CLINICAL CYTOLOGY AUDIT

Clinical Cytology Audit

Abstract

To describe the cervical cytology diagnoses and cyto-histological correlation in the Department of Pathology, National University of UK in 1997 and to compare the data with international figures. A database search of all cervical cytology cases diagnosed in the department in 1997 as well as follow-up biopsies was carried out. The data was then critically analysed. 10,207 cases were reviewed. 96% of the cases had a diagnosis of “negative”. Under 1% of cases were labelled as “inadequate”. “Atypia” was diagnosed in 1% and dysplasia and/or malignancy was diagnosed in 1%. These figures correlate well with international data. Of the dysplasia cases, 78% were followed by biopsy. Of the high-grade dysplasia cases that were biopsied, 97% of the biopsy diagnoses were within the acceptable concordance range with the cytology diagnoses and in only 3% was there a significant discrepancy. Of the cases diagnosed as atypia, 39% were subsequently biopsied at the same institution as the next procedure and only one showed high grade dysplasia. A total of six cases showed a significant discrepancy between the cervical cytology result and the subsequent biopsy diagnosis and these were reviewed to elucidate the reasons for the discrepancies. The cervical cytology service is of a high diagnostic standard. A subset of patients is probably being prematurely biopsied and may benefit from having a repeat smear instead. Specific clinical protocols regarding subsequent therapy following cytology results and closer cyto-histological correlation are two main areas where the cytology service can be improved.

Table of Content

Abstract2

Introduction4

Methodology5

Findings6

Overall figures6

Follow-up data7

ASCUS7

Mild Dysplasia (LSIL)8

Moderate And Severe Dysplasia (HSIL)8

Carcinoma9

Negative For Dysplasia Or Malignancy9

Review Of Significantly Discrepant Cases10

Discussion10

Overall results10

ASCUS11

LSIL and HSIL12

Negative for Dysplasia or Malignancy12

Significantly discrepant cases13

Conclusion14

Recommendations15

References16

Clinical Cytology Audit

Introduction

The introduction of cervical screening programmes has arguably been one of the most successful cancer detection and prevention strategies in the history of medicine. Cervical screening programmes in many countries have been shown to reduce the death rate from cervical carcinoma significantly. Carcinoma of the uterine cervix is the 4th commonest cancer among women in UK, making up 7.2% of all female cancers diagnosed between 1993 and 1997(5). While a coordinated national programme for cervical cancer screening is about to be established, cervical smears have been carried out in increasing numbers, in both the public and private sectors. The agestandardised rate of cervical cancer incidence in UK has been declining over the years from 18 per 100,000 per year in 1968 to 14 per 100,000 per year in 1999 (Avise, 2002, 58).

This figure is very close to countries with an established screening programme (like the 13.7 per 100,000 per year reported in the Birmingham, UK, study) and contrasts with other Asian countries with no such programmme (38.9 per 100,000 per year in Madras, India)(6). The cervical cytology service plays a key role in the cervical screening/investigation process. The quality of a cervical cytology service is in part monitored by the overall percentages of the various diagnostic categories diagnosed, the review of routine cases as well as the histological and clinical ...