| At
the TVCS Watford Meeting 10 November 2001,Nick Dudding, from the regional
cytology training school (Leeds), was the first speaker of the morning
session. He listed the advantages and disadvantages of LBC and gave
his thoughts on applying liquid based ctyology to cervical smears.
He described the appearance of the different types of normal and dyskaryotic
cells and of some of the common infectious organisms found in smears.
His talk concentrated on morphology.
He thought that,
recently, more negative comments have been made with regard to LBC.
He himself is not sure of the value of the method after the initial
enthusiasm. It is interesting that in Scotland the Scottish Office
does not want it but the staff do, whilst in England it is the opposite.
Nick then listed
the following the advantages to the screener:
- with thin
prep the area for screening is smaller about 19mm/12mm.contiaing
50,000-70,000 cells per smear.
- the smear
is cleaner,with less blood and polymorphs, flatter but not monolayer,
- fewer fields.
He went on
and categorised the appearances of the various types of cells and
organisms as
- Almost
identical to the conventional smear - e.g. organisms, koilocytes,
mild dyskaryosis and endocervical cells.
- Similar
- e.g. endometrial cells, atrophy, squamous metaplasia, repair
and squamous carcinoma
- Quite
different - e.g. severe dysk and CGIN.
This was followed
with transparency of candida, actinomyces and herpes. Actinomyces
is not as good as that identified on the conventional smear (no
spider legs), but Herpes is excellent on the thin prep due to the
good preservation.
The transparencies
demonstrating mild desk and kilobytes were very good and still appear
in groups as most low grades. The endocervicals are slightly smaller
, more crowded and hyperchromatic. You need to look more closely
by using the high power in the case of endometrial cells. An example
of CGIN showed cells with a well preserved prominent nucleoli. Christine
Page of Newport made the comment that the features of GCIN still
there although they do look different on the thin prep.
Nick then reminded
the audience that single cells showing severe dysk are difficult
to pick at the low power and more emphasis on this at the training
schools will help prevent serious misses. Examples of microbiopsies
were also shown.
The next topic
was on the inadequte smear. Using ThinPrep, inadequates score 0.5%
in Scotland. However it raises the question of getting a seemingly
adequate smear from an inadequate sample. An imcreased emphasis
that smear takers should be properly trained is necessary if this
techniques is implemented.
Toward the
end of the talk few members of the audience made different comments
some these as follows:
- After screening
thin prep smears for the last ten months I do find them now quite
tiring
- How do you
judge the smear as inadequate.
- Borderline
figures did not go down.
- There are
problems with CIN 3 and metaplastic cells.
- I am happy
to go back to the conventional smears.
- Why do we
have to change?
- Nick Dudding
thought that most screeners like it so why not give to them.
Finally when
the question of cost was mentioned, Nick added that in Scotland
16 of the general practices like the thin prep method so much that
they pay for the kits themselves. Also, a deal will be worked out
as the NHS will be baying the kits in large bulks.
The audience found Nick Dudding's talk very interesting, stimulating
and full of good humour it was a good start for this bright saturday
morning.
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