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The Role of the Cytology Laboratory
Irene Samphier
Cytology Department
Pathology
East Surrey Hospital
Liquid Based Cytology
• Randomised cells presented as a thin layer preparation on slide
• Cells collected with plastic broom• Transported in liquid medium• Smaller area to screen• Better cell preservation• ThinPrep and SurePath
Beware the difference
• Different technologies have slightly different requirements (brush head in or out)
• If you move areas, check technology being used
• Will need a short conversion course if move to a Surepath area
• PIN number from this training valid for all of Kent, Surrey, Sussex
Advantages of LBC
• Almost mono-layer of cells, therefore each cell is easy to view
• Cells are well preserved
• Facilitates 14 day turnaround
• Subsequent HPV typing possible
HPV testing
• Not available on NHS yet, being introduced by March 2012
1) Testing as a low grade cytology triage test
at initial diagnosis stage
2) Test of cure: negative cytology, negative HPV test, routine recall.
14 DAY Turnaround time
• 14 day turnaround from sample taking to the lady receiving her result
• Every aspect of the cervical screening has to play its part to achieve this vital sign
• Target is 98% 14 day TAT including time for HPV testing
PreservCyt fluid
• Methanol based collection fluid –
health and safety considerations (toxic – keep out of reach)
Wash splashes off the skin thoroughly with soap and water
Eye contact: Irrigate thoroughly for at least 10 mins. If discomfort persists seek medical attention.
Use by date on pot
T3000 main processor
• Processes up to 60,000 specimens per year• Automated process• Racks of 80 vials take approx 2 hours to
process.• Vials are bar coded• T3000 reads each barcode and transfers the
information to an LBC slide for that specimen
Papanicolaou stain
• Originator of the cervical smear
• Stain designed to be gentle on the eye and be able to see through layers of cells to the cells below
• Nuclear stain: Haematoxylin
• Cytoplasmic stains (Papanicolaou stains): EA50 and OG 6
Coverslipping• Slides are stained and then to protect the
cells, a very thin glass coverslip is placed over them
• Stuck in place with mountant with same refractive index as glass
• Therefore down microscope all you see are the cells
• Slides are stored for 10 years for audit
Processing chain
• Samples and request forms checked and verified and then bar coded at original Laboratory
• Racks of vials sent to HUB each day for processing and staining
• The prepared LBC slides (and vials) next day• Original Laboratory screen and report the
specimens
Interpretation of reports
• The report will have the cytological pattern eg negative, mild dyskaryosis etc
• The report will be graded as the highest abnormality seen
• A specimen will not be called inadequate (even if very few cells present or technically inadequate) if any abnormal cells are seen.
Mild, Moderate, Severe Dyskaryosis.
• Cytological grading used to predict underlying histology.
• Mild dyskaryosis predicts CIN I
• Moderate dyskaryosis predicts CIN II
• Severe dyskaryosis predicts CIN III
• Borderline change – uncertain significance
• The report should also have a management recommendation
eg normal recall, repeat in x months,
gynaecological referral etc
• This laboratory operates direct referral for colposcopy for GP and community clinic samples– the result should be stamped to say this has happened if require.
Inadequate samples due to cellularity
• Heavily blood stained
• Contamination with lubricant
• Insufficient cells present
• Cells obscured by polymorphs
• No endocervical cells when following up endocervical lesions
• Thin prep can cope with a small amount of blood, but large quantities make the specimens inadequate
• Before we report a specimen as inadequate due to blood we will have reprocessed it to remove some of the blood
Inadequate samples due to paperwork/technical:
• Unlabelled vial
• Incorrectly labelled/partially incorrect
• Sample taken more than 6 weeks prior to receipt in lab
• Leaked so insufficient specimen for processing
• No PIN number/not recognised
Quality assurance in the laboratory
• Each person reporting cervical samples (Screeners and Pathologists) participates in an interpretive EQA
• Quarterly statistics are performed on all the screeners work to ensure that they are competent
• Have to be within national detection rates - Especially important for the high grade dyskaryosis 0.8- 1.4%•