroadenoma
Pregnancy and Lactational Changes
Fat Necrosis
Radiation Change
Mastitis
Subareolar Abscess
Gynecomastia
Papillary Neoplasms
Phyllodes Tumor
Breast Cancer
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Medullary Carcinoma
Mucinous (Colloid) Carcinoma
Tubular Carcinoma
Metaplastic Carcinoma
Uncommon Breast Tumors
Microglandular Adenosis
Apocrine Carcinoma
Adenoid Cystic Carcinoma
Non-Hodgkin Lymphoma
Peri-implant Seroma and Anaplastic Large Cell Lymphoma
Sarcoma
Metastatic Tumors
References
10 - Thyroid
Aspiration Technique and Slide Preparation
Terminology for Reporting Results
Nondiagnostic (ND) or Unsatisfactory
Benign
The “Indeterminate” Categories
Malignant
Accuracy
Molecular Testing
Evaluation of the Specimen
Benign Conditions
Benign Follicular Nodules
Chronic Lymphocytic (Hashimoto) Thyroiditis
Subacute (de Quervain) Thyroiditis
Riedel Disease
Amyloid Goiter
Black Thyroid
Radiation Changes
Suspicious for a Follicular Neoplasm or Follicular Neoplasm
Suspicious for a Follicular Neoplasm, Hürthle Cell Type
Malignant
Papillary Thyroid Carcinoma
Management
Poorly Differentiated Thyroid Carcinoma
Anaplastic Thyroid Carcinoma
Squamous Cell Carcinoma
Medullary Thyroid Carcinoma
Management
Primary Thyroid Lymphoma
Rare Primary Thyroid Tumors
Metastatic Tumors
Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance
Parathyroid Tumors
References
11 - Salivary Gland
Rationale, Indications, and Technical Considerations
Classification
Diagnostic Overview
The Normal Aspirate
Nonneoplastic Conditions
Acute and Chronic Sialadenitis
Granulomatous Sialadenitis
Sialadenosis
Lymphoepithelial Sialadenitis
Non-neoplastic Cysts
Squamous-Lined Cysts
Mucin-Containing Cysts
Amyloidosis
Benign Neoplasms
Pleomorphic Adenoma
Pitfalls Associated with Pleomorphic Adenomas
Sparse or Absent Matrix
Adenoid Cystic-Like Matrix
Cytologic Atypia
Metaplastic Changes
Myoepithelioma
Basal Cell Adenoma
Warthin tumor
Oncocytoma
Carcinomas of Salivary Gland Origin
Mucoepidermoid Carcinoma
Acinic Cell Carcinoma
Adenoid Cystic Carcinoma
Carcinoma Ex Pleomorphic Adenoma
Salivary Duct Carcinoma
Secretory Carcinoma
Polymorphous Adenocarcinoma
Rare Malignant Neoplasms
Basal Cell Adenocarcinoma
Epithelial-Myoepithelial Carcinoma
Clear Cell Carcinoma
Primary Small Cell Carcinoma
Lymphoepithelial Carcinoma
Adenocarcinoma, Not Otherwise Specified
Other Malignancies
Squamous Cell Carcinoma
Lymphoma Involving the Salivary Gland
Miscellaneous
Summary of Salivary Gland FNA
References
12 - Lymph Nodes
Technical Aspects
Reporting Terminology and Accuracy
Ancillary Studies
Flow Cytometry
Immunocytochemistry
Molecular Genetic Studies
Nonneoplastic Lesions
Reactive Hyperplasia (Without Specific Etiology)
Benign Lymphadenopathies with Specific Etiology but without Characteristic Fine-Needle Aspiration Findings
Inflammatory/Infectious Conditions with Characteristic Fine-Needle Aspiration Findings
Sarcoidosis
Bacterial and Fungal Lymphadenitis
Cat Scratch Disease
Mycobacterial Lymphadenitis
Rosai–Dorfman Disease (Sinus Histiocytosis with Massive Lymphadenopathy)
Kikuchi Lymphadenitis
Infectious Mononucleosis
HIV-Associated Lymphadenopathy
Dermatopathic Lymphadenitis
Silicone Lymphadenitis
Neoplasms
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Lymphomas of Small Cells
Follicular Lymphoma
Marginal Zone Lymphoma
Small Lymphocytic Lymphoma
Mantle Cell Lymphoma
Differential Diagnosis: Small Cell Lymphomas
Lymphomas of Large Cells
Diffuse Large B-cell Lymphoma
Variants of Diffuse Large B-Cell Lymphoma
High-Grade B-Cell Lymphoma
Burkitt Lymphoma
Plasmablastic Lymphoma
T-Cell Lymphomas
. Peripheral T-cell lymphoma of unspecified type (PTCL, NOS) is much more common in Asia than Europe or North America. In the Un...
. Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin lymphoma that was recognized after the discovery of the CD30...
. AITL is a typically an advanced stage lymphoma of T cells with a T follicular helper immunophenotype (e.g., expressing PD1, CD...
. Mycosis fungoides is a primary cutaneous T-cell lymphoma, but in advanced stages lymph nodes and viscera may be involved. Such...
. Adult T-cell leukemia/lymphoma is a disease of adult patients in endemic regions (including the Caribbean islands in the Weste...
. Lymphoblastic lymphoma is an aggressive lymphoma that comprises almost one-half of childhood non-Hodgkin lymphoma, is more com...
Posttransplant Lymphoproliferative Disorders
Differential Diagnosis: Large Cell Lymphomas
Nonlymphoid Neoplasms
Carcinomas
Malignant Melanoma
Seminoma/Germinoma
Sarcomas
References
13 - Liver
Normal Liver
Infections
Hepatic Abscess
Echinococcal Cyst (Hydatid Cyst)
Other Infections
Benign Lesions
Solitary Cysts
Cirrhosis
Focal Nodular Hyperplasia
Hepatic Adenoma
Bile Duct Hamartoma and Adenoma
Hemangioma
Angiomyolipoma
Malignant Tumors
Hepatocellular Carcinoma
Cholangiocarcinoma
Hepatoblastoma
Angiosarcoma
Epithelioid Hemangioendothelioma
Metastatic Tumors
References
14 - Pancreas and Biliary Tree
Indications
Sampling Techniques
Complications
Rapid On-Site Evaluation
Sample Preparation and Cyst Fluid Analysis
Accuracy and Limitations
Reporting Terminology
Normal Pancreas and Bile Duct
Pancreatitis and Reactive Changes
Pancreatic Intraepithelial Neoplasia
Ductal Adenocarcinoma
Variants of Ductal Adenocarcinoma
Neuroendocrine Neoplasms
Acinar Cell Carcinoma
Solid-Pseudopapillary Neoplasm
Pancreatoblastoma
Pancreatic Cysts
Pseudocyst
Serous Cystadenoma
Lymphoepithelial Cyst
Mucinous Cysts: Mucinous Cystic Neoplasm and Intraductal Papillary Mucinous Neoplasm
Secondary Pancreatic Neoplasms and Ectopic Splenic Tissue
References
15 - Kidney and Adrenal Gland
The Kidney
Indications and Sampling Methods
Specimen Collection and Preparation
Accuracy
Adequacy
Normal Elements
Glomeruli and Tubular Cells
Benign Lesions
Oncocytoma
Papillary Adenoma
Angiomyolipoma
Metanephric Adenoma
Mixed Epithelial and Stromal Tumor
Renal Abscess
Tuberculosis
Xanthogranulomatous Pyelonephritis
Renal Infarct
Renal Cysts
Other Benign Lesions
Renal Cell Carcinoma
Clear Cell Renal Cell Carcinoma
Papillary Renal Cell Carcinoma
Oncocytic Papillary Renal Cell Carcinoma
Chromophobe Renal Cell Carcinoma
Clear Cell Papillary Renal Cell Carcinoma
Tubulocystic Renal Cell Carcinoma
Renal Medullary Carcinoma
Collecting Duct Carcinoma (Bellini Tumor)
MiT Family Translocation Renal Cell Carcinoma
Mucinous Tubular and Spindle Cell Carcinoma
Urothelial Carcinoma
Lymphoma
Metastatic Tumors
Pediatric Tumors
Rare Entities
The Adrenal Gland
Specimen Collection, Preparation, and Accuracy
Myelolipoma
Adrenal Cortical Neoplasms
Pheochromocytoma
Metastatic Tumors
References
16 - Ovary
Obtaining the Specimen
Preparing the Specimen and Reporting Results
Accuracy
Benign Tumor-Like Lesions of the Ovary
Nonneoplastic Cysts
Cystic Follicle and Follicle Cyst
Corpus Luteum Cyst
Endometriotic Cyst
Simple Ovarian, Paraovarian, and Paratubal Cysts
Hydrosalpinx
Tuboovarian Abscess
Benign Surface Epithelial–Stromal Tumors
Benign Serous Tumors
Benign Mucinous Tumors
Benign Brenner Tumor
Malignant Surface Epithelial-Stromal Tumors
Serous Borderline Tumor and Serous Carcinoma
Mucinous Borderline Tumor and Mucinous Carcinoma
Endometrioid Carcinoma
Clear Cell Carcinoma
Germ Cell Tumors
Teratoma
Mature Teratoma
Immature Teratoma
Carcinoid Tumor
Dysgerminoma
Embryonal Carcinoma and Other Malignant Germ Cell Tumors
Sex Cord–Stromal Tumors
Granulosa Cell Tumors
Adult Granulosa Cell Tumor
Juvenile Granulosa Cell Tumor
Thecoma
Fibroma
Uncommon Primary Ovarian Tumors
Metastatic Tumors
References
17 - Soft Tissue
Specimen Collection and Preparation
Ancillary Studies
Reporting Terminology
Adipocytic and Lipogenic Neoplasms
Lipoma
Hibernoma
Spindle Cell/Pleomorphic Lipoma
Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma
Pleomorphic Liposarcoma
Myxoid Neoplasms
Intramuscular Myxoma
Soft Tissue Perineurioma
Myxofibrosarcoma
Low-Grade Fibromyxoid Sarcoma
Myxoid Liposarcoma
Lipoblastoma
Myxofibrosarcoma-Like Dedifferentiated Liposarcoma
Myxoinflammatory Fibroblastic Sarcoma
Extraskeletal Myxoid Chondrosarcoma
Spindle Cell Neoplasms
Leiomyosarcoma
Schwannoma
Malignant Peripheral Nerve Sheath Tumor
Synovial Sarcoma
Solitary Fibrous Tumor
Desmoid (Deep) Fibromatosis
Nodular Fasciitis
Dermatofibrosarcoma Protuberans
Inflammatory Myofibroblastic Tumor
Adult Fibrosarcoma
Fibrohistiocytoid Neoplasms
Tenosynovial Giant Cell Tumor, Localized and Diffuse Types
Giant Cell Tumor of Soft Tissue
Angiomatoid Fibrous Histiocytoma
Round Cell Neoplasms
Neuroblastoma
Ewing Sarcoma
Desmoplastic Small Round Cell Tumor
Embryonal Rhabdomyosarcoma
Alveolar Rhabdomyosarcoma
Undifferentiated Round Cell Sarcomas, including CIC-Rearranged Sarcoma
Epithelioid Neoplasms
Epithelioid Sarcoma
Clear Cell Sarcoma of Soft Tissue
Alveolar Soft Part Sarcoma
Epithelioid Hemangioendothelioma
Pseudomyogenic Hemangioendothelioma
Epithelioid Angiosarcoma
Granular Cell Tumor
Pleomorphic Neoplasms
Undifferentiated Pleomorphic Sarcoma
Pleomorphic Rhabdomyosarcoma
Dedifferentiated Sarcomas
Nonneoplastic Soft Tissue Lesions
Idiopathic Retroperitoneal Fibrosis
Elastofibroma
Amyloidoma (Tumoral Amyloidosis)
References
18 - Bone
Introduction
Cartilaginous Tumors
Chondroblastoma
Chondromyxoid Fibroma
Enchondroma
Chondrosarcoma and Chondrosarcoma Variants
Giant Cell–Rich Tumors
Giant Cell Tumor of Bone
Aneurysmal Bone Cyst
Osteogenic Tumors
Osteoblastoma
Conventional Osteosarcoma and Osteosarcoma Variants
Low-Grade Osteosarsarcoma
Notochordal Tumors
Benign Notochodal Cell Tumor
Chordoma
Tumors of Other Lineages
Adamantinoma
Vascular Tumors
Hematopoietic and Histiocytic Neoplasms
Plasmacytoma/Myeloma and Non-Hodgkin Lymphoma
Langerhans Cell Histiocytosis
Nonneoplastic Bone Lesions
Metastasis
References
19 - Laboratory Management
Agencies and Organizations
Centers for Medicare and Medicaid Services
The Joint Commission
College of American Pathologists
Commission on Accreditation of Allied Health Education Programs
Occupational Safety and Health Administration
National Fire Protection Association
Regulations
Clinical Laboratory Improvement Amendments of 1988
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Laboratory Personnel
Laboratory Director
Technical Supervisor
General Supervisor
Cytotechnologist
Policy and Procedure Manuals
Workflow
Billing
Procedure Codes
. This is the most widely used in pathology. It denotes that only the physician professional component of the service is being b...
. This modifier denotes a reduced service from the customary procedure. In cytology, a good example is the manual review of a sl...
. Modifier 59 denotes a “separate procedure,” such as a different specimen (e.g., washing vs brushing) or anatomic site. Payers ...
. Teaching physicians must append modifier GC to CPT and HCPCS codes on Medicare claims when a resident or fellow actively parti...
. These modifiers are applied to Pap test HCPCS codes when billing Medicare. They clarify the laboratory’s right (or lack thereo...
. This modifier denotes the facility technical component of the service being billed, and thus is the counterpart of the CPT 26 ...
International Classification of Diseases (ICD)-10-CM Codes
Coding Pap Tests
The Screening (Routine) Pap Test
The Screening (High-Risk) Pap Test
The Diagnostic Pap Test
Coding Nongynecologic, Non-Fine-Needle Aspiration Cases
Coding Fine-Needle Aspirates
Coding Consultation Cases
Quality Control and Quality Assurance
Prospective 10% Rescreen
Retrospective Rescreen (“5-Year Lookback”)
Cytologic-Histologic Correlation
Annual Statistics
Workload Records
Competency Assessment
Proficiency Testing
General Description of Cytology PT
Scoring
Results
Performance Evaluation
Measures of Cytotechnologist Performance
Screening Skills
. Inevitably, when enough cases interpreted as negative by one CT are rescreened by another, abnormal cells are identified in so...
. The abnormal rate is the percentage of abnormal cases (ASC, AGC, SIL, and carcinoma) diagnosed by a CT divided by the total nu...
Interpretive Skills
. CLIA 88 requires that the performance of a CT be based, in part, on an evaluation of the cases submitted to the pathologist fo...
. The unsatisfactory rate is the proportion of all Pap test results that are interpreted as unsatisfactory by a CT. A low unsati...
Measures of Cytopathologist Performance
Atypical Squamous Cells-to-Squamous Intraepithelial Lesion Ratio
High-Risk Human Papillomavirus Positivity Rates for Atypical Squamous Cells of Undetermined Significance
Cytology/Biopsy Correlation
Safety
OSHA Bloodborne Pathogens Standard
Exposure Control
Hepatitis B Vaccination
Communication of Hazards to Employees
Recordkeeping
OSHA Laboratory Standard
National Fire Protection Association Standard for Health Care Facilities
NFPA Standard on Fire Protection for Laboratories Using Chemicals
References
content