- 1. Introduction and an overview of the evolution of the Pap smear to cervical cancer screening as it is today
- Evolution of the Pap smear to cervical cancer screening today
- 2. Anatomy, histology and function of the uterine cervix
- Function of the cervix
- Squamous epithelium
- The columnar epithelium of the endocervix
- Metaplastic change in the cervix and its physiological basis
- 3. Cervical cancer epidemiology and aetiology of cervical carcinoma
- Aetiology of cervical cancer
- Mechanisms of HPV and other risk factors in oncogenesis
- References
- 4. Pathogenesis of cervical cancer
- Risk of progression of CIN3 to invasive carcinoma
- Adenocarcinoma and adenocarcinoma in situ
- Clinical presentation, stages and treatment of cervical cancer
- References
- 5. The principles of screening and measurement of accuracy
- Distinguishing progressive from reversible lesions
- Potential risks of treatment of high-grade CIN
- Measurement of accuracy
- References
- 6. The effect of screening on incidence and mortality
- Screening interval, age group and birth cohort
- Importance of quality control on the effect of screening
- Detection of early-stage occult cancers
- References
- 7. Use of HPV tests in cervical cancer screening and the effect of vaccination
- Uses of HPV testing in triage of cervical cytology
- HPV primary screening
- References
- 8. Collecting and processing cellular samples from the cervix
- Processing cytology samples in the laboratory
- References
- 9a. Terminology and criteria for adequacy
- Criteria for adequacy of a cervical cytology sample
- Guidelines for reporting negative cytology
- Guidelines for reporting abnormal cytology
- Atypical and borderline changes
- References
- 9b. Normal cytology and benign reactive changes
- Organisms seen in cervical cytology
- Reactive cytological changes
- References
- 9c. Cytological abnormalities
- Squamous cell abnormalities of the cervix
- Atypical squamous cells of undetermined significance (ASC-US)
- High-grade squamous intraepithelial lesion (HSIL)
- Distinction between moderate and severe dyskaryosis
- Four major presentations of HSIL
- Atypical squamous cells cannot exclude HSIL (ASC-H)
- Squamous cell carcinoma (SCC)
- Glandular abnormalities of the cervix
- References
- 9d. Management of women with normal and abnormal cytology
- 10. Pitfalls in cervical cytology
- Potential false negatives
- Potential false positives
- Avoidance of over-reporting of atypical/borderline cytology
- References
- 11. Quality assurance, quality control and quality standards
- QA and QC of the complete cervical screening process
- Collecting, preparing and fixing the cellular samples
- Processing the sample in the laboratory
- Cytological screening
- Reporting the cytology
- External quality assurance (EQA) procedures
- References
- 12. Cytology in a multidisciplinary setting
- Cytology review at the MDT meeting
- HPV test results discussed at the MDT meeting
- Colposcopic findings discussed at the MDT meeting
- Cervical biopsies presented at MDT meetings
- Summary of patient management in a multidisciplinary setting
- References
1. Introduction and an overview of the evolution of the Pap smear to cervical cancer screening as it is today
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These chapters of the website were primarily designed for
Cytotechnologists and Pathologists (trainee and practicing)
who regularly examine cervical cytological preparations
The chapters are also designed for
Histopathologists
Gynaecologists
General practitioners
Nurse practitioners
All these professional groups could benefit from the chapters that explain the effectiveness and limitations of cervical cancer screening as well as the sensitivity, specificity and predictive values of the various modalities involved in an increasingly multidisciplinary process
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Summary of Chapters
The central theme of this section of the website is cervical cytopathology, which includes:
- Guidelines for collecting cellular samples, comparison between conventional and liquid-based cytology, processing samples in the laboratory and automation
- Criteria for adequacy and terminology, normal cytology and benign/reactive changes, cytological abnormalities of precancerous lesions and cancer, and recommendations for management
- Pitfalls in cytological diagnosis
- Quality control, quality assurance and quality standards
Chapters on background information include chapters on
- Anatomy, histology and function of the cervix
- Epidemiology and aetiology
- Pathogenesis of cervical cancer and its precursors
- Principles of screening and measurement of its accuracy
- Effect of screening on incidence and mortality
- The role of HPV tests in cervical screening and the effect of vaccination
The final chapter will describe the place of cytology, colposcopy findings, HPV status and biopsies in a multidisciplinary setting
Chapter 1 provides a histological overview up to the present day and refers to the chapters listed above. References and sources of images in Chapter 1 are provided in the relevant chapters.
Although these chapters primarily deal with cervical cytology, the central focus is the woman, whose precancerous lesions must be diagnosed accurately and removed safely to prevent unnecessary anxiety or damage to her cervix while reducing the risk of progression to invasive carcinoma
