Potential false positives
Potential false positives Although the clinical implications of false positives seem less significant than false negatives, they cause unnecessary anxiety to patients and may lead to unnecessary excisional treatment, which is now known to increase the risk of premature rupture of membranes in pregnancy. Although the risks are associated with large excisions rather than LLETZ […]
Guidelines for reporting abnormal cytology
While describing the features of the spectrum of squamous and glandular abnormalities seen in cervical cytology and histology it is essential to use terminology that is understood by everyone involved in the screening process and for results to be comparable to those reported in other regions and countries. Much of the world uses the Bethesda […]
Collecting, preparing and fixing the cellular samples
Sources of error A chapter has been dedicated to guidelines for taking a cellular sample, fixing and processing conventional and liquid-based preparations. Here we discuss sources of error during this stage in the process. Clinical condition of the patient at the time of sampling Samples taken during, or in the few days before or after, […]
Atypical and borderline changes
Definitions of borderline and atypical In the BSCC classification The term BNC [borderline nuclear change] is used as a holding category when there is genuine doubt as to whether or not the changes are neoplastic. (Denton et al. 2008). Since the Bethesda system was first introduced (Kurman & Solomon 1988) the category atypical cells of […]
10. Pitfalls in cervical cytology
Classic cytological appearances of high-grade intraepithelial lesions are frequently not encountered in routine practice and there are many mimics of benign and neoplastic changes that may lead to errors in diagnosis. Pitfalls in cervical cytology may conveniently be divided into three categories: Potential false negatives Potential false positives Unnecessary atypical/borderline reports The aim of […]
HPV primary screening
HPV primary screening is an attractive option to health service managers because the results are not subject to inter-observer variation. Also, in the long run, HPV screening may be cheaper than cytology because the costs of personnel, training, update and quality control may be lower. Nevertheless, HPV testing also requires equipment, reagents, training, quality control […]
Distinguishing progressive from reversible lesions
Cytological screening has been so successful in preventing invasive cervical carcinoma that its importance as a health problem tends be overshadowed by the disadvantages and possible risks of screening itself. In England, where screening coverage since the NHS Cervical Screening Programme was officially launched in 1988 has been high, CIN3 has most frequently been found and […]
11. Quality assurance, quality control and quality standards
Quality assurance The maintenance of a desired level of quality in a service [or product] especially by means of attention to every stage of the process of delivery or production (www.oxforddictionaries.com) In order to maintain the desired level of quality in cervical cancer screening, the following systems are required: Quality control: internal measures to […]
References
Arbyn M, Ronco G, Anttila A et al. (2012). Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 30 (suppl. 5):F88-99. Arbyn M, Roelens J, Cuscheiri K et al. (2013). The APTIMA HPV assay versus the Hybrid Capture 2 test in triage of women with ASC-US or LSIL cervical cytology: a meta-analysis […]
Potential risks of treatment of high-grade CIN
Local ablation or excision of the transformation zone has been highly successful in treating high-grade CIN and greatly reduces the risk of progression to invasive carcinoma but it is not itself without risk (Kyrgiou 2014). It is probable that the increase in second trimester miscarriages due to premature rupture of membranes reported after excision biopsy […]