Challenges in Cytology | Table of Contents

Acknowledgements

Foreword	7
Introduction	8
Purpose and Scope Purpose of the Pap test Role of the NSW Cervical Screening Program	8 8 9
Part 1: An Approach to Detection and Interpretation:High Risk Patterns	11
Sources of Error	12
Human factors Cytological criteria Characteristics of the specimen	12 14 16
Detecting High Risk Patterns	17
Interpreting High Risk Patterns	20
Interpretation: Multiple abnormal criteria Interpretation: Variation within a cell population	20 21
Variation in nuclear features Variation in other cell features Difficulties applying variation	21 22 22
Will Screening for High Risk Patterns Lead to Oversensitivity?	23
Part 2: Specific High Risk Patterns	27
High Risk Pattern Group 1 - Crowded Sheets and Unusual Glandular Cells	29
Crowded sheets	29
Interpretation of crowded sheets Subtypes of crowded sheets	29 46
Crowded sheets of endocervical cells Crowded sheets of immature squamous metaplasia Crowded sheets of reactive metaplasia, regeneration or tissue repair Crowded sheets of parabasal cells Crowded sheets of endometrial cells Crowded sheets of stromal cells	46 47 52 56 57 63
Unusual glandular cells	66
Interpreting unusual glandular cells - Distinguishing squamous lesions from glandular Interpreting unusual glandular cells - Subtypes of AIS Interpreting unusual glandular cells - Applying AIS criteria Interpreting unusual glandular cells - Distinguishing AIS from benign cell patterns Interpreting unusual glandular cells - Distinguishing adenocarcinoma from AIS Interpreting unusual glandular cells - Distinguishing adenocarcinoma from benign	66 66 72 76 80 80
High Risk Pattern Group 2 - Single Cells and Small Cell Groups	81
Bare nuclei Immature metaplastic cells Histiocytes Minor atypia Parakeratosis or miniature squamous cells	82 83 90 90 91
Subtypes of parakeratosis or miniature squamous cells	92
Pleomorphic parakeratosis High N/C ratio parakeratosis Pale parakeratosis	92 92 92
High Risk Pattern Group 3 - Additional Patterns that may be associated with Invasive Squamous Cell Carcinoma	99
Part 3: Final Considerations	103
Other Situations Presenting Specific Difficulties and Risks	104
Liquid based cytology Air drying and degeneration Post irradiation	104 104 104
Improving Cytological Diagnosis by Critical Follow-up	106
Summary	107
Appendices	109
APPENDIX 1 - Nuclear Shapes: Artefactual / Degenerate / Physiological / Mechanical APPENDIX 2 - Nuclear Structures: Degenerate APPENDIX 3 - Nuclear Shapes: Stromal or Histiocytic APPENDIX 4 - Nuclear Structures: Abnormal APPENDIX 5 - Nuclear Shapes: Abnormal APPENDIX 6 - Architectural Features of Adenocarcinoma-in-situ APPENDIX 7 - List of Tables APPENDIX 8 - List of Figures	109 110 111 112 115 116 118 119
References	121

Title: Challenges in Cytology
Publication Date: October 2002
ISBN: 1 74080 029X
Published by: NSW Cervical Screening Program, Westmead Hospital NSW 2145

© NSW Cervical Screening Program and R C Bowditch Pty Ltd 2002