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CONTENTS Vol 27 No 2 2016

EDITORIAL 1 Sharon Roberts-Gant

PRESIDENT’S PIECE 2 Allan Wilson

CHAIRMAN’S COLUMN 3 Paul Cross

QUATE 5 Allan Wilson

ROLE OF BIOMEDICAL SCIENTISTS WITHIN THE PROVISION OF A 8 NON-GYNAECOLOGICAL CYTOLOGY SERVICE

CHANGING LBC SUPPLIERS IN A HIGH VOLUME LABORATORY — IMPROVING 10 QUALITY AND EFFICIENCY — ONE LABORATORY’S EXPERIENCE Alison Cropper

WHEN IT’S THERE… IT’S THERE 14 Hedley Glencross

CEC JOURNAL BASED LEARNING 16

CASE STUDY 18 Gavin Laing

THE 40TH EUROPEAN CONGRESS OF CYTOLOGY IS NEARLY HERE! 19 Paul Cross

CEC LOCAL OFFICERS 20

“SLEEPLESS IN SEATTLE” 21 Dave Nuttall

ECC 2016 DRAFT PROGRAMME 24

www.britishcytology.org.uk

Front Cover image: A cervical cytology casewith occasional barenuclei, reported as highgrade dyskaryosis, bestregarded as moderatedyskaryosis. LLETZ – CIN3.Supplied by Sue Mehew.

Cover 27_2 RRG_Draft cover APR 2015 03/08/2016 09:54

President

Chair

General Secretary

Treasurer

Members

BAC Executive Committee

Mr Allan Wilson Pathology Department, Monklands Hospital, Monkscourt Avenue, Airdrie.ML6 0JS Tel: 01236 712087 Email:[email protected]

Dr Paul Cross Dept of Pathology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear.NE9 6SX Tel: 0191 445 6551 Email: [email protected]

Sue Mehew Cytology Laboratory and Scottish Cytology Training School. PathologyDepartment, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh. EH16 4SA. Tel: 0131 2427149 Fax: 0131 2427169. E-mail: [email protected]

Kay Ellis ABMSP/Cytology Manager, Cytology Department, Floor E, Royal HallamshireHospital, Glossop Road, Sheffield S10 2JF Tel: 01142 713697 Fax: 01142 261213. Email:[email protected]

Helen Burrell Consultant Biomedical Scientist & Manager, South West Regional CytologyTraining Centre, Pathology Sciences Building, Southmead Hospital, Bristol BS10 5NBTel: 0117 323 5649Email: [email protected]

Dr Ashish Chandra Consultant Pathologist, Cellular Pathology, 2nd floor North wing, St. Thomas'Hospital, London SE1 7EHTel: 0207 188 2946 Email: [email protected]

Alison Cropper Cytology Department, 5th Floor, Derby Hospitals NHS Foundation Trust,Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NETel: 01332 789327Email: [email protected]

Dr Thomas Giles Dept of Pathology, Royal Liverpool University Hospital, Prescot Street,Liverpool L7 8XPEmail: [email protected]

Hedley Glencross Advanced Specialist Biomedical Scientist, Cytology Department,Queen Alexandra Hospital, Southwick Hill Road, Portsmouth PO6 3LYTel: 023 9228 6700Email: [email protected]

Jackie Jamison Cytology Department, Antrim Area Hospital, County Antrim BT41 2RL.Tel: 02894 424101Email: [email protected]

Mr Dave Nuttall Head of Laboratory Services, Screening Division, PHW, 18 Cathedral Road,Cardiff. CF11 9LJTel: 02920 787857 Email: [email protected]

Dr Louise Smart Department of Pathology, Medical School Building, Foresterhill, Aberdeen.AB25 2ZDTel: 01224 553794 Email: [email protected]

Cover 27_2 RRG_Draft cover APR 2015 03/08/2016 09:54

As I write this it is a week since we had the Daily Mail announcement that the National Cervical ScreeningProgramme is changing to the new HPV test which should be available nationwide in 2 years. It is unfortunatethat the cytology community had to find out about its introduction from the national media even though itwasn’t unexpected, of course the article was a little short on detail. The article focusses on how far moreaccurate the new test is compared with the current test which is subjective and relies on cell experts lookingdown a microscope — well be proud all of you ‘cell experts’ you have saved thousands of women’s lives.There will always be progress but that does not detract from the achievement of the national cervicalscreening programme in the reduction of cervical cancer related deaths. At the time of writing we are stillawaiting guidance on implementation so timelines are likely to slip. Hopefully by the time this edition is inprint we will have had implementation details.

Looking to the future — ECC 2016 — cytology is not dead merely changing, the scientific programme of ECC2016 is interesting and stimulating, there is still time to book your place. There are details of ECC 2016 in thisedition of SCAN.

Dave Nuttall has written the cytology version of ‘Sleepless in Seattle’, although I didn’t spot any night-callers!Alison has written about changing suppliers in a high volume laboratory — something a few will need to learnfrom as they prepare to do the same with HPV. We have cells from Hedley Glencross and Dr Gavin Laing —they will still be there for us to examine, microscopy is not going away as can be seen from the biomedicalscientist role in the provision of the non-gynaecological cytology service.

I would like to give my thanks to Andrew Evered, my co-editor, who has decided to step down from editingSCAN. Andrew came on board in 2008 and has produced many excellent editions since. Thank you Andrew.

Sharon

Copy date for April 2017: February 3rd 2017Editor: Sharon Roberts-Gant

INFORMATION FOR CONTRIBUTORSArticles for inclusion in SCAN can be emailed to the editor if less than 1MB in size or supplied on CD/DVDor memory stick. Text should be in a standard text format such as a Word document or Rich Text Format(rtf file). Please supply images as separate files in tiff or high quality jpeg files at a resolution of not lessthan 300 dpi (600 dpi if the image includes text). 35mm slides and other hard copy can be supplied forscanning if no electronic version is available. Graphs are acceptable in Excel format.

If you are unable to supply files in the above formats or would like advice on preparing your files,please contact Robin Roberts-Gant on 01865 222746 or email: [email protected]

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Editorial

Sharon Roberts-Gant

SCAN 27_2 OCT16_SCAN OCT15 03/08/2016 10:24 Page 1

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I am writing my Presidents piece on the train backfrom the IBMS AGM where I was re-elected to IBMSCouncil for a second three year term. I would like totake this opportunity to thank all the BAC memberswho voted for me — the number of votes cast werethe highest for many years.

I have previously mentioned the QUATE exam inSCAN and an article on this qualification is included inthis edition of SCAN. I was in Billund, Denmark for theQUATE exam last month, rather bizarrely the examwas held in the Legoland hotel surrounded by youngfamilies on holiday — a rather odd experience. Theexam itself went well and highlighted a few issuesthat have previously been touched on in SCAN. Thestatus of cervical cytology in Russia is difficult toassess but a few Russian candidates have now sat theQUATE and it appears that in parts of Russia cervicalsmears are stained with Romanowsky stains. I assumescreeners must simply become accustomed to thisstain over time but this is obviously notrecommended practice in most countries. This doesraise another issue — how would a country who usesstains other than Papanicolaou convert to HPVprimary? The additional complication is around thenecessity to move to LBC and Pap staining.Candidates can sit the QUATE exam in conventionalsmears, Thinprep or Surepath. As countries movetowards LBC conversion in anticipation of HPVprimary screening, candidates are increasingly optingto sit the exam using technologies in which they havelimited experience and inadequate training.

The guidance on conversion training has now beenpublished by the NHSSCP and provides a structure forconversion and a monitoring procedure to validatethe conversion training. The document can be usedfor individual conversion or whole lab conversion. TheUK conversion guidance may well be used by othercountries who will need to convert staff fromconventional smears to LBC before moving to HPVfirst. It is clear from evidence from the QUATE examthat the resources required to convert fromconventional cytology to LBC has beenunderestimated and must be included in any plan tomove to HPV primary screening.

On a personal note, 1st June 2016 marked a milestonein my career: 40 years in cytology. I have tried not towallow in nostalgia but it is perhaps worth noting thephenomenal changes that have occurred in cytologysince I started in Glasgow Royal Infirmary as a junior B

(or was it junior A, I am sure someone of my age willremember better than I can the rather odd job titles inplace in the 70s). In 1976 there was no organisedscreening programme, no computer systems and LBCwas not on the horizon. QA really didn’t exist, IQC wasin its infancy and the significance of HPV was only justbeginning to emerge. Immunocytochemistry wasonly just emerging in histopathology but was rarelyused in cytology. The UK had more than 500 cytologylabs. Screening staff were not trained in the featuresof CGIN. Staff were smoking in their offices andscreening rooms and the pub at lunchtime for a fewdrinks was fairly common place! The progress that wehave made over the last four decades has beenconsiderable and the investment in the programmeand staff dedication has resulted in a programme thatis the envy of the world. We should be rightly proud ofour achievements.

The move to HPV first continues to be a slow processwith no immediate prospect of a clear timeline. Thelonger the delay in decision making the higher the riskto the ability of cytology labs to deliver the service.Recruitment is becoming more and more difficult andlocum staff harder to find and more expensive. I knowof one lab who interviewed over the phone andrecruited from abroad. This also raises the issue oftraining of staff from outside the UK who do not havethe certificate of competence or its equivalents. Labsare so desperate to recruit staff they will take ontrained staff from other countries and deliverconcentrated training programmes to enable them topractice within the UK screening programmes. Weneed to consider how we manage the laboratoryservice with shrinking staff resources but a staticworkload. The most obvious solution is to leverage theexisting staff resource by offering additional hours andovertime to plug gaps in capacity. However, Agendafor Change (AfC) terms and conditions are notattractive to staff, particularly part time staff andscreeners are often unwilling to give up theirweekends for only a slight increase in their hourly rate.A strong case could be made for a “special case”highlighting recruitment and retention issues toenhance the overtime rate for screeners but manyNHS employers are adhering rigidly to AfC terms andconditions and will not enter into negotiations. Anational approach would be best but attempts inScotland for a pan-Scotland solution have made littleprogress and some Health Boards are “going their ownway” leading to a piecemeal approach to this growingproblem. A solution must be found to the growing

President’s PieceAllan Wilson


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gap between the primary screening capacity ofcytology labs across the UK and the number ofsamples which continue to roll in to our labs.

As planning progresses for the European Congress ofCytology in Liverpool in October, I would like paytribute to the local organising team and in particularPaul Cross, Kay Ellis, Dave Carter, Alison Cropper, AshChandra and Mina Desai for the incredible effort theyare putting in to ensure the conference will be asuccess. Much of this work is carried out in their own

time and the success of the Liverpool meeting will belargely be down to this team of dedicatedprofessionals. The reason this edition of SCAN isslightly early is an attempt to orchestrate a last pushto encourage member to register for Liverpool andalso to get involved in submitting short papers andposters. Please register for this major event and if youor your staff are involved in research or audit projectsplease consider submitting posters or short papers.We want the Liverpool congress to be a showcase forcytology in the UK.

Chairman’s ColumnDr Paul Cross

As I write my Chairman's piece the fallout from theEuropean referendum decision is beginning tosink in for everyone. The world will go on despitesome of the apocalyptic claims by both sides.Whilst the UK has decided to leave the EU, wecannot nor would we wish to withdraw fromEuropean cytology circles. Cytology is a smallworld at the best of times, and withdrawal into aninsular view of the world would not be good for usas cytology professionals and certainly not thepatients we serve. The forthcoming 40thEuropean Congress of Cytology, which the BAC isorganising, is an opportunity for us in the UK topromote the best of UK cytology but it is also afantastic opportunity for us to learn from ourEuropean colleagues, and those colleagues fromfurther afield. We are honoured to be organisingthe 40th ECC meeting, and given it is on our owndoorstep, I hope as many of you will attend as youcan. The programme is varied and a great mix ofall aspects and areas of cytology, and I amindebted to Mina Desai and Ash Chandra forlargely developing the programme and personallyapproaching many of the speakers and chairs forthe meeting. I must also thank Kay Ellis, AlisonCropper and Allan Wilson for their efforts inhelping me with the organisation of the meetingin general. Thanks also goes to David Carter forhelping engage with the many commercialcompanies that are attending: these contacts notonly allow them to exhibit their products but alsohelp with helping to reduce the costs throughtheir sponsorship. We are all doing this as well asour NHS jobs, and have engaged the services of aprofessional conference organiser, ConferencePartners. For a meeting of this size, we cannot

cover all the aspects or do the chasing up ofthings or look after all aspects — you need thehelp of people who do this regularly andprofessionally. The company we have engaged todo this have a great track record, and are doing agreat job for us. There is still time to book for themeeting and attend — don't miss this greatopportunity! All the meeting details are on thededicated meeting website:

www.cytology2016.com.

Check it out if you haven't already registered!

Like all professional bodies the BAC is alwayslooking to recruit new members, and especiallyfor the Executive. I am delighted that we have newmembers joining the BAC, and this bodes well forcytology as a whole and the BAC into the future.We depend on new blood and with it new ideasand experiences to progress, and the vibrancy ofany association and the work it can do andachieve depends on this. We all have opinionsabout cytology but few get motivated enough toactually do something about it.

We are all aware of the NSC's recommendationabout the adoption of HPV primary screeningwithin the cervical screening programme, but weall await an announcement about timescales andimplementation. As an association we have askedthese questions to try and get answers. We awareof ongoing work on these issues at national level,and have pressed for early announcements. In themeantime many labs are struggling to maintainservices, and staff retention and recruitment are


problematic in the extreme, and morale hasdropped. I can assure you that the BAC is workinghard on this. Not everyone agrees with the NSCdecision and in the absence of any concreteinformation people do make up their own stories.The decision has been made on very solidscientific evidence and we must move forward. Ihope that useable information will come out soonto assist us all. We will continue to press on this.

The joint statement on Biomedical Scientist roleswithin a diagnostic cytology service which we drewup along with IBMS and RCPath was issued a fewmonths ago, and can be found within this edition ofSCAN. This statement took over a year to produce —not that impressive in time I would agree, but I dobelieve that getting three way backing for it was amajor achievement, and gives it great weight. This“triple approach” I am sure is the way forward, and

ensures that the three major professional groupsinvolved in cytology support and agree with suchguidance. There is much more we can achievetogether than working alone, but we need toaccelerate the process of doing so.

This edition of SCAN contains a good mix ofmaterial. The is Allan Wilson's article on theQUATE exam, possibly something not many UKtrained cytologists may know much about, AlisonCropper's article on how to change LBC systemsand still deliver a service, a very real problem formany labs, Dave Nuttall's nocturnal musings onhis American trip and educational CEC materialand more too. Don't just leave it to the BACexecutive to fill these pages — send your materialtoo! We always welcome copy for it, and wouldvalue material from any BAC member. The nextedition will come around soon, so get writing!

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Cytopathology journal impact factor up yetagain!

Congrats to the Cytopathology team! Cytopathology,the scientific peer reviewed journal of the BAC,has increased its impact factor yet again. Theimpact factor (IF) of an academic journal is ameasure reflecting the yearly average number ofcitations to recent articles published in thatjournal. It is frequently used as a proxy for therelative importance of a journal within its field,with journals with higher impact factors deemed

to be more important than those with lower ones.The impact factor has increased to 1.761, up from1.481 in 2014, and it has moved up 11 places inthe journal rankings in the Pathology category ofthe 2015 Journal Citation Reports®. We would liketo congratulate the journal’s Editor-in-Chief, MinaDesai, and her editorial team, as well as all theauthors and reviewers that have contributed tothis success.

Membership DetailsPlease email or write to Christian Burt if any of your contact details change.

Email: [email protected]

BAC Office, 12 Coldbath Square, London EC1R 5HL


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Most SCAN readers will be well aware of the historyand format of the primary screening qualification inthe UK which has been running under a variety ofnames since the 1990’s. However, I suspect less wellknown is its overseas cousin, the QUATE exam. TheQUATE (Quality Assurance, Training andExaminations committee) Aptitude Test is aninternational examination for cytotechnologistswho fulfil the criteria for accreditation in their owncountries.

The exam has been running since 1992 and a tableshowing the venues and pass rates is shown in Table1. The exam is designed to provide an objectiveassessment of a cytotechnologist’s competence toscreen conventional cervical smears or liquid basedcytology samples and is available in conventionalsmears, Surepath or Thinprep technologies.

The exam is administered and funded by theEuropean Federation of Cytology Societies (EFCS).BAC is a member of the EFCS

Unlike the UK, many European countries did nothave their own “registry examination” for staff whoprimary screen to demonstrate their screeningcompetence and the QUATE exam plugs this gapand offers a test as a qualifying examination forcervical cytology primary screening staff.

The examination team is Allan Wilson, Mina Desaiand Elisabeth Fedl, a cytotechnologist from Austria.As we are all relatively new to the exam, we have allattended the exams but as we develop more

experience and confidence it is likely that examswith relatively small numbers of candidates will onlyrequire two examiners.

Format of the examThe exam comprises both a written and practicalelement. The written element is in the form of 50multiple choice questions (MCQs). Each has onlyone correct answer and there is no negativemarking.

The practical component comprises 16 slides,divided into two groups of eight with a short breakbetween each group. These are available inconventional smears or Thinprep and Surepathtechnologies.

Candidates are allowed 10 minutes per conventionalcervical smear or 8 minutes for an LBC preparation. The pass mark for each section of the exam is asfollows:

• MCQ 50%• Screening test 75%

Candidates must pass each section in order to beawarded an overall pass. There is no transfer ofmarks between different sections of theexamination.

Missing an abnormal sample will mean automaticfailure. However an overcall of a negative smear asabnormal in the screening test scores zero. Repeatedovercalling of negative slides is the commonestreason for failing the screening test.

The examination papers will be marked and thecandidates notified of the results on the day of theexam.

Sample exam timetable — conventional slides

09:00 Candidate registration and ID check09:30 Instructions to candidates10:00 Written paper (MCQ)11:00 Break11:15 Screening test (slides 1 to 8)12:35 Break13:15 Screening test (slides 9 to 16)14:35 Exam finishes15:45 Exam results given to candidates

QUATEAllan Wilson

Table 1: QUATE aptitude tests 1992 to 1999


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Slide selection for the examThe criteria for slide selection is practically the sameas the UK exam. No “trick” slides are used; borderlineand unsatisfactory slides are not included. The slidesassessed are intended to reflect routine practice andare assessed by many pairs of eyes before beinglogged onto the slide bank. The difference is thatthree slide banks are required; one for each of slideformats available to candidates.

Largely the same slide sets have been used over thelast two years. This has been a deliberate strategystarted by Nick Dudding who was my predecessor asexaminer. The reason is simple — to try and producedata to allow a comparison between performance ofcandidates from different countries. It is tempting tosuggest that the resulting data could be used as anindicator of effectiveness of training in differentcountries.

However, there are risks of using the same slides setsand great care is taken to avoid using the same setfor candidates who are re-sitting the exam. It is alsovital to record the country of training as this maydiffer from the base lab. Movement across borders isrelatively common.

Examples of good practiceAnalysis of recent exam results has allowed us tosuggest areas of good practice. For example, all 18 ofthe Slovenian candidates passed and 13 of thesescored maximum marks on the screening. In thesame exam 11 Slovenian candidates scored over40/50 in the MCQs. These are exceptional results fora small country and there may be much to learn bylooking at training methods in Slovenia.

An example of a complex examThe candidate numbers varies widely. A minimum ofsix candidates are required for a viable exam andgenerally the exam is offered in the language of thehost country and English. This does mean that thelocal hosts must commit to providing someone totranslate the MCQ’s and the clinical histories.However, the exam is often held at the EFCScongress meetings where a wider range ofnationalities may be interested in sitting the exam.

In an attempt to increase candidate numbers, theexam has been recently offered in multiplelanguages although this does provide a challenge tofind willing translators for potentially small numberof candidates. In addition, the introductory guidanceto candidates delivered as a PowerPointpresentation at the beginning of the exam mayrequire a simultaneous translation in the host venuelanguage. It is clear that some words and phrasessimply do not translate easily from English into other

languages, for example, the phrase “iatrogenicchange” has caused confusion in many translatedpapers.

Perhaps the most complex exam in recent times isthe Milan exam last year which featured thefollowing:

• 27 candidates• 3 technologies • 4 languages• Translation of MCQ’s, clinical histories, response

sheets• Different clinical histories for all technologies• 29 different documents to prepare• Simultaneous translation of introductory

presentation• All carried out simultaneously in one room

QUATE local supportLocal support is vital to the success of each QUATEexam. Exams initiated by local teams that have beenoffered annually or biannually work well as there isan existing infrastructure and knowledge of theexam. Exams at congress and tutorials can be morechallenging as the venue and local team may bedifferent each time and responsibilities may not beclear.

Local knowledge of candidates is often very helpfulparticularly when there is a language barrier and

QUATE Milan 2015


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translation support during exam particularly duringthe MCQ’s and feed back after results are issued isvital. Feedback to candidates on the same day ischallenging and can be traumatic for candidates andexaminers but is an important and welcome part ofthe examination process. It is vital that feedback ismanaged carefully and sensitively and there is localsupport available for candidates who do not pass.Standard feedback sheets are given to all candidateswho fail the exam highlighting the main reasons forthe fail; however, we do not discuss individual slideswith candidates

The impact of primary HPV screening on theQUATE examMany countries in Europe are in further ahead in themove to HPV primary screening than the UK. Forcountries where the move to “HPV first” was madefrom conventional smears this represents anadditional problem; conversion from conventionalto LBC for the cytology triage. The UK has astructured approach to conversion betweentechnologies and this has been tightened recentlywith new guidance from the NHSCSP. However, insome countries the resources required to convertfrom conventional to LBC has been underestimatedand this has been reflected in the results of theQUATE exam. It is clear that supplier conversion onits own is inadequate and additional training isrequired.

There has been an increased uptake of LBC QUATEoption recently and it is clear that this is due toconversion to HPV primary screening. This hassolved a potential problem with slide selection as itwas increasingly difficult for UK based examiners toprovide conventional slides for the exam. In additionan examiner from Austria, Elisabeth Feld has beenco-opted as an examiner. Conventional smears arewidely used in Austria and Germany. The obviousconsequence of this move to LBC is an increase inexams that must be offered in all three technologies.This increases the complexity of the exam and thetime required to prepare.

Careful planningThe exam slides and paperwork travel in a suitcaseand careful planning is required based onexperience of previous exams and examiners. Thefirst time an examiner sees the venue and meets thelocal hosts is often the day of the exam! Flexibilityand planning for potential issues will not preventunforeseen issues arising on the day. Fast thinkingand the support of the local team is vital in ensuringthe success of logistically complex exams.

An expansion of the LBC slide bank is required tomeet the increasing demands of the move to HPV

primary screening and to allow multiple matchedsets to be held in different locations in case of delaysin transport to the venue by the examiners orsudden inability to attend the exam.

QUATE and EurocytologyOne of the ambitious aims of the QUATE committeeis to link the exam to the Eurocytology website. Amock exam is already available on the QUATEwebsite but it is also hoped to use the teachingresources on the website to address training issuesidentified from analysis of exam results and theperformance of MCQ’s and slides. For example, fromanalysis of candidate performance in recent yearsthere appears to be some issues in location andinterpretation of hyperchromatic crowded groups inLBC slides. This will be addressed through theEurocytology website.

The mock exam on the website could be developedfurther but there is the risk of giving away theanswers to too many MCQ’s. It must be rememberedthat our field is narrow and there is a limit to thenumber of MCQ’s that can be put on the website.Another suggestion under consideration is themandatory completion of Eurocytology modulesbefore sitting QUATE exam.

QUATE and medical staffAlthough the exam is primarily aimed at primaryscreening staff, there has been a small number ofmedical staff sitting the QUATE exam over the lastfew years. We emphasise to medical staff applicantsthat this qualification does not permit reporting ofabnormal samples or medical staff roles in cytologybut there is still a steady demand, particularly fromEastern Europe to sit the exam.

QUATE — non-gynae optionsThere is an ambition to develop a QUATE non-gynaeexam for Cytotechnologists, Biomedical Scientistsand Cytology Screeners similar to the gynae exambut this suggestion has barely got of the ground anddiscussions are very much at the preliminary stage.Given that some mainland European countries havebetter developed training schemes than the UK itwould make sense to involve potential examiners inother EFCS countries. The option of an exam forcytopathologists would be a logical second phase.

Further work to be doneAs the exam expands in frequency and complexityand more examiners are involved, documentationbecomes vital to ensure the exam is deliveredconsistently across Europe. The discussion abovesuggests we already have analytic tools to assesscandidate, slide and MCQ performance. This is farfrom the truth. A database to hold all the exam data


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including morphology features in slides wouldpermit analysis from multiple perspectives and allowus to focus on gaps in training programmes andproblems with MCQ and slide performance.

The exam is delivered by examiners located acrossEurope making administrative support difficult.Funding is available but given the complexity ofQUATE exam delivery the best use of this fundinghas yet to be decided.

As suggested above, there is more work to be doneto Identify strengths and weaknesses of individualcountries training programmes and to learn frombest practice and address substandard practice.

Translation of the MCQ’s is usually carried out afterquestion selection and is often followed by anervous wait as the translation is usually carried outby local hosts and other “volunteers” in their owntime it is not unusual to receive the translatedpapers only a few days before the exam. A betterapproach would be to translate the entire bank asthis would ease the pressure close to the exam. Thiswould require a bank of “willing” translators.

Uptake of the exam across Europe is patchy this ispartly because some countries such as the UK havetheir own registry exam but countries that do nothave any exit exams for primary screener trainingshould be encouraged to adopt the QUATE exam.

SummaryI have now been an examiner for the QUATE examfor just over a year and have had the pleasure oftaking the exam to Slovenia, Austria, Italy andDenmark. The most recent exam was in Billund,Denmark and was held in the Legoland conferencecentre which was an interesting experience. It hasbeen a pleasure and a privilege to visit thesecountries and as with all such visits there is alwayssomething to learn about how cytology is deliveredacross Europe and it has been fascinating to watchthe evolution of the exam over a relatively shortperiod. I would like to thank Peter Smith for his hardwork in raising the profile of the exam as Mina’spredecessor as lead examiner and Nick Dudding forhis tireless work in modernising and delivering theexam and for his unselfish approach to passing thebaton to Elisabeth and myself and his quickresponses to any questions we have had has led to asmooth handover.

The next exam will be in Liverpool at the ECC inOctober, we do not expect many UK candidates forthe QUATE exam but we hope to see as many BACmembers as possible for the scientific programme.

Further information can be found athttp://www.eurocytology.eu/en/quate

Role of Biomedical Scientists within the provisionof a non-gynaecological cytology service

IntroductionThe provision of a non-gynaecological cytology(NGC) (also referred to as diagnostic cytology)service involves a team of trained health careprofessionals. Historically this was typicallyprovided by medically trained pathologists whowould report and sometimes take samples,especially fine needle aspiration (FNA) cytologyand biomedical scientists and laboratory staff whowould receive and prepare the sample forreporting. This model has evolved significantly inrecent years for many reasons including:

• requirement for better use of limited resources• service expansion/service delivery changes• changes in training programmes/competency

assessment facilitating the expansion ofscientific roles

• staff skill shortages. • development of quality guidance and

standards In many ways these changes are not fullyrecognised in existing guidance. Given this theyrequire clarification to assist laboratories andclinical teams and hospitals in service provision.


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Sample preparationOnce a cytology sample is received into alaboratory it will be processed by a biomedicalscientist and/or other grades of laboratorytechnical staff, working to existing guidance andlaboratory standard operating procedures (SOPs).1

Such SOPs should be produced and agreed withinthe laboratory in line with quality standards.2,3

ReportingThe reporting of all types of NGC can beundertaken by Consultant Pathologists, withappropriate post-FRCPath training if required.

Pre-screening of NGC samples is done in manylaboratories, with biomedical scientists offeringan opinion as to diagnosis prior to being reportedby either a Consultant Pathologist or suitablytrained/qualified biomedical scientist. Thisprovides a valuable quality assurance andeducation/training opportunity.

Biomedical scientist staff in many departmentsreport out appropriate negative exfoliative NGC,as long as this is agreed based on experience,competency and repertoire in line with thelaboratory’s quality assurance process which themedical head will be part of; attainment of theDiploma of Expert Practice in Non GynaecologicalCytology (DEP) would be suitable evidence ofcompetence for the areas it covers.

Biomedical scientists who hold the AdvancedSpecialist Diploma in Non-Gynaecological Cytology(ASD) are able to report out positive samples fromrespiratory exfoliative cytology, urine and serous fluids.

The attainment of the DEP and ASD qualifications isadvocated as independent external evidence ofattainment of suitable skills in these areas. Thereporting of fine needle aspiration cytology is notconsidered appropriate for biomedical scientists.

Ultimately it is the Medical Head of Department whois responsible for the issue of all diagnostic cytologyresults.4 As is the case for Pathologists, no biomedicalscientist should be working in isolation, and shouldhave access to colleague(s) for case discussion.

Ancillary TestingIn some areas of cytology, ancillary testing (e.g.molecular or genetic markers) is indicated.Depending on the laboratory facilities, these maybe done by biomedical scientist staff, often fromCellular Pathology, but may involve otherpathology disciplines also. This will requiresuitable training in the required methodology andtechnology, again with participation in theappropriate EQA scheme(s).

Sample assessment for adequacy for reportingCertain NGC samples are taken by specific clinicalprocedures (e.g. mediastinal EBUS, FNA of manysites) by clinical teams or by Pathologists. Anopinion as to sample adequacy and sometimes adiagnosis can be offered by a Pathologist at thetime the sample is taken. In most settings though,resources do not allow for this. A comment onsample adequacy (Rapid on-site evaluation —ROSE) may be offered by a biomedical scientist. Ifthe biomedical scientist has suitable experiencebased on competency and service needs andappropriate training/qualifications they may alsobe able to offer a preliminary opinion mainly fortriage of the sample material rather than forpatient management as well as ROSE.

Multi-disciplinary Team Meetings (MDTMs)The majority of MDTMs are cancer related, andoffer an opportunity for the whole clinical team tomeet and discuss all the relevant informationconcerning a patient to help arrive at the bestindividualised treatment option(s). Many of thesewill involve cytology and also histology. In mostcases it will require a Pathologist to report/reviewthe cytology and histology. The development ofbiomedical scientist histology reporting may alterthis in the future.5 A biomedical scientist mayattend and present at MDTMs, and on occasionstand in for a pathologist, but the MDTM namedPathology lead will always be a Pathologist.6

Biomedical scientists who hold the AdvancedSpecialist Diploma in Non-GynaecologicalCytology can review and present appropriatecytology.7

Clinical Scientists in CytologyClinical Scientists in Cytology are uncommon,although the role is more common in otherPathology disciplines. It is possible thatbiomedical scientist cytology staff in this grade ofpost will increase in the future8 withdevelopments in biomedical scientist careerpathways. Trusts/employing hospitals and thosein such posts should follow guidance onappointment to such a post.9 The Health and CareProfessions Council for Clinical Scientist Standardsof Proficiency state that they are able to practiceas an autonomous professional, exercising theirown professional judgement.10

Continuing education/assessment/appraisalAll staff operating at Consultant level requireappraisal which covers their whole scope of work,and for a biomedical scientist operating at thislevel in cytology this is best done in a similarmanner to that of a medical Pathologist. This willensure their development, education andmonitoring is the same in this capacity as a


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Pathologist. This would include participation inCPD and showing evidence of this through audit,quality improvement activities, review of materialand participation in relevant EQA etc. They shouldalso be supported in their role with access tosuitable training and education, as is appropriateto the departmental quality assurance process,departmental needs and individual roles.

References1. Tissue pathways for exfoliative cytology and fine needle

aspiration cytology. RCPath January 20102. BSCC Code of Practice — exfoliative cytopathology

(excluding gynaecological cytology) Cytopathology 2009;20; 211–213

3. BSCC Code of Practice – fine needle aspiration cytologyCytopathology 2009; 20; 283–289

4. Clinical responsibility for cytology services. RCPath March2012

5. Breaking new ground in histopathology: report from thepilot of BMS histopathology reporting. The Bulletin of theRCPath. Jan 2015; 169; 27–30

6. The role of the lead pathologist and attending pathologistsin the multidisciplinary team. RCPath March 2014

7. Guidance for the Advanced Specialist Diploma in Non–Gynaecological Cytology. IBMS/RCPathhttps://www.ibms.org/go/qual i f icat ions/advanced-specialist-diplomas

8. Scientist Training Programme (STP) Certificate ofEquivalence AHCS ver v4, October 2014

9. Guidance on the appointment of consultant clinicalscientists. RCPath September 2014

10. Standards of Proficiency — Clinical Scientists, HCPChttp://www.hcpc-uk.org/publications/standards/index.asp?id=42

Changing LBC suppliers in a High VolumeLaboratory — Improving Quality and Efficiency— one laboratory’s experienceAlison Cropper, Consultant Healthcare Scientist in Cytology, The Royal Derby Hospital

Almost 3 years ago the Derby cytology laboratorychanged LBC platforms and this account tells thestory of how and why that change occurred. Firstpresented at the European Congress of Cytologyin Milan in September 2015, the data has beenupdated for this article.

BackgroundThe Derby cytology laboratory is one of largest inthe UK, expecting to process in excess of 170,000samples during 2016/17. This high volumeworkload has been created from the merger offour laboratories in 2010, when the totalcombined workload was then 170,000 but whichfell to around 142,000 with the introduction ofHPV Triage and Test of Cure in 2012. The recentacquisition of another contract whichcommenced in April this year has brought theworkload back up to over 170,000.

Derby had used SurePath™ (SP) technology sinceLBC implementation in 2006, initially on a 5 yearcontract which was then renegotiated in 2011 toinclude the combined workload from the merger,

and the contract was rolled over for another 2 years,being due for renewal in 2013.

At this time Cytology service provision was beinglooked at across a wider area as part of a totalPathology services’ review, and the remit was toincorporate future plans for HPV primaryscreening. We needed to find the most suitablesystem for centralised LBC processing and HPVtesting with a potential combined workload ofaround 240,000 LBC samples.

A Cytology clinical delivery group was establishedacross the proposed new area and a mid to longterm strategic direction was agreed by all parties— to perform HPV primary screening andassociated cytology reporting, probably on onesite, acknowledging that in the short term thiswould likely require further standardisation andconsolidation of the existing Cytology laboratoryservices involved.

The group were tasked with working up a modelto centralise all LBC preparation and HPV testing


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onto one site in the short term, recognising thatwe all needed to be using a single LBC systembefore this could happen. Two of the laboratoriesused SurePath™ and one ThinPrep™ (TP). Anoption appraisal was undertaken to compare theadvantages and disadvantages of both LBCtechnologies, considering clinical, quality andcost elements, in order to identify the single mostefficient system for centralised processing andHPV testing.

The option appraisal identified that centralisedprocessing with SurePath™ would be almostimpossible because none of the 3 laboratories hadsufficient room or staff, and that ThinPrep™ wouldbe easier for processing large volumes of work in asingle laboratory, being fully automated and withan integral chain of custody providing less risk in acentralised processing set-up. At the time therewas also the added benefit of a potential pricereduction for all laboratories because thesouthern half of the region was already usingThinPrep™ and a regional discount would beapplicable.

Of course there were risks as well as benefitsidentified with converting LBC technology — re-training of sample takers and laboratory staffwould be required; risk of breaching TAT targetsduring the transition phase; processing both LBCtechnologies during transition phase and apotential significant rise in inadequate samples —a concern of commissioners and sample takers,but the outcome of the option appraisal was still arecommendation for two centres to convert toThinPrep™.

The recommendation was approved by both Trustboards and all associated service commissionersand a new contract was awarded via the NHSsupply chain in September 2013, with a start dateof January 2014 — giving just 3 months toundertake the whole conversion process!

The conversion processConversion was required in 3 main areas, detailedin the following sections:

Screening staff — conversion training for cytologists of allgrades in the interpretation of ThinPrep samples wasrequired This must be provided by an NHSCSP approvedCytology Training Centre but our local CytologyTraining Centre (CTC) did not provide TP trainingso we had to find another which had capacity andtime within our short timescale, which thankfullywe did. We also applied to become a satellitetraining site for an NHSCSP approved CTC so thatwe could have the conversion training deliveredon-site and approval was given following aninspection in October 2013.

Staff were divided into 4 groups and undertook a1 day course comprising a lecture, workshopcases, multi-header slides and a self-assessmentset on the day. This was followed by aconsolidation set of 100 slides to be completedwithin 2 weeks. High grade sensitivity wascalculated (using Cyres) on these 100 slides with a‘pass mark’ of >95%. Any individual with a highgrade sensitivity of < 95% had to do second set of100 slides. A final assessment set of 20 slides wasthen undertaken and a specificity of >80% wasrequired to complete the training and be awardeda conversion certificate. All staff were fullyconverted by January 2014

Laboratory support staff — needed training in the useof new processing equipment & staining machinesTwo Thinprep™ T5000 Autoloaders were installedand Hologic provided on-site training for allsupport staff. A new staining/coverslippingmachine was also installed and on-site trainingundertaken for this.

For a 2 month period both SP and TP systems werein use and very careful rota planning was neededfor the support staff!

Sample takers — training in new technique wasrequired for all sample takersTraining was undertaken by laboratory andHologic staff in sessions of one hour comprisingtwo talks and a practical demonstration of thetechnique, followed by a Q&A session. A minimum


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of one sample taker from each practice/clinic hadto attend a face-to-face training session and atraining package was supplied (DVD andlaminated instruction sheet) to facilitate cascadetraining within each practice. Certificates ofconversion were awarded to all sample takers andmore than 3000 sample takers were converted injust 3 months!

Changeover of sample taking kits — all practicesand clinics were sent new kits (TP vials and greenhandled Cervex brushes) prior to their go-livedate and asked to ensure all SP kits were removedonce their TP kits arrived. This actually resulted innearly 30,000 unused SurePath vials and brushesbeing returned to the laboratory and highlightsjust how many consumables are stock-piled bypractices and clinics! We also continued to receiveSP samples after the changeover dates so we set adeadline after which any SP samples wererejected, one month after conversion whilst westill had both processing technologies on-site.

Conversion timelineStart to finish was just 3 months! In this time 35cytologists were converted and more than 3000sample takers, including those at 9 other Trusts(Colposcopy, Gynaecology and GUM clinics). Thelaboratory was re-fitted to enable installation ofnew processing and staining machines, and in themiddle of all this we moved into the second yearof HPV testing and the number of HPV testsquadrupled!

Impact of conversionTurn Around Time (TAT)TAT inevitably increased but this was not all to dowith conversion. We had planned conversion inDecember as it is usually a quiet month butconversion lasted into January when our workloadrocketed, along with many other laboratories, andit stayed that way until August! We did experiencereduced screening productivity duringconversion, as had been anticipated, but we alsohad our screening capacity further reduced when

one Cytoscreener resigned, one retired and twowent on maternity leave! Locum (agency)screeners were then employed in order to achieveand sustain the 14 day TAT.

Screener confidence & productivityOnly 2 of the 35 cytologists converted were requiredto do the additional 100 slide consolidation set butwith hindsight we think 200 slides have been bebetter for all staff; many screeners said they wouldhave preferred this and felt they lacked confidenceafter just 100 slides. There was extra pressure oncheckers because the amount of checking doubledin the first month, but the checkers were no moreexperienced than screeners in TP interpretation!Multi-header microscope sessions were frequentand essential, and the on-site additional trainingsessions provided by both Hologic and the CTC wereinvaluable.

Morphology changes — reactive endocervicalcells posed the main problem to start with butultimately cells are cells, dyskaryosis isdyskaryosis, etc., and as all staff were alreadycompetent morphologists they soon got used towhat they were looking at and also the differentstaining appearance — some screeners had neverscreened conventional smears so had notexperienced ‘orange’ before and we had a degreeof overcalling of ‘orange’ as possible viral/borderline changes in the first few months.

Scanty and blood-stained samplesGaps and spaces in slide preps took some gettingused to and adequacy was difficult to judge in theearly days, especially in the absence of anynational adequacy guidelines. Cell counts weretried but are not used so rigidly now — commonsense must prevail and a cytological assessmentof atrophy, presence of TZ cells, etc., should beused as well as cellularity to judge adequacy.

Bloodstained samples caused confusion initially.Some screeners put all scanty samples for an acidtreat, blood or no blood, and some put all blood-stained samples for an acid treat even if it was acellular sample, but we soon learnt that onlyscanty blood-stained samples benefit from acidtreatment! Acid treatment is a time consumingprocess, with associated costs, so the number ofsamples treated should be kept to a minimum.

Key Performance IndicatorsInadequate rate — Increased from ~2% to ~3%, sonot the significant increase that had been a causeof concern to sample takers and commissioners.

Low Grade detection rate — remained stablearound 4–5%.


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High Grade detection rate — has increased almost2-fold in first two full years of conversion, from0.8% to 1.5%. This is not thought to be due toover-calling as the positive predictive value (PPV)for CIN 2+ for the same periods has remainedhigh:

Further analysis of the increased high gradesensitivity is currently being undertaken, but onecontributory factor is thought to be possibly dueto the screening staff now having experience inboth technologies and therefore being moreaware of the different morphologicalpresentations and pitfalls in both types of slidepreparations, which has led to increased vigilanceand consequently detection of abnormalities.

Of the conversion overall — objective achieved?The original option appraisal was to identify themost efficient system for centralised processingand HPV testing, so yes, our objective wasachieved in that we now have a much morestreamlined processing lab with no moreprocessing delays whilst awaiting samples beingbooked into the computer.

The smaller footprint of the new processingmachines freed up a lot of bench space andenabled a re-design of the laboratory so that wenow have a much ‘leaner’ workflow within thedepartment.

The significant reduction in the hands-on timeneeded for processing enabled existing staff toabsorb the increased HPV workload with norequirement for new staff or additional hours.

There are also on-going savings equating to 3 w.t.e.laboratory support staff because of the reducedhands-on processing time, and so overall therehas also been no increase in the cost per test tocommissioners for the last 3 years.

There were some costs attached to the conversion— the pump priming of sample taker kits(although this has now been addressed byHologic and sample taker kits can be purchased

separately for pump-priming) but we did manageto offset most of these costs by selling on thereturned kits!

And if other laboratories were considering LBCsystem conversion — what advice would we give?- Do not under-estimate time needed for sample

taker training!- Ensure all practices and clinics are pump-

primed with new kits and remove old kits- Allow sufficient time for support staff to train

on the new processing machines to avoid aprocessing backlog developing - more operatortraining pre ‘go-live’ date

- Beware running two systems at the same time —minimal staff to be allowed off in transition phase

- Screener conversion — more training slidesrequired (this has now been addressed as aresult of our experience and new nationalconversion training guidelines have beenproduced by NCCETC for the NHSCSP)

- Try and get locum screeners in sooner to ‘mopup’ the old technology slides and allow staff toconcentrate on new technology slides

But for Derby none of these were show stoppers,and we successfully converted as did the otherlaboratory involved, although it is somewhatironic that the planned alliance which drove theconversion never actually happened, but that’sanother story!

AcknowledgementsHologic Ltd and the Birmingham CTC for theirinvaluable support during conversion

YearHG detection rate (% adequatesamples)

PPV (previous 12months from KC61)

2011/12 0.83 91.6

2012/13 0.84 93.9

2013/14 1.26 95.0

2014/15 1.56 92.6

2015/16 1.51 88.3


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So-called ‘difficult dyskaryosis’ has been a feature ofcervical cytology screening programmes, probablysince their introduction, but perhaps only fullyrecognised and described as an ‘entity’ some yearslater. A number of names have been ascribed todescribe the various features seen in the differenttypes of ‘difficulties’ including amongst others:‘confusing comparables’, ‘diagnostic pitfalls’,‘diagnostic difficulties’, ‘lookalikes’ and ‘pale stainingdyskaryosis’. 1,2,3,4 These types of difficult slides arestill a feature of liquid-based cytology samplesregardless of the removal of blood or polymorphsand the ‘cleaner’ nature of the final preparations.5 Itis also evident that difficult dyskaryosis will continueto be a problem even if the recommendation tomove to primary screening by HPV is adopted. Wealready know that cytologically negative samplesmay be HPV positive from test of cure, so cytologytriage preparations will still require careful scrutinyto ensure that dyskaryotic cells are not missed whena woman is HPV positive on primary screening.

Of the difficult dyskaryoses, perhaps sparse high-grade dyskaryosis is even more difficult to recognise,as by their sparse nature these cells present anumber of problems in screening, particularly if theyare also small, pale, occur as micro biopsies only or ifthe high-grade dyskaryosis exists concurrently withlow-grade dyskaryosis.

Described below are three cases received in thedepartment recently. All slides were made usingSure PathTM liquid-based cytology and the originalscreener marks in green have not been removed.

Case 1 Female aged 26, first call. Only two marks made bythe primary screener, with no other marks added atchecking or reporting. Mark 1 (figure 1) shows a veryshadowy and indistinct group of koilocytes. Mark 2(figure 2) shows a ‘squared off’ hyperchromaticcrowded group of cells, with some disorganisationand variation in the size and shape of the cells. Thechromatin patterns are slightly disturbed, nucleoliare prominent and three mitotic figures are alsonoted (one of which is visible indicated by the lowerarrow in figure 3). The primary screening opinionwas very scanty low-grade dyskaryosis plus a singlegroup of cells highly suspicious for severedyskaryosis. Punch biopsy revealed CIN 1 & CIN 2.Follow up LLETZ CIN2.

When it’s there … it’s there!Hedley Glencross, Advanced Specialist Biomedical Scientist,Cytology, Queen Alexandra Hospital

Figure 1

Figure 2

Figure 3: higher power view of the group in figure 2, showingthe 3D nature of the group. At the periphery, the variation inthe size and shape of individual nuclei can be seen, with a

mitotic figure arrowed.


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Case 2 Female aged 34, last smear negative 13 yearspreviously. Seven marks were made by the primaryscreener, with no other marks added at checking orreporting. The marks mostly showed small singlecells (although one small group was also identified)with disturbed chromatin patterns and high nuclearcytoplasmic ratios (figures 4 & 5). The primaryscreening opinion was severe dyskaryosis. Punchbiopsy revealed CIN 1 & CIN 2.

Case 3 Female aged 25, first call. Four marks were made bythe primary screener, with no other marks added atchecking or reporting. The marks showed smallclusters (3 – 5/6 cells) of small cells, with disturbedchromatin patterns and high nuclear cytoplasmicratios (figure 6). The primary screening opinion wassevere dyskaryosis. Punch biopsy revealed CIN 3.

Although none of these cases were eventuallyreported as conclusively high-grade dyskaryosis, allthe women were referred in line with the PublicHealth England national algorithm and have had adiagnosis established. While further surgery/LLETZ isawaited and CIN 3 has not yet been reported in twoof the cases, the primary screening opinion wasessentially correct in all instances, in that high-gradeCIN has been identified by cytology.

These cases remind us that sparse high-gradedyskaryosis can be notoriously difficult, but notimpossible to recognise at primary screening, orindeed in cytological triage if primary HPV screeningis introduced. Careful examination of the variety ofpresentations of these types of cells is paramountand when in doubt, try to go back to basicdyskaryotic criteria and try not to be put off whenonly small numbers of cells are present.

Remember, when it’s there… it’s there!

References1. Grubb C. Colour Atlas of Gynaecological Cytopathology: HM &

M, Aylesbury UK 19772. Coleman DV, Evans DMD. Biopsy Pathology and Cytology of the

Cervix: Chapman and Hall, London UK 19883. Gray W. Diagnostic Cytopathology: Churchill Livingstone,

London UK 19954. Smith PA, Turnbull LS. Small cell and ‘pale’ dyskaryosis:

Cytopathology 1997; 8: 3 – 8 5. Gupta N, John D, Dudding N et al. Factors contributing to false-

negative and potential false-negative cytology reports in SurePathTM liquid-based cervical cytology: Cytopathology 2013; 24:39 – 43

Figure 4

Figure 5

Figure 6


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CEC: Journal Based LearningColposcopy and Programme management guidelines for the NHSCSP(NHSCSP Publication 20, March 2016)

1. Give 4 reasons (apart from automatic ceasing) why a woman might be withdrawn from The NHS CervicalScreening Programme? (4 marks)

2. What is the recommended management for a woman with negative cytology but an abnormal cervix?(1 mark)

3. If a woman has a LLETZ of less than 10mm depth/width, is she at increased risk of pre-term labour infuture? (1 mark)

4. Give 4 examples of cases that should be discussed at colposcopy MDT (4 marks)

5. How many NHSCSP referrals should a practising colposcopist see in order to maintain their clinical skills,and how often should they attend a BSCCP registered meeting? (2 marks)

6. What should the predictive value of a colposcopic diagnosis of CIN2 be, provided the assessment isadequate? (1 mark)


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7. When can cryocautery be used and why? (1 mark)

8. Give 2 reasons why endocervical curettage is not advised for the assessment of cervical glandularneoplasia? (2 marks)

9. What is the recommended management if CIN is suspected during colposcopic assessment of a womanwho is pregnant? (2 marks)

10. How often should women receiving cytotoxic chemotherapy for non-genital cancers undergo cervicalscreening and why? (2 marks)

Please send or email your answers to me (please note change of address)

Helen BurrellConsultant BMS & ManagerSouth West Regional Cytology Training CentrePathology Sciences BuildingSouthmead HospitalBristolBS10 5NB

[email protected]


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Clinical Details: The patient, a 73 year old male, presented with a two year history of productive cough and, morerecently, intermittent haemoptysis. An initial CT chest scan revealed a mass lesion in the right hilum and bronchoscopy atthis time showed an abnormal area of bronchial mucosa within the right upper lobe (RUL) anterior segment. Bronchialbrushings, washings and biopsies were obtained and demonstrated inflammatory features only. Microbiology grewHaemophilus parainfluenzae and antibiotics were commenced.

A clinical decision was taken to repeat the bronchoscopy in six weeks’ time, which showed the abnormal area within theRUL anterior segment was still present, but was now a lobulated lesion with a black, necrotic surface. Further bronchialbrushings (figures 1 and 2), washings and biopsies were obtained from this site and are shown below.

What might the differential diagnosis include? Is there any further information you would like to know from the MDT?How would you confirm the diagnosis?

Case Study — An Unexpected DiagnosisDr Gavin Laing, Specialty Registrar in Histopathology/Cytopathology Aberdeen Royal Infirmary, Aberdeen

Figure 1. BronchialBrushings (highmagnification) —ThinPrepR slidestained by Papanicolaou(PAP) method.

Figure 2. BronchialBrushings (highpower) — ThinPrepRslide stained by PAP method.(Answers on page 28)


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The final planning for the 40th European Congressof Cytology is well underway. Planning for aninternational meeting over four days, not just forthe programme itself (which is hard enough) butalso the venue, hotels, commercial input, speakermanagement, abstracts etc. etc. it is a BIG job!! TheBAC were proud to be awarded the prestigious40th ECC meeting at the 38th ECC in Geneva in2014, and whilst 2016 seemed a long time awaythen, it doesn’t now! The BAC Local OrganisingCommittee (LOC) has met regularly and heldnumerous teleconferences and sent far too manyemails. I am amazed at how well the LOC haspulled together, and how much we haveachieved. One decision we made early on was toappoint a Professional Conference Organiser, andafter a series of interviews we appointed a firmcalled Conference Partners. They organisemeetings for a living, and drawing on theirexpertise has been invaluable. I cannot thankthem enough for all they, and the LOC, have doneto deliver what I am sure will be a great meeting.

However, the proof of the pudding, as they say, isin the eating…

The meeting will be held between 2–5th October2016, at the Arena and Convention Centre (ACC)in Liverpool, on the banks of the River Mersey. TheBAC held its one day ASM there last year, and thefeedback we have had was very positive — our dryrun was a success! The 40th ECC will have 37separate sessions on all aspects of cytology,including 4 oral paper sessions, and 27 hands onworkshops. We expect well over 500 delegatesfrom all over the world, and over 180 posters. Avery strong commercial presence will be on site

for the duration of the meeting, with at the time ofwriting, two sponsored lunch sessions from ourGold partners Hologic and BD. The openingceremony will include the Lord Mayor ofLiverpool, adding a very local feel to the meeting.There is a Gala Dinner on the Tuesday night at thenearby Rum Wharehouse, where a Beatles themedevening with the famous Mersey Beatles, andthree course dinner, will allow delegates to relaxand even dance after a hard day’s conferencing.The lunch and coffee breaks will allow delegatesto mix and socialise, as well as keep in touch withthe many commercial stands and also the posterssubmitted for the meeting.

Like all meetings people will look for differenttopics, speakers, themes or nuggets they can takeback to their base. With up to five parallel sessionsmost days you will be spoilt for choice! Many ofyou will already have booked up for it, in part or infull. If not, take a look at the dedicated meetingwebsite at: www.cytology2016.com. If youhaven’t booked up then you still have time — butbe quick!! We look forward to seeing as many BACmembers at the meeting as we can. Let’s all makethe 40th ECC meeting the best yet!

The 40th European Congress of Cytology is nearly here!Paul Cross


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CEC LocalOfficers(Autumn 2016)

Alison Baseley Viv BeaversCytology Dept Manchester Cytology CentreRoyal Hampshire County Hospital Central Manchester Healthcare TrustWinchester, Hants P.O. Box 208, CSB 2S022 5DG Oxford Road, ManchesterTel: 01962 825371 M13 9WWFax: 01962 824664 Tel: 0161 276 5115e-mail: [email protected] e-mail: [email protected]

Hilary Diamond The Laboratories Belfast City Hospital Lisburn Rd, Belfast BT9 7AD Tel: 028 9026 3651 e-mail: [email protected]

In the absence of a local officer in your area, please send CEC items directly to me at the address below.

Helen BurrellHelen BurrellConsultant BMS & ManagerSouth West Regional Cytology Training CentrePathology Sciences BuildingSouthmead HospitalBristolBS10 5NBTel: 0117 323 5649e-mail: [email protected]

Please remember to make a copy ofeverything before it is sent — there

have been one or two losses in the post.Thank you


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“Sleepless in Seattle”

Dave Nuttall

Seattle; a city situated on Puget Sound in the pacificnorth-west of the United States of America. It issurrounded by water, mountains and evergreenforests, and encompasses thousands of acres ofparkland (hence its nickname, "Emerald City"). It ishome to some of the big names in the informaticsindustry, with Microsoft™ and Amazon.comheadquartered in its metropolitan area. The futuristicSpace Needle, a legacy of the 1962 World’s Fair, is itsmost recognizable landmark — and was once thetallest building west of the Mississippi River.

It is also home to Boeing, the world’s largest aircraftmanufacturer and the first Starbucks coffee shopopened there in Pike Place Market in 1971. Seattlewas also the birthplace of rock legend Jimi Hendrixand was the first city in the US to play a Beatles recordon the radio! Bruce Lee’s grave can be found atLakeside Cemetery, next to that of his son, BrandonLee. On a lighter theme, Seattleites seem to enjoydiscarding their clothing in public, evidence by theannual “No Pants Light Rail Ride” where riders wereencouraged to take off their pants and “pretend thateverything is normal”. Even more extreme is theannual Naked Pumpkin Run is held every year inOctober — “Go as bare as you dare” is the motto!

So what took me there? Well, I’m in the 5th year of myPhD studies into the application and implementationof Computer Assisted Screening (CAS) in cervicalscreening programmes. I’m enrolled on a 6 year, part-time course at the School of Medicine, TrinityCollege, Dublin (TCD). One of the requirements of thecourse is that a student should present at aninternational or national conference that is related tothe area of study of the individual concerned.

I was over in Dublin in November 2015, attendingone of my regular face-to-face meetings withProfessors John O’Leary and Cara Martin when thesubject came up and the resulting discussionconcluded that I should submit some of my work as apresentation for the 2016 series of pathology relatedconferences. First on the list was the Annual ScientificMeeting of the United States and Canadian Academyof Pathology (USCAP).

So I submitted an abstract summary of my workinvestigating the Becton Dickinson FocalPoint™ GS”No Further Review” technology, in the hope that itwould be accepted as a poster submission or even aplatform presentation. I didn’t have high hopes as

this is a big event — upwards of 3500 presentationsubmissions are received annually and around tenpercent, that is around 350 platform presentationsare accepted. Imagine my excitement when mysubmission was accepted for platform presentation— over the moon doesn’t quite describe my feelings;however, suffice to say, I was mightily pleased!

The USCAP ASM 2016 ran from March 12–18th and Iwas due to present on Monday, March 14th at 09.15 am(programme starts at 08:00 at this meeting, withcompanion society meetings running to 21:00 mostdays — so I guess you could say you get yourregistration fees’ worth!). Anyhow, I registered for theASM, booked accommodation and flights fromManchester and I was set to go.

As it turned out our research group at TCD submitteda number of presentations to USCAP and we securedtwo platform presentations and several posters — agood result! Prof. O’Leary was travelling over topresent at the meeting and we arranged to meet upon the Saturday (12th March) afternoon. March 11tharrived and I boarded the flight from Manchester toSeattle via Schiphol, Amsterdam at 05.55 GMT andarriving at Seattle Tacoma at 11.26 Pacific StandardTime (PST) — 8 hours behind the UK. I had a good tripacross — the only issue was that due to the early


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start, I didn’t sleep at all the night before I departed.Nor did I sleep on the flight — so I could honestly saythat I was “Sleepless before Seattle!”. I took the trainfrom the airport and checked in at the Westin SeattleHotel. My room was on the 24th floor and I had aterrific view from that level, albeit of other impressivetall buildings.

The next morning I rose at around 10.00 and left thehotel to explore my immediate surroundings and tolocate the Washington State Conference Centre. Myfirst impression during my walkabout was how cleanthe city was and how quiet! Considering it was mid-morning on a Saturday there was hardly a soul about,however it livened up later on. I loved the Americanconvention for identifying their streets in avenuesand streets and as the Conference Centre wassituated near the junction of Pike and Seventh, that’swhere I headed. When I arrived I was very impressedwith the Conference Centre and its facilities and asregistration was later in the day, I carried on with mywalking tour.

I returned later in the day to find the registrationaisles heaving with arriving delegates and I took myplace in one of the queues. I had just registered whenI received and e-mail from John O’Leary to let meknow that he would be arriving later in the afternoonand we agreed to meet up for a meal. Johnintroduced me to that fine American establishment— the Cheesecake Factory — where we spent a mostagreeable couple of hours!

That evening I had booked to attend a companionsociety meeting — that of the Papanicolaou Society.The meeting was very interesting and honouredsome of its members, including Dr David C. Wilbur,with whose work I am quite familiar with — being asit is concerned with Computer Assisted Screening,specifically with the AutoPap™ system and then itslater derivative the BD FocalPoint™. John and I thenpinned up the posters that had been submitted fromTCD in the Trade Show area.

On Sunday morning, March 13th, John and I took acoach tour around the city — in the pouring rain! Wewere taken down to the markets and past the firstStarbucks coffee shop. Then we headed around tothe suburbs and on to the coast. In the afternoon Iattended another companion society meeting — thistime that of the International Society ofGynaecological Pathologists. What interested me atthis meeting was the level that molecular


23

technologies such as second generation sequencingwere now implemented at the coal face — providinghitherto unprecedented levels of personalised andprecision medicine.

Later that evening I met up with John for a meal andthen we rehearsed our respective presentations forthe following day. Monday duly arrived and I was atthe presentation theatre a half hour early to checkthat my presentation had been uploaded. What wasdaunting was the size of the theatre — it was huge —with two massive screens to boot. Fortunately therehearsals did the trick and things went very well!

Once John had delivered his talk we visited the tradeshow which was well attended by representatives ofthe various suppliers. Given that this was probablythe premier event in the US pathology conferencecalendar — the size of the trade show reflected thatand I just wished I had more time to wander aroundand take it all in. I must admit that I was impressed bythe demonstration by Sekura of the automatedmicrotome prototype — complete with multiplesection drying ovens set at different temperaturesdepending on the staining requirements for theslide!

That evening I attended the last companion societymeeting that I had booked — that of the American

Society of Cytopathology (ASC). This ran from 19.30to 22.30 with some very high quality presentationson diagnostic and screening cytology and onenotable presentation regarding the limitationsplaced on cytology services by medical insurancecompanies! A very strange concept for a delegatefrom the UK with nigh on 40 years experience withthe NHS!

The next day I took the train back to Seattle Tacomaand boarded my flight homewards. All wentaccording to schedule and after another change offlight at Schiphol, Amsterdam — I landed atManchester. I picked up my car and drove home to StAsaph in North Wales. I didn’t really feel too tireduntil I walked through the front door at about 14.00on the Wednesday — the trail of discarded luggageand belongings through the house on the way to thebedroom told another tale though! I reckon I wasn’tso sleepless once back home in the UK!

It was a memorable trip — perhaps the conferenceexperience of a career and I feel really privileged tohave had the opportunity. Which brings me to theBAC — without the financial support of ourAssociation through a BAC bursary I might not havemade the trip and I am extremely grateful for thesupport. All they wanted in return was this article — agood deal! Thank you BAC!


24

ECC 2016 Draft Programme

Updates to the programme are frequent, current programme can be found at

http://cytology2016.com/scientific-programme/

Colours denote separate rooms

Sunday 2nd October

Parallel EFCS Cytology Symposium: Croatian Cytology Society Chairs: Ika Kardum-Skelin, Danijela Vrdoljak-Mozetič, Karmen Trutin-Ostović

Cervical Cytology Look a likes and mimics GS Chair: Dr D Mody

Applying the Paris System for reporting urinary tract cytology GS Chair: Dr Eva Wojcik

Parallel EFCS Cytology Symposium: Greek Cytology Society "Cytopathological and molecular diagnosticand prognostic procedures towards a precise clinical management". Chairs: Maria Nasioutziki, Panagiota Mikou, Emmanuel Mastorakis

Does knowledge of HPV status help or hinder morphological interpretation in cervical cytology? GS Chairs: Ms Helen Burrell, Mr Chris Evans

Use of CINTEC plus in cervical diagnosis GS Chair: TBD

Companion society symposium: Indian academy of cytology Chair: Dr RGW Pinto

Cervical Cytology Glandular lesions GS Chair: Dr Ritu Nayar

EUS-FNA of abdominal organs: An approach to reporting onsite and triage for ancillary testing GS Chair: Dr Roberto Dina Co-chairs: Dr Darshana Jhala, Dr Nirag Jhala

Parallel EFCS Cytology Symposium: Turkish Cytology Society Slide seminar on rare cases of FNA : learningfrom mistakes Chairs: Pinar Firat, Aysun Uguz

Invasive Cervical cancer audit GS Chairs: Mr Nick Dudding, Mrs S Mehew

Relative merits of LBP & direct smears in FNA services GS Chairs: Dr Ed Cibas, Dr Glen Dixon


25

Monday 3rd October

Gynae symposium 1: Cervical cancer prevention around the world: key challenges Chairs: Professor Mina Desai, Dr Karin Denton

Companion Society symposium: Pap Society Cytologic Diagnosis "Atypical": Criteria and ControversiesChairs: Zubair Baloch and Fernando Schmitt

Free Oral Paper Session Gynae Cytology Chair: Mrs Sue Mehew

FNA breast: interpretation & pitfalls on ThinPrep and direct smears GS Chairs: Dr Rana Hoda, Dr Syed Hoda

The little grey cells: CNS touch imprints and CSF cytology GS Chair: Prof Mousa Al-Abbadi, Dr Eyas Al-Hattab

Gynae symposium 1: contd. Cervical cancer prevention around the world: key challenges Chairs: Dr Karin Denton, Professor Mina Desai

Cytological preparations for molecular analysis- preanalytical issues for EBUS TBNA specimens AV Chair: Dr Gilda da Cunha Santos, Dr Mauro Ajaj Saie Pio Zeppa, Dr Giancarlo Troncone

Free Oral Paper Session Non-Gynae Cytology Chair: Mr Hedley Glencross, Dr Sabine Pomplun

Pulmonary cytology: a clinical approach to reporting terminology GS Chair: TBD

Breast cytology: Application of diagnostic criteria GS Chairperson: Dr Andrew Field Co-chairs: Dr Philippe Vielh & Dr Voichita Suciu

Key Note lecture: Cytopathology in the public eye. Chair: Dr Tom Giles

Colposcopy symposium Walter Chair: TBD

Telecytology as a learning tool AV Chair: Dr Roberto Dina, Dr Arrigo Capitanio

Symposium: EUS FNA of the pancreas & biliary brush cytology: reporting and clinical advice VM Chair: Prof Martha Pitman, Dr Miguel A. Perez - Machado

UK NEQAS CPT — Stains in NG Cytology GS Chair: Mrs Anna Patterson

Synovial Fluid Cytology AV Chair: Mr Paul Hermansen, Professor Tony Freemont

EFCS/RCPath/IBMS Educational Symposium Chair: Dr Martin Totsch, Dr Tom Giles

BAC symposium & Erica Wachtel lecture — Dr Amanda Herbert (30 mins) ACCEPTED Chair: Mr A Wilson

Medico-Legal Session Chair : TBD

UK NEQAS CPT — Immunohistochemisty on cytology samples GS Chair: TBD

UK NEQAS CPT — Immunohistochemisty on cytology samples GS Chair: TBD

Borderline ASCUS Cervical cytology GS Chair: Dr Roberto Dina, Mrs Elizabeth Fedl, Peter Heptinstall


26

Tuesday 4th October

Nongynae symposium 2: Digital cytology Chairs: Roberto Dina, Dr Arrigo Capitanio

HPV primary screening and vaccination: lessons learnt Chairs: Kate Cuschieri, Dr Jesper Bonde

EUS FNA pancreas & submucosal lesions of the upper GI tract VM Chairs: Dr Barbara Centeno, Dr Mark Howard

Soft tissue and Paediatric Cytology Dr Jerzy Klijanienko, Dr Helena Barocca

Thyroid cytology: practical tips in applying diagnostic criteria GS Chairs: Prof Zubair Baloch, Prof.Guido Fadda, Dr Poller David

Nongynae cytology slide seminar — the Sherlock Holmes cases Chair: Dr Julie McCarthy

EFCS Programme: Chair: TBD

Cervical cancer screening: who has the solution ?”

Guidelines in Gynae and Non Gynae cytology Chair: Dr Louise Smart

Multidisciplinary discussion of cytology, HPV, histology and colposcopy GS Chairs: Dr P Cross, Mrs A Cropper, Mr Chris Evans

FNA lung carcinoma with the current and future perspective: small or no-small, does size matter? Chairs: Professor Siddiqui, Dr Canberk

Key Note Lecture More than a decade of Molecular Diagnostic Cytopathology : How do we Practice it,how do we Teach it? Prof Manuel Salto-Tellez, Chair: Professor Fernando Schmitt

Gynae cytology slide seminar — the Agatha Christie mysteries Chair: Dr Dina Mody

Focussing on the future of cervical screening: how can we improve uptake and save lives. Chair: Mrs Ruth Stubbs 15. 45 – 16.00 Panel discussion and open Q&A

InCyt/EACC: Widening the horizons of cytotechnologists and cytopathologists Chair: Mr Allan Wilson

Anal Cytology, HPV and histology GS Chairs: Professor Mina Desai, Professor Ray MacMahon, Dr Teresa Darragh

An approach to reporting salivary gland lesions using the Milan terminology GSChairs: Dr William Faquin, Diana Rossi, Marc Pusztaszeri

Companion society symposium: ASC Uses and Misuses of Ancillary Tests in Cytopathology Dr Eva Wojcik, Professor Zubair Baloch, Dr William Faquin, Dr Edmund Cibas

Practical application of the ultrasound to assist pathologists in performing FNA HANDS ON SESSION Chairs: Dr Rose Ngu, Dr Ash Chandra

EACC Session Chair: TBD

WORKSHOP Serous effusions: morphological patterns in reactive and neoplastic conditions GS Chairs: Prof Ben Davidson, Dr Gareth Rowland

Lymph node FNA: morphology and interpretation of flow cytometry data GSChairs: Prof Mousa Al-Abbadi Samer Al Quran, Nayef Aqel, UK


27

Wednesday 5th October

Revised Terminology in cervical cytology, histology and colposcopy Chair: Dr John Smith

EBUS TBNA: Diagnosis and staging of lung carcinoma VM Chair: Prof George Santos

Free Oral Session Non-Gynae Chair: Mrs J Jamison

QUATE and IAC exam Prof M Desai, Mr A Wilson, IAC Lead Examiner Mrs Allison Austin

Head & Neck FNA cytology: thyroid, salivary gland and lymph node lesions Format: Glass slide microscopyworkshop Chairperson: Dr Massimo Bongiovanni Co-chair: Dr Beata Bode-Lesniewska

Companion society symposium: IAC A Breast FNAB Cytology Reporting System: Draft Proposals Co-Chairs: Dr A Field and Dr P Viehl

Cytogenetics and Cytology Chair: TBD

Free Oral Session Gynae Chair: Mr D Nuttall


Key Note Lecture Chairperson: Dr David Poller Co-chairs: Dr William Faquin



28

Case study answerDr Gavin Laing, Specialty Registrar in Histopathology/Cytopathology Aberdeen Royal Infirmary, Aberdeen

Metastatic malignant melanoma in thebronchus

Examination of the bronchial washings wasunremarkable with no malignant cells identified.However the brushings revealed, on abackground of normal respiratory epithelial cells,an abnormal population of large pleomorphiccells predominantly singly dispersed but with afew small clusters. These cells had large,irregularly shaped nuclei with prominent nucleoliand moderate cytoplasm. Several binucleatedand multinucleated forms were identified.Pigment was not evident within these cells. Thecytological differential diagnosis at this stageincluded poorly differentiated carcinoma,lymphoma and melanoma. Similar malignant cellswere present in the biopsy specimen (figure 3).

On looking into the patient’s past medical historyit was revealed they had a cutaneous malignantmelanoma diagnosed six years previously. Thislesion was excised from the left pre-auricular areaand histology confirmed superficial spreadingsubtype with a Breslow thickness of 2.8mm andno evidence of lymphovascular space invasion. Asentinel lymph node biopsy was not diagnostic asno lymph node tissue was obtained. Final stagingwas documented as pT3a fully excised.

For economical reasons immunohistochemistrywas performed on the biopsy and showed thetumour cells to be positive with Melan A (figure 4)and S100, confirming the diagnosis of metastaticmalignant melanoma in the bronchus. The blackappearance of the lesion was not due to pigmentand was attributed to high vascularity andhaemorrhage. The patient was subsequentlycommenced on immune modulatory therapy(Ipilimumab).

Metastatic melanoma can involve any organ andcommonly metastasises to the lungs and lymphnodes. Bronchial involvement however is veryuncommon and is rarely reported in theliterature. The most relevant piece of clinicalhistory (melanoma) was not stated on thepathological request form, a not infrequentomission in clinical practice. This widened ourinitial differential diagnosis until further clinicalinformation was obtained and confirmatoryimmunohistochemistry was available. In anycytology sample comprising singly dispersed ordiscohesive pleomorphic cells with a variety ofmorphological forms melanoma should always beexcluded.

Figure 4 Immunohistochemistry slide (low magnification) —Melan A.

Figure 3: Bronchial biopsy (low magnification) —Haemotoxylin and Eosin (H&E) stain.

(see page 18)


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Scottish Cytology Training School

Programme 2016/17

No course fee is charged for Gynae

cytology courses to employees of Scottish NHS Trusts

Training School Director Sue Mehew

Tel: 0131 242 7149 Email: [email protected]

Training School Manager

Fiona McQueen Tel: 0131 242 7149

Email: [email protected]

Training School Administrator

Training School Administrator Pathology Department

Royal Infirmary of Edinburgh 51 Little France Crescent

Edinburgh EH16 4SA

Tel: 0131 242 7135 Email:[email protected]

Application forms available on request from:

[email protected]

NHSCSP Accredited Training Centre

Courses held at The Bioquarter, Royal Infirmary of Edinburgh,

1st Floor, Building 9, Edinburgh Bioquarter, 9 Little France Road, Edinburgh. EH16 4UX

unless states (QEUH)

Queen Elizabeth University Hospital, Glasgow.

Non NHS Labs – price on application All courses are Liquid Based Cytology (ThinPrep)

Courses are CPD accredited

Introductory Course

5th September – 30th September 2016

20th February – 17th March 2017

£1000

Colposcopy Course 11th – 12 January 2017 tbc

or 10th – 11th May 2017 tbc

Introductory Course Part 2

21st November – 25th November 2016

Update Course

8th – 9th November 2016 (QEUH)

7th – 8th December 2016 1st – 22nd February 2017

22nd - 23rd March 2017 7th – 8th June 2017 (QEUH)

7th – 8th November 2017 (QEUH)

£100 per day

Pre-Exam Course

22nd – 24th Aug 2016 (for Oct Exam)

£250

Update Course Medical/Consultant BMS Staff

29th November 2016

£100

ST1 Introduction to Cervical Cytology

5th – 9th September 2016

Non-Gynae Courses - for Trainee Medical (ST3) & BMS staff

20th – 22nd September 2016 tbc

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President

Chair

General Secretary

Treasurer

Members

BAC Executive Committee

Mr Allan Wilson Pathology Department, Monklands Hospital, Monkscourt Avenue, Airdrie.ML6 0JS Tel: 01236 712087 Email:[email protected]

Dr Paul Cross Dept of Pathology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear.NE9 6SX Tel: 0191 445 6551 Email: [email protected]

Sue Mehew Cytology Laboratory and Scottish Cytology Training School. PathologyDepartment, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh. EH16 4SA. Tel: 0131 2427149 Fax: 0131 2427169. E-mail: [email protected]

Kay Ellis ABMSP/Cytology Manager, Cytology Department, Floor E, Royal HallamshireHospital, Glossop Road, Sheffield S10 2JF Tel: 01142 713697 Fax: 01142 261213. Email:[email protected]

Helen Burrell Consultant Biomedical Scientist & Manager, South West Regional CytologyTraining Centre, Pathology Sciences Building, Southmead Hospital, Bristol BS10 5NBTel: 0117 323 5649Email: [email protected]

Dr Ashish Chandra Consultant Pathologist, Cellular Pathology, 2nd floor North wing, St. Thomas'Hospital, London SE1 7EHTel: 0207 188 2946 Email: [email protected]

Alison Cropper Cytology Department, 5th Floor, Derby Hospitals NHS Foundation Trust,Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NETel: 01332 789327Email: [email protected]

Dr Thomas Giles Dept of Pathology, Royal Liverpool University Hospital, Prescot Street,Liverpool L7 8XPEmail: [email protected]

Hedley Glencross Advanced Specialist Biomedical Scientist, Cytology Department,Queen Alexandra Hospital, Southwick Hill Road, Portsmouth PO6 3LYTel: 023 9228 6700Email: [email protected]

Jackie Jamison Cytology Department, Antrim Area Hospital, County Antrim BT41 2RL.Tel: 02894 424101Email: [email protected]

Mr Dave Nuttall Head of Laboratory Services, Screening Division, PHW, 18 Cathedral Road,Cardiff. CF11 9LJTel: 02920 787857 Email: [email protected]

Dr Louise Smart Department of Pathology, Medical School Building, Foresterhill, Aberdeen.AB25 2ZDTel: 01224 553794 Email: [email protected]

Cover 27_2 RRG_Draft cover APR 2015 03/08/2016 09:54 Page 2

SCANISSN 2050–8891

SCAN is published bythe British Association forCytopathology (BAC) inEngland and produced

by the MedicalInformatics Unit, NDCLS,University of Oxford.

©BAC MMXVI No part ofthis publication may bereproduced in any form

without the priorpermission in writing of

the Editor. Editorialprerogative to shortenor amend material may

be exercised wherenecessary. The Editorand the ExecutiveCommittee do not

accept responsibility foropinions expressed by

contributors orcorrespondents.

Material for publicationshould be sent direct to

the Editor; all othercorrespondence withthe Association shouldbe addressed to the

Secretary.

CONTENTS Vol 27 No 2 2016

EDITORIAL 1 Sharon Roberts-Gant

PRESIDENT’S PIECE 2 Allan Wilson

CHAIRMAN’S COLUMN 3 Paul Cross

QUATE 5 Allan Wilson

ROLE OF BIOMEDICAL SCIENTISTS WITHIN THE PROVISION OF A 8 NON-GYNAECOLOGICAL CYTOLOGY SERVICE

CHANGING LBC SUPPLIERS IN A HIGH VOLUME LABORATORY — IMPROVING 10 QUALITY AND EFFICIENCY — ONE LABORATORY’S EXPERIENCE Alison Cropper

WHEN IT’S THERE… IT’S THERE 14 Hedley Glencross

CEC JOURNAL BASED LEARNING 16

CASE STUDY 18 Gavin Laing

THE 40TH EUROPEAN CONGRESS OF CYTOLOGY IS NEARLY HERE! 19 Paul Cross

CEC LOCAL OFFICERS 20

“SLEEPLESS IN SEATTLE” 21 Dave Nuttall

ECC 2016 DRAFT PROGRAMME 24

www.britishcytology.org.uk

Front Cover image: A cervical cytology casewith occasional barenuclei, reported as highgrade dyskaryosis, bestregarded as moderatedyskaryosis. LLETZ – CIN3.Supplied by Sue Mehew.

Cover 27_2 RRG_Draft cover APR 2015 03/08/2016 09:54 Page 1

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