1. The Role of the Cytology Laboratory
Irene Samphier
Cytology Department
Pathology
East Surrey Hospital

2. 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

3. 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

4. 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

5. TP (Macroscopic)
• The key difference in presentation is no longer seeing the smear pattern. ThinPrep takes the same material which is concentrated onto the center of the slide in a thin, uniform layer. Specimen preparation is standardized, eliminating the inconsistency associated with manual preparations.

6. HPV testing Not available on NHS yet, being introduced by March 2012
Testing as a low grade cytology triage test
at initial diagnosis stage
2) Test of cure: negative cytology, negative HPV test, routine recall.

7. 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

8. 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

9. ThinPrep® Process In the laboratory
1. Dispersion
2. Cell Collection
3. Cell Transfer

10. Liquid Based Cytology
THINPREP™

11. 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

12. ThinPrep® 3000 Processor

13. Staining and Coverslipping

14. 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

15. Normal squamous cells

16. 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

17. 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

18. 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.

19. 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

20. The report should also have a management recommendation
eg normal recall, repeat in x months,
gynaecological referral etc

21. 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.

22. Normal Cervix

23. Normal Cervix

26. Mild dyskaryosis

27. Mild Dyskaryosis

28. Mild Dyskaryosis with HPV

29. Mild dyskaryosis with wart virus

30. Moderate dyskaryosis – more cytoplasm than severe dyskaryosis

31. Moderate Dyskaryosis

32. Severe Dyskaryosis

33. Severe Dyskaryosis

34. Invasive Cancer

35. Abnormal Endocervicals

36. Dyskaryotic endocervical cells

37. Herpes simplex virus

38. Trichomonas Vaginalis

39. Candida

40. 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

41. 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

42. 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

43. Look easy?

44. Normal endometrial cells

45. Severe dyskaryosis microbiopsy

46. 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 %

47. KC61
Department of Health statistics –published every autumn
Clinical Pathology Accreditation (CPA)
QARC visits