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.

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This paper describes the application of fine needle aspiration cytology (FNAC) performed on92 patients with salivary gland lesions in a Head and Neck Surgery Clinic. The aspirates were immediately reported by a cytopathologist and the reports conveyed to the surgeon during the same clinic visit. FNAC results were then compared with histology in those patients who underwent surgery and with the clinical course of the disease at subsequent clinic visits in patients where surgery was not performed. The cytological diagnosis was incorrect in five cases, one of which was a false negative result. There were no false positive results. The sensitivity was 90.9 per cent and the specificity 100 per cent. This rapid report system of fine needle aspiration cytology has been found to be safe, free of complications, and helpful in the planning of treatment.

The aims of this study were to review the diagnostic pathway of women with smears reported as 'glandular neoplasia' and to outline the management, colposcopy findings, treatment and final histological diagnosis in these women. The design was a retrospective review. A total of 114 women were identified over a 5-year period from the cytology database at the Royal Liverpool University Hospital Cytology Department, whose hospital case notes were available for review. Methods included a review of the case notes for the demographic details, indication for smear, colposcopic findings, investigation and/or treatment procedures, histology, final diagnosis and current disease status. Of 114 smears reported as 'glandular neoplasia', 67 were reported as consistent with cervical glandular intra-epithelial neoplasia (CGIN), six with endocervical adenocarcinoma, 36 with endometrial adenocarcinoma and five with other glandular neoplastic abnormalities. The average age was 46.5 years. 79 (69.3%) smears were routine call/recall and 36 (30.7%) women were symptomatic. The positive predictive value (PPV) for a significant histological abnormality in the CGIN smear group was 80.6% (23.9% invasive carcinomas, 43.3% CGIN and 13.4% CIN) and the PPV of an 'endometrial adenocarcinoma' smear was 86.1%. Smears indicating glandular neoplasia are associated with a high probability of clinically significant lesions, the PPV of a CGIN smear being over 80%. Immediate referral for colposcopy and assessment by an experienced colposcopist is recommended.

The correct diagnosis of the highest possible number of cervical smears showing severe dyskaryosis (high grade squamous intra-epithelial lesion) is of fundamental importance in the cervical screening programme, and it is apparent from three lines of evidence that some diagnosable cases of severe dyskaryosis are being missed.First, a review of the smears of 97 women subsequently developing invasive squamous cell carcinoma concludes 'that many cytoscreeners and cytopathologists are unable to recognize (or are unaware of the existence of) the small and hypochromatic types of dyskaryotic and malignant cells' 1 .Second, both authors are frequently asked to review cervical smears for medicolegal reasons. When cytological errors have occurred, they have usually been present in more than one smear from the patient and have involved errors of interpretation, rather than detection. Often large quantities of abnormal cellular material have been misinterpreted as a normal smear constituent. When the abnormal cells are squamous in type, severe dyskaryosis of either small or large non-keratinizing cells has almost invariably been missed. Although, given the normal processes of screening, these errors are usually made by the primary screener, this is not necessarily the case, and checkers and pathologists alike have made similar errors.Third, experience of examiners in the British Society for Clinical Cytology (BSCC) Certificate of Competence Examination has suggested that the importance of nuclear hyperchromasia as a feature of dyskaryosis has been over-emphasized, and that some candidates have a 'blind spot' for the recognition of small dyskaryotic cells.We conclude that there has been a failure of education and training at all levels in this subject, and that as a result, not everyone has been taught to recognize the complete spectrum of the appearance of squamous dyskaryosis.Discussion of these problems in the standard textbooks is variable. The great range of appearances of squamous dyskaryosis was beautifully illustrated by Hashime Murayama for George Papanicolaou in his Atlas in 1954 2 , but subsequent works have been less comprehensive. Koss 3 describes the problem of small dyskaryotic cells and warns that they may be misinterpreted as other, non-neoplastic small cell types, but hypochromatic or pale dyskaryosis is not specifically emphasized. Vooijs 4 relates increasing degrees of nuclear abnormality to increasing hyperchromasia, while Coleman and Evans 5 describe the

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