Chapter 10 Answers to discussion questions

Lower respiratory tract cytology

10.1 Discuss the role of cytology in diagnosis of lower respiratory tract conditions.

Briefly discuss specimen types. Is there a role for cytology in diagnosis of infections? Is there any role in non-neoplastic diseases? What about malignancy? Can cytology identify major subtypes of lung cancer? How can ancillary techniques supplement cytological diagnosis?


10.2 Discuss the potential problems in interpretation of small cell anaplastic carcinoma.

Briefly define these subtypes? Briefly describe cytology of small cell anaplastic carcinoma. Does preparation type affect cellular features? Do artefacts affect cytological features? What are differential diagnoses of small cell carcinoma; consider reserve cell hyperplasia, lymphocytes, carcinoid tumour, non-small cell carcinoma, etc.


10.3 Discuss the role of immunocytochemistry in respiratory cytology.

How does immunocytochemistry help in improving specificity of cytological diagnosis? Give examples of various diagnostic scenarios: primary lung cancer vs metastatic cancers, small cell carcinoma vs non-small cell carcinoma. Can immunocytochemistry help differentiate between subtypes of non-small cell carcinoma?


10.4 Discuss the role of the cytology laboratory in the diagnosis and treatment of lung cancer.

Cytology of EBUS, FNA, sputum, washing and brushings; Small cells vs non-small cell; Treatment options; Identification of secondary tumours; Staging; EFGR, ALK, ETC


10.5 Briefly discuss the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) in respiratory disease.

What happened before EBUS? Mediastinoscopy; Diagnosis of Mediastinal masses; Diagnosis and staging of lung cancer; Diagnosis of inflammatory conditions; TB/Sarcoidosis; Value of on-site assessment; Collecting material for BMS; Collecting material for cellblock; IC; Molecular studies.

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