The MSRSGC appears to be a useful tool to guide clinical management and provide an indication of possible risk of malignancy. We favour implementing use of these categories in our reporting practice with a future re-evaluation to assess maintenance of service quality as well as the clinical utility of this reporting system.

No abstract

The revised BSCC terminology for abnormal cervical cytologyThe BSCC terminology was originally published in 1986 and although highly successful, requires revision. Through a process of professional consensus and literature review this has been undertaken by the BSCC. The revision takes account of recent developments and improvements in understanding of morphology and disease process and is compatible with other terminologies in use elsewhere, whilst still maintaining a focus on practice in the UK cervical screening programmes.

In order to compare and contrast conventional preparation (CP) with ThinPrep 2000 (TP) in respiratory cytology, 207 samples were divided equally and processed by the two different preparation methods, generating three CP and one TP slide per sample. No lesion identified by CP was missed by TP and there were no significant differences between TP and CP in the diagnostic categories. However, two cases of squamous cell carcinoma were detected on TP which had been classified as unsatisfactory and moderate squamous dyskaryosis, respectively, on CP. ThinPrep was found to be superior to CP in many respects as it provided standardized preparations in a greater proportion of cases and problems such as cell overlapping and background debris were markedly reduced. In several instances the diagnostic accuracy in CP was compromised by smears that were either too thick, too thin, or too scanty. Cell preservation was also better on TP when compared with CP, facilitating more accurate diagnosis and significantly reducing the primary screening and reporting time, especially of sputum samples. A major advantage of TP methodology is the fact that it facilitates optimal use of skilled cytotechnologists and streamlines the workflow in the laboratory.

Urine cytopathology is a useful and noninvasive tool in the diagnosis and follow-up of urothelial neoplasia, which remains complementary to emerging molecular tests. These specimens may be challenging and there are numerous mimics and diagnostic pitfalls with which to contend. This review discusses these various entities and includes consideration of ancillary tests that may be useful in the diagnostic procedure.

Results: 120 EUS-FNA pancreas specimens from 111 patients were received, of which 112 (93.3%) specimens had follow-up data. There were 79 and 41 EUS-FNA pancreas specimens from solid and cystic lesions, respectively. Based on the cytology diagnosis the specimens were classified as Panc 1 (7.5%), Panc 2 (33.3%), Panc 3 (2.5%), Panc 4B (2.5%), Panc 4O (15.0%), Panc 5 (3.3%) and Panc 6 (35.9%). The performance indicators for diagnosis of malignancy or neoplasia with malignant potential, included sensitivity (95.4%), specificity (100%), positive predictive value (100%), negative predictive value (92.3%), false positive rate (0%) and false negative rate (4.6%). Conclusions:The Papanicolaou Society of Cytopathology pancreaticobiliary terminology classification scheme is a logical system that can easily be introduced in a diagnostic cytopathology service. This classification scheme acts as an aid to diagnostic reporting, clear communication of significant results including risk of neoplasia/malignancy to clinicians, clinical audit and comparison of results with other centres.

Postmenopausal bleeding triggers urgent investigation by sequential invasive tests that are avoidable for the 90–95% of women who do not have endometrial cancer. A simple, non-invasive tool that accurately identifies cancer and safely reassures healthy women could transform patient care. Here we report, in a cross-sectional diagnostic accuracy study of 103 women with known cancer and 113 with unexplained postmenopausal bleeding, that urine and vaginal cytology has a combined sensitivity of 91.7% (95% CI 85.0%, 96.1%) and specificity of 88.8% (81.2%, 94.1%) for gynecological cancer detection. Cytology identifies 91 endometrial, two fallopian tube and one cervical cancer from 103 known cancer cases. In women with unexplained postmenopausal bleeding, cytology identifies all four endometrial cancers and three others (cervical, ovarian and bladder), for a 12/107 (11.2%) false positive rate. We show proof-of-principle that endometrial cancer can be detected in urine and vaginal fluid. Prospective validation of these findings will support incorporation of this non-invasive test into clinical practice.

This study investigated the 5-year follow-up status of women with cervical smears showing borderline nuclear changes (BNC) or mild dyskaryosis and the effect of koilocytosis on the outcome. Thirteen per cent of women with cervical smears showing BNC had high-grade cervical intraepithelial neoplasia (CIN). In contrast, 28% of women with cervical smears showing mild dyskaryosis had high-grade CIN. The presence of koilocytosis (24% for borderline smears and 34% for mild dyskaryotic smears) did not appear to influence the risk of developing high-grade CIN. Our results suggest that the simultaneous implementation of the British Society for Clinical Cytology proposed terminology and the colposcopy guidelines from the British Society for Colposcopy and Cervical Pathology could have an impact on colposcopy services.