Cytology ABCDE: A Practical ABCDE Algorithm for Cytology Diagnosis
Abstract
Aims
An approach to the process of undertaking cytopathology diagnosis for medical students and those who operate with cytology specimens is presented.
Material and Methods
This simple mnemonic (ABCDE) can be used as a memory aid determining the order in which cells or tissue fragments should be evaluated. When receiving a slide for diagnosis and prior to examining it under the microscope we need to make sure that it is correctly labelled and prepared (Correct) and we also need to know or gather all available information concerning the patient (A, Available Information). Once under the microscope, we check the type of cells and the adequacy of specimen (B, Body & Being Adequate). Next, by taking into consideration the cellular morphology and potentially by performing ancillary studies we proceed to answer if the cells are neoplastic or not (C, Cancer). We then either form a differential diagnosis list or we end up with our final diagnosis (D, Differential diagnosis or Diagnosis), which is followed by the writing of the report (E, Exhibit).
Results
These sequential steps (Correct ABCDE) followed as an ad hoc procedure by most pathologists, are important in order to achieve a complete and clear diagnosis and report, which is intended to support optimal clinical practice.
Conclusions
This ABCDE concept is a generic standard approach which is not limited to specific specimens and can help improve both cytopathology diagnoses and the quality of the final cytopathology reports.
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References
2. Kocjan G, Chandra A, Cross P, Denton K, Giles T, Herbert A, et al. BSCC Code of Practice--fine needle aspiration cytology. Cytopathology [Internet]. 2009 Oct [cited 2014 Nov 13];20(5):283–96. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19754835
3. Denton K, Giles T, Smith P, Chandra A, Desai M. Tissue pathways for exfoliative cytology and fine needle aspiration [Internet]. The Royal College of Pathologists. 2010 [cited 2014 Nov 13]. Available from: http://www.rcpath.org/Resources/RCPath/Migrated Resources/Documents/G/g086tpexfoliativecytologyfnacytology.pdf
4. Thyroid cytology structured reporting protocols [Internet]. 1st ed. The Royal College of Pathologists of Australasia. The Royal College of Pathologists of Australasia; 2014 [cited 2014 Nov 10]. Available from: http://www.rcpa.edu.au/getattachment/b0545d63-2198-4d39-b190-9624ed686404/Protocol-thyroid-FNA-cytology.aspx
5. Cancer Program Standards 2012: Ensuring Patient-Centered Care [Internet]. Commision on Cancer, American College of Surgeons. 2012 [cited 2014 Nov 10]. p. 65–6. Available from: https://www.facs.org/~/media/files/quality programs/cancer/coc/programstandards2012.ashx
6. Connolly, J.L.; Schnitt, S.J.; Wang, H.H.; Dvorak, A.M.; Dvorak HF. Principles of Cancer Pathology. In: Bast, RC Jr; Kufe, DW; Pollock R et al. ., editor. Holland-Frei Cancer Medicine [Internet]. 5th ed. Hamilton (ON): BC Decker; 2000 [cited 2014 Feb 26]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK20935/
7. Elias A, Linthorst G, Bekker B, Vooijs PG. The significance of endocervical cells in the diagnosis of cervical epithelial changes. Acta Cytol [Internet]. [cited 2014 Feb 6];27(3):225–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6575534
8. Elumir-Tanner L, Doraty M. Management of Papanicolaou test results that lack endocervical cells. CMAJ [Internet]. 2011 Mar 22 [cited 2014 Feb 6];183(5):563–8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3060184&tool=pmcentrez&rendertype=abstract
9. Erozan YS, Ramzy I. Pulmonary Cytopathology (Essentials in Cytopathology). 2nd ed. Springer Science + Business Media, LLC; 2014.
10. Abramowitz M, Davidson M. Molecular Expressions Microscopy Primer: Anatomy of the Microscope - Introduction [Internet]. [cited 2014 Dec 2]. Available from: http://micro.magnet.fsu.edu/primer/anatomy/introduction.html
11. Immunocytochemistry [Internet]. [cited 2014 Dec 2]. Available from: http://www.lifetechnologies.com/gr/en/home/references/protocols/neurobiology/neurobiology-protocols/immunocytochemistry.html
12. Brown M, Wittwer C. Flow Cytometry: Principles and Clinical Applications in Hematology. Clin Chem [Internet]. 2000 Aug 1 [cited 2014 Dec 2];46(8):1221–9. Available from: http://www.clinchem.org/content/46/8/1221.full
13. Salto-Tellez M, Koay ESC. Molecular diagnostic cytopathology: definitions, scope and clinical utility. Cytopathology [Internet]. 2004 Oct [cited 2014 Nov 11];15(5):252–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15456412
14. Aisner DL, Sams SB. The role of cytology specimens in molecular testing of solid tumors: techniques, limitations, and opportunities. Diagn Cytopathol [Internet]. 2012 Jun [cited 2014 May 6];40(6):511–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22619126
15. Illustrating the Pathologic Assessment of Non–Small Cell Lung Carcinoma: A Case Report [Internet]. [cited 2014 Feb 9]. Available from: http://www.medscape.org/viewarticle/757558
16. Pathology Reports - National Cancer Institute [Internet]. [cited 2014 Feb 26]. Available from: http://m.cancer.gov/topics/factsheets/pathology-reports
17. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol [Internet]. 2011 Feb [cited 2014 Nov 6];6(2):244–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21252716
18. Metaplasia-Dysplasia-Neoplasia.Tissue evidence of carcinogenic factors at work [Internet]. [cited 2014 Dec 9]. Available from: http://library.med.utah.edu/WebPath/NEOHTML/NEOPL106.html
19. Ali S, Parwani A. Breast Cytopathology. Rosenthal D, editor. Springer Science + Business Media, LLC; 2007.
20. Tumor Grade Fact Sheet - National Cancer Institute [Internet]. [cited 2014 Dec 13]. Available from: http://www.cancer.gov/cancertopics/factsheet/detection/tumor-grade
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