Cytopathology in Focus: Glass slide programs to have latest terms, ancillary clues

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Medullary carcinoma. Thyroid fine needle aspiration, Papanicolaou stain, high magnification.

What a huge undertaking! The CAP cytology glass slide programs contain more than 25,000 slides, most of which are in constant circulation to participating laboratories. The committee decided to tackle one body site at a time. To accomplish this, the CAP staff must retrieve all of the slides in circulation from that body site and replace them with new slides from another body system. Concomitantly, committee members review and update the CAP diagnostic response menu to mirror current recommended terminology. At each quarterly committee meeting, a subgroup of committee members manually review every retrieved slide for quality, rejecting those that are faded, broken, or poor examples of an interpretation. The slides are then reclassified to reflect the newly proposed diagnostic response menu. Because many of the existing slides were submitted to the program before the committee began to require associated ancillary studies and biopsy diagnostic confirmation, many of the cases require augmentation by the committee’s Web Enhancement team in order for a definitive diagnosis to be rendered. If necessary, the Web Enhancement team supplements the case with images of immunocytochemistry, flow cytometry, or other studies that confirm diagnostic impressions and allow participants to choose the most specific response. Once this process is complete, the reclassified slides, with their enhancements, are released back into the glass slide programs.

Medullary carcinoma. Thyroid fine needle aspiration, calcitonin immunocytochemical stain, high magnification.

Thyroid fine needle aspirations were the first slides to be reclassified and categorized under the Bethesda System for Reporting Thyroid Cytopathology terminology. When participants receive their glass slide mailing they can view the enhancement images for those cases on the CAP website. The committee strives to have identical morphology for the ancillary studies and the diagnostic slide, but in some circumstances ancillary studies from a morphologically similar case are substituted. As of 2014, the committee requires enhancements for newly submitted glass slides that need them for participants to confidently render a specific interpretation (for example, metastatic melanoma with an HMB-45 positive immunocytochemical enhancement image).

The committee has almost finished reclassifying lung slides, so participants can look forward to increasingly enhanced slides in the program and less confusion as to appropriate interpretive terminology when selecting answers.

1. Ali SZ, Cibas ES, eds. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria and Explanatory Notes. New York: Springer; 2010.
2. Nayar R, Wilbur DC, eds. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria and Explanatory Notes. New York: Springer; 2015.
3. Pitman MB, Layfield LJ. Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review. Cancer Cytopathol. 2014;122(6):399–411.
4. Rosenthal DL, Wojcik EM, Kurtycz DFI, eds. The Paris System for Reporting Urinary Cytology. New York: Springer; 2016.
5. Travis WD, Brambilla E, Noguchi M, 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. 2011;6(2):244–285.

Dr. Crothers is chair of the CAP Cytopathology Committee and program director of the pathology residency, Walter Reed National Military Medical Center, Bethesda, Md.