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Cervical cytology

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Authors: Amanda Herbert

The cervical chapters comprise the following material:

  1. Introduction
  2. Anatomy, histology and function of the cervix
  3. Cervical cancer epidemiology and aetiology
    • Cervical cancer worldwide and in Europe
    • HPV as a causative agent and other risk factors
  4. Pathogenesis of cervical cancer and its precursors
    • CIN and squamous cell carcinoma
    • AIS and adenocarcinoma
    • Presentation, stage and treatment of invasive cancer
  5. Effect of screening on incidence and mortality
    • Fall in incidence and mortality due to screening (US, Nordic countries, England)
    • Factors affecting incidence and mortality rates
  6. Principles of screening and measurement of accuracy
    • Requirements of screening programmes
    • Measurement of accuracy
  7. HPV tests in cervical cancer screening
    • HPV triage and test of cure
    • Primary HPV testing; HPV-cytology co-testing
    • Vaccination and its consequences for screening
  8. Collecting cellular samples from the cervix
    • Guidelines for taking cellular samples
    • Comparison of conventional and liquid-based cytology
    • Criteria for adequacy
  9. Cervical cytopathology
    • Terminology
    • Normal cytology; benign/reactive changes
    • Squamous intraepithelial lesion (SIL)
    • Low-grade SIL; High-grade SIL
    • Aytpical/borderline cytology
    • ASC-US: bordering on LSIL
    • ASC-H: suspicious for HSIL or cancer
    • Squamous cell carcinoma
    • Adenocarcinoma in situ/adenocarcinoma/CGIN
    • Atypical glandular cells
  10. Pitfalls in cytology
    • Potential false positives and false negatives
    • Limiting borderline and atypical reports
  11. Quality control
    • Rapid re-screening; rapid pre-screening; automation
    • Comparison of reporting rates (LSIL; HSIL; ASC; AGC)
    • Proficiency testing
    • Invasive cervical cancer audit
    • Laboratory accreditation
  12. Cytology in a multidisciplinary setting
    • Role of the multidisciplinary team
    • Accuracy of cytology and HPV tests
    • Accuracy of colposcopy and punch biopsy