9a. Terminology and criteria for adequacy
Introduction An agreed terminology for cervical cytology is not only important to ensure consistency of screening and reporting slides but also to enable cytology results to be compared between laboratories, regions and countries, and to be correlated with colposcopy findings, histopathology results and clinical outcome. Among the countries of Europe and to an even greater […]
Importance of quality control on the effect of screening
An additional factor is evident from a closer look at the situation in England, which may well be relevant to other countries. While incidence, mortality and rates of carcinoma in situ were increasing in women below 35 years of age, those were the women from whom 65% of Pap smears were taken at the time […]
Detection of early-stage occult cancers
Detection of occult invasive cancers in asymptomatic women may increase the incidence of cancer in early rounds organised screening. An audit of 382 cancers from 1985 to 1996 in Southampton, during the introduction of organised screening in the background of opportunistic screening with poor quality control, showed a trend from symptomatic to screen-detected cancers with […]
References
Adelstein AM, Husain OA, Spriggs AI. Cancer of the cervix and screening. BMJ 1981;282:564. Arbyn M, Anttila A, Jordan J et al. (Eds). (2008). European guidelines for quality assurance in cervical cancer screening, second edition. Chapter 3 pp.87-88. European Communities 2008. Available as www.screening.iarc.fr/doc/ND7007ENC_002.pdf Albow R, Kitchener H, Gupta N, Desai M (2012). Cervical screening […]
7. Use of HPV tests in cervical cancer screening and the effect of vaccination
Developments that radically change cervical cancer screening Until recently exfoliative cytology formed the basis for cervical cancer screening and to a major extent fulfilled the criteria defined many years ago for an effective method of screening . Its success has been demonstrated in many countries during the past 50 years ; but recent developments in […]
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 […]