The future of cytopathology in Europe. Will the wider use of HPV testing have an impact on the provision of cervical screening?

Abstract

The emphasis of the EFCS Congress held in Venice in October 2006 was on the future of Cytopathology in relation to events in Europe. Much of the discussion centred on the role of human papilloma virus testing and its impact on the provision of cervical screening. The following is a transcript of the discussion that took place at the Advisory Board Meeting for the journal Cytopathology, with some additional written comments received prior to the meeting. A brief summary has been provided as a conclusion by Dr A. Herbert.

Reproducibility of Classification and Correction for Verification Bias as Determinants of Performance of Papanicolaou Smear Cytology in the Screening Setting

“…[12][13][14][15]22,23,[25][26][27] This fact certainly hampers finding a common language and is one of the major obstacles for international standardization of this time-honored diagnostic tool. [4][5][6]14,15,21 These obstacles are well illustrated in the present study, in which performance of conventional Pap smear cytology as a screening tool was tested in low-resource settings of 3 NIS countries.…”

“…21 At the same time, several other European countries (Germany, the Netherlands, Switzerland, France, Italy) introduced even more complex modifications in the original Papanicolaou classification. 12,13 Thus, because this is not a unique problem confined to the NIS countries only, but has more widespread implications in standardization of Pap smear cytology at European level, [12][13][14][15] it was felt appropriate to run the present analysis to demonstrate how the different approaches to convert the Papanicolaou classification to TBS contribute to the performance of Pap test. In addition, because of an increasing interest recently focused on verification bias in cohort studies, 32,33 we wanted to demonstrate how correcting for the verification bias affects the performance indications of these 3 classifications (original, TBS1, TBS2).…”

“…These figures are fully comparable with the results reported in the LAMS study, in which TBS was used as the original classification. 29 Thus, in any future transformations of the existing different modifications of the Papanicolaou classification to TBS, 12,13 it is essential to carefully consider where to settle the cutoff for the ASCUS category.…”

“…[16][17][18][19][20] The problems in conventional Pap smear cytology have prompted several active measures taken to counteract these inherent flaws in this traditional diagnostic tool. Most important, these include technical innovations in the late 1990s leading to the development of liquid-based cytology techniques, 9 cytology automation [1][2][3]12,13 and rigorous quality control measures to improve the reproducibility. 7,8,15,18,[21][22][23][24][25][26] As part of our systematic efforts to improve the quality of conventional Pap smear cytology, 21,22,25,27 we recently developed laboratory software (CONQUISTADOR) to assist this intraobserver and interlaboratory quality assurance, validated in a simulation study 28 and recently shown useful in a screening setting ongoing in Latin America (the LAMS study).…”

Survey of training and education of cytotechnologists in Europe

“…We believe that ancillary techniques as well as non-gynaecological cytology should be included in training to develop multiskilled and flexible CTs for future needs in cytopathology. [1][2][3][4] A survey of training and education in Europe was executed by the members of the European Advisory Committee of Cytotechnology (EACC) in 2006, as was done for medical training. 5 An updated overview was needed to obtain information that could help to harmonize the training and education of CTs in Europe.…”