The BSCC Code of Practice – exfoliative cytopathology (excluding gynaecological cytopathology)

Abstract

The BSCC Code of Practice -exfoliative cytopathology (excluding gynaecological cytopathology)Exfoliative cytopathology (often referred to as non-gynaecological cytology) is an important part of the workload of all diagnostic pathology departments. It clearly has a role in the diagnosis of neoplastic disease but its role in establishing non-neoplastic diagnoses should also be recognised. Ancillary tests may be required to establish a definitive diagnosis. Clinical and scientific teamwork is essential to establish an effective cytology service and staffing levels should be sufficient to support preparation, prescreening, on-site adequacy assessment and reporting of samples as appropriate. Routine clinical audit and histology ⁄ cytology correlation should be in place as quality control of a cytology service. Cytology staff should be involved in multidisciplinary meetings and appropriate professional networks. Laboratories should have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd. Consultant pathologists should sign out the majority of exfoliative cytology cases. Where specimens are reported by experienced biomedical scientists (BMS), referred to as cytotechnologists outside the UK, this must only be when adequate training has been given and be defined in agreed written local protocols. An educational basis for formalising the role of the BMS in exfoliative cytopathology is provided by the Diploma of Expert Practice in Nongynaecological Cytology offered by the Institute of Biomedical Science (IBMS). The reliability of cytological diagnoses is dependent on the quality of the specimen provided and the quality of the preparations produced. The laboratory should provide feedback and written guidance on specimen procurement. Specimen processing should be by appropriately trained, competent staff with appropriate quality control. Microscopic examination of preparations by BMS should be encouraged wherever possible. Specific guidance is provided on the clinical role, specimen procurement, preparation and suitable staining techniques for urine, sputum, semen, serous cavity effusion, cerebrospinal fluid, synovial fluid, cyst aspirates, endoscopic specimens, and skin and mucosal scrapes.

Investigation of a unilateral pleural effusion in adults: British Thoracic Society pleural disease guideline 2010

“…This can be performed on a cytology sample, cell block or a clot 72. There is particularly extensive morphological overlap between malignant mesothelioma and metastatic adenocarcinoma cells and immunocytochemistry can assist in their differentiation.…”

Assisting the neurologist in diagnosis of CNS malignancies ‐ Current Possibilities and Limits of Cerebrospinal Fluid Cytology and Immunocytochemistry

“…In hematology (30% of all malignancies in the CSF) flow cytometry has been confirmed as a method of choice superior to immunocytopathology by many studies (Chamberlain et al., 2009; Chandra et al., 2009; Kaplan et al., 1990; Weston et al., 2011). Nevertheless, it faces frequently the same problem of sample volume.…”

“…Nevertheless, identification of the neoplastic cells is only partly achievable with cytomorphology and histochemical stainings (Glantz et al., 1998; Kaplan et al., 1990; Twijnstra et al., 1987; Wasserstrom et al., 1982). Ancillary techniques are now a part of guidelines and even routine investigations (Chamberlain et al., 2009; Chandra et al., 2009; Coakham et al., 1984; Weston et al., 2011). …”

Should cytology be an acceptable means of diagnosing malignant mesothelioma?

“…Cell blocks made from cytological samples allow equivalent (some say superior) results to biopsy material and the vast majority of laboratories should be in a position to perform a simple panel of immunocytochemistry on cell blocks, which is recommended in the BSCC Code of Practice. 10 Molecular techniques on the other hand are largely restricted to specialist units at present, although there is current expansion in this field. Many ÔspokeÕ laboratories in the developing UK networks have a local ÔhubÕ where they can access such facilities and this is likely to be the case for the rest of Europe and the United States.…”