Cervical cytology Flashcards

Question

What are some of the current screening programmes

Answer 1

Bowel screening - all aged 50-74 Cervical - women aged 25-64 Diabetic screening - from age 12, annual eye test Breast screening - aged 50-70 Screening in pregnancy Sickle cell and thalassaemia Infectious diseases Screening in newborns PKU hearing screening

Answer 2

Invitations are sent out: Prior to sending invitations, a list of eligible patients is sent to the GP Reminder letters are sent out Non-responders notified to GP The aim is to achieve 80% coverage of eligible women for cervical screening programme Supported by rigorous quality assurance to ensure tests are accurate and they are provided with appropriate follow-up care. Information is provided to patients Acknowledging barriers to screening Multi-disciplinary team working

Answer 3

Invitation as required for people who have had recent abnormal tests. People who have not had an adequate screening test reported since age 50 may be screened on request

Answer 4

if they have no cervix, women who have uterus removed due to age - over 60 with normal tests result dont require it previous raditherapy to the pelvic region - can cause cellular changes that can make cytological diagnosis difficult under the mental capacity act Patients can request screening, even if they fall outside the typical guidelines, provided they are fully informed about the decision.

Answer 5

The squamo-columnar junction (SCJ) is the area in the cervix where two types of cells meet: Squamous cells: These are flat, thin cells that line the outer part of the cervix (the part that extends into the vagina) and the vaginal canal. Columnar cells: These are taller, column-like cells that line the inner cervical canal (the passageway that leads into the uterus).

Answer 6

The transformation zone is an important area in the cervix, where the squamous cells gradually replace the columnar cells. This is the region most susceptible to changes caused by human papillomavirus (HPV), which can lead to abnormal cell changes and, potentially, cervical cancer.. During a Pap smear (or cervical screening), cells from the transformation zone around the squamo-columnar junction are collected because this is where most abnormal cell changes (such as those caused by HPV) are likely to occur. HPV infections typically affect the squamo-columnar junction and the surrounding areas, which is why it’s the focus of cervical screening tests.

Answer 7

The Brush: During a cervical screening (Pap smear), a small brush is used to collect cells from your cervix (the entrance to your womb). Into the Vial: After the brush collects the cells, it’s pushed into a small container (called a vial). The brush is pushed to the bottom of the vial to spread open the bristles and release the cells it collected. Swirling the Brush: The brush is then swirled around in the vial, which helps the cells fall off the brush and mix into the liquid inside the vial. This liquid is special (an alcohol-based fixative) and helps preserve the cells so they don’t get damaged. After the cells are in the vial, the brush is thrown away in the clinical waste,

Answer 8

Ensure the sample was taken at the correct time (within the screening interval). Check that the vial and request form have all required information. Make sure the vial isn’t leaking. Check that the broom head is properly removed from the vial. Confirm that the vial is within its expiry date. Label the sample correctly and enter it into the lab’s system (LIMS).

Answer 9

Qiagen Hybrid Capture 2 High-Risk HPV DNA Test A method to detect the presence of high-risk HPV types by capturing and amplifying the DNA of the virus.

Answer 10

HR-HPV testing is better at detecting cervical abnormalities (more sensitive), but it may identify women who don’t have significant issues (less specific). A positive HR-HPV test significantly increases the risk of high-grade abnormalities or precancerous changes. A negative HR-HPV test is very reliable at ruling out cervical abnormalities (99.8% accuracy). Cytology (Pap smears) are more specific, meaning they are better at detecting actual abnormalities, but they are less sensitive and may miss some cases. Combining HR-HPV testing with cytology triage creates a stronger, more accurate screening system, especially with the introduction of HPV vaccination.

Answer 11

About 85% of samples tested by the Roche Cobas 8800 will not show HR-HPV, meaning no significant HPV infection is present, and further cytology is not needed. About 15% of samples will show HR-HPV detected, prompting a cytology slide preparation using papnicolau stain

Answer 12

Primary Screening by Cytologist: Cytologist screens the slide, marks abnormalities, and sends abnormal slides for further checking. Negative slides are quickly reviewed by another cytologist to confirm no issues. Checking: Senior biomedical scientists review abnormal slides and can downgrade low-grade abnormalities to negative or confirm the grade of abnormalities. Abnormal or high-grade slides are sent for a final review by a consultant. Consultant Reporting: Consultant pathologists or senior BMS report on abnormal or high-grade samples.

Answer 13

Changes in cells which suggest preinvasive process, they do not look for cancer

Answer 14

- uniform shape and size - rounded shape - smooth regular outlines -even chromatin pattern - normochromasia This term means that the chromatin has a normal, moderate staining intensity, meaning it doesn’t appear unusually dark or light when stained in preparation for microscopic examination. It reflects normal DNA content and activity within the nucleus.

Answer 15

hormones like oestrogen (appear pinkish) and progesterone (purple)

Answer 16

Lack of oestrogen

Answer 17

Can be due to menopause, post natal, breastfeeding, contraception * Cells fail to mature, predominance of parabasal type cells * Always need to check clinical details i.e if patient is on menopause, age, on HRT * Can make interpretation difficult

Answer 18

CIN Grade Full Name Description Corresponding Bethesda Cytology Term CIN 1 Mild dysplasia Abnormal cells in lower 1/3 of epithelium LSIL CIN 2 Moderate dysplasia Abnormal cells in lower 2/3 of epithelium HSIL CIN 3 Severe dysplasia / a in situ Abnormal cells in more than 2/3, up to full thickness HSIL (refer to google docs)

Answer 19

Nuclear enlargement with variable increase in nuclear: cytoplasmic rations Nuclear plemorphism (variable shapes) Hyperchromasia (dardker nuclei) Chromatin abnormality - may be clumped

Answer 20

<50 % May show koilocytosis

Answer 21

> 75% can be single cells or sheets

Answer 22

bizzare cell shapes often large numbers of severely dyskaryotic cells very large nucleoi Atypical mitosis Tumour diathesis - Tumor diathesis is a term used in cytology (especially in Pap smears or fine needle aspirates) to describe the background debris seen in smears from high-grade malignant tumors, particularly invasive carcinomas

Answer 23

Scanty dyskaryosis refers to the presence of very few dyskaryotic cells on a Pap smear — not enough to make a strong or confident interpretation, but still enough to suggest a potential abnormality. Dyskaryosis- abnormal nuclear changes in squamous cells, often due to HPV infection or precancerous lesions.

Answer 24

Lymphocytes, enodmetrial cells, histioctes and severe dyskaryosis cells all look the same, making it harder to disntinguish

Answer 25

Features of endocervical glandular cell neoplasia * Increased endocervical cell content * Nuclear crowding * Elongated nuclei and increased N:C ratios * Coarse nuclear chromatin * Pseudostratification, often presenting as 'strips' * Rosettes and feathering of cells at edge of groups

Answer 26

* Most likely to be endometrial, occasionally ovarian – due to proximity to sample site * Less likely to pick up as a coincidental finding now, as not HPV related.

Answer 27

3 dimensional 'scalloped' clusters of cells * Prominent nucleoli pouch Vacuolation of cytoplasm (bubbly places within the cytoplasm) * Neutrophil polymorph ingestion (Tumor cells may engulf neutrophils, showing phagocytic behavior)

Cervical cytology Flashcards

(55 cards)