PAP PAP Cytology Interpretation and Reporting 2 — Questions and Answers
Question 1: What is the recommended management for a patient with an ASCUS Pap result and a negative high-risk HPV co-test?
- Immediate colposcopy referral
- Return to routine screening intervals (Correct answer)
- Repeat Pap test in 6 months
- Endometrial biopsy
Correct answer: Return to routine screening intervals
When ASCUS is accompanied by a negative high-risk HPV test, the risk of significant disease is very low and routine screening intervals are resumed.
Question 2: What is the nuclear-to-cytoplasmic (N:C) ratio used to assess in cervical cytology interpretation?
- Cell size relative to a red blood cell reference
- The proportion of nuclear area to total cell area (Correct answer)
- The number of nucleoli visible per cell
- Chromatin texture pattern alone
Correct answer: The proportion of nuclear area to total cell area
The N:C ratio compares nuclear size to total cell size; an elevated ratio — larger nucleus relative to cytoplasm — is a key feature of dysplasia and malignancy.
Question 3: Which Bethesda System category applies to atypical glandular cells that may originate from the endocervix or endometrium?
- ASCUS
- HSIL
- AGC (Atypical Glandular Cells) (Correct answer)
- ASC-H
Correct answer: AGC (Atypical Glandular Cells)
AGC (Atypical Glandular Cells) is used for glandular cells that are not clearly benign but do not meet diagnostic criteria for adenocarcinoma in situ or invasive adenocarcinoma.
Question 4: What is the primary clinical difference between ASC-US and ASC-H in the Bethesda System?
- ASC-H cannot exclude HSIL, while ASC-US cannot exclude LSIL (Correct answer)
- ASC-US requires immediate biopsy while ASC-H does not
- ASC-H applies to glandular cells while ASC-US applies to squamous cells
- There is no meaningful clinical difference between the two categories
Correct answer: ASC-H cannot exclude HSIL, while ASC-US cannot exclude LSIL
ASC-H indicates atypical squamous cells where HSIL cannot be excluded, carrying substantially higher risk than ASC-US where only low-grade lesions are uncertain.
Question 5: In the Bethesda System, what does 'negative for intraepithelial lesion or malignancy' (NILM) mean?
- The specimen was unsatisfactory for evaluation
- No epithelial cell abnormality consistent with dysplasia or malignancy was identified (Correct answer)
- HPV co-testing was negative
- The transformation zone was not adequately sampled
Correct answer: No epithelial cell abnormality consistent with dysplasia or malignancy was identified
NILM is the Bethesda System terminology for a normal Pap result, indicating no cellular abnormalities consistent with dysplasia or malignancy were found.
Question 6: Which cytologic features distinguish an HSIL cell from an LSIL cell under microscopy?
- HSIL cells are always larger in size than LSIL cells
- HSIL cells have a markedly elevated N:C ratio and irregular hyperchromatic chromatin (Correct answer)
- LSIL cells consistently have darker nuclei than HSIL cells
- HSIL cells always display koilocytic change with perinuclear halos
Correct answer: HSIL cells have a markedly elevated N:C ratio and irregular hyperchromatic chromatin
HSIL cells exhibit a markedly elevated N:C ratio, hyperchromatic nuclei with coarse irregular chromatin, and scant cytoplasm compared to LSIL cells.
PAP PAP Cytology Interpretation and Reporting 2
What is the recommended management for a patient with an ASCUS Pap result and a negative high-risk HPV co-test?