Head and neck cancer in the UK: what is expected of cytopathology?

Objective:  This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists' guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them.     

American Society for Cytotechnology quality assurance survey data. Summary report

The data produced by membership surveys undertaken by the American Society for Cytotechnology that pertain to the quality diagnosis of Papanicolaou smears are reviewed. The results documented the parameters in such areas as workload, quality control, health and safety, continuing education, productivity measurement, reporting systems and salaries and helped to pinpoint problems in these areas. Some of these problems are being addressed through cooperative efforts with other groups concerned with improving the diagnostic accuracy of cytopathology.     

Quality assurance activities of the College of American Pathologists

Since its inception, the College of American Pathologists (CAP) has played a fundamental and pivotal role in the development and execution of quality assurance programs for laboratories. Within the realm of anatomic pathology, operational programs include those in surgical pathology, immunohistochemistry and cytopathology. The emphasis of prior cytopathology programs on cervical cytology has now been expanded to include body fluids and fine needle aspiration material. CAP's role in the expansion of quality assurance programs in cytology may be enhanced in the future by intersociety cooperation with established cytology organizations and will also be influenced by and closely linked to the expansion of its quality assurance programs in surgical pathology. As for the Papanicolaou smear, it can no longer be regarded as the "Cinderella of cytology"; it is in fact the present-day cynosure in the laboratory. In recognition of this, CAP has undertaken efforts to help heighten public awareness about the value of Papanicolaou smear testing and is encouraging women to become more informed about the process involved in the examination of their smears.     

The cytopathologist's role in developing and evaluating artificial intelligence in cytopathology practice

Artificial intelligence (AI) technologies have the potential to transform cytopathology practice, and it is important for cytopathologists to embrace this and place themselves at the forefront of implementing these technologies in cytopathology. This review illustrates an archetypal AI workflow from project conception to implementation in a diagnostic setting and illustrates the cytopathologist's role and level of involvement at each stage of the process. Cytopathologists need to develop and maintain a basic understanding of AI, drive decisions regarding the development and implementation of AI in cytopathology, participate in the generation of datasets used to train and evaluate AI algorithms, understand how the performance of these algorithms is assessed, participate in the validation of these algorithms (either at a regulatory level or in the laboratory setting), and ensure continuous quality assurance of algorithms deployed in a diagnostic setting. In addition, cytopathologists should ensure that these algorithms are developed, trained, tested and deployed in an ethical manner. Cytopathologists need to become informed consumers of these AI algorithms by understanding their workings and limitations, how their performance is assessed and how to validate and verify their output in clinical practice.     

Impact factor in cytopathology journals: what does it reflect and how much does it matter?

B. AbdullGaffar
Impact factor in cytopathology journals: what does it reflect and how much does it matter? Objective: To study the trends of impact factor (IF) in four cytopathology journals. To investigate the factors that might influence IF in cytopathology literature and whether IF has any impact on cytopathology practice. Methods: The IFs of four cytopathology journals were searched from 2005 to 2009. The IFs and their relationships with the types and number of publications, publishers, the official societies, readership, the quality of their contents, the topics covered and the levels of evidence were compared. Results: Cancer Cytopathology (CC) had the highest IF. Acta Cytologica (AC) had the lowest IF, which appeared to be in decline. Cytopathology (C) and Diagnostic Cytopathology (DC) had a slow but steady increase in their IF. Components that might influence these differences could include the category and the society of the journal, targeted readers and certain types of publications. Publishers, the number of publications, the types of topics covered and the levels of evidence probably have no major effect on IF. Conclusions: IF has its own benefits and original applications. IF is a quantitative measure that does not reflect the levels of evidence in cytopathology journals. IF should not be abandoned because it might encourage competition between cytopathology journals, but it should not dictate their contents.     

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 Non‐gynaecological 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.     

The UEMS Section/Board of Pathology,Chapter 6: Requirement for Recognition of Postgraduate Training in Pathology: a presentation of the Paris Document

M. Tötsch, C. Cuvelier, L. Vass and A. Fassina and on behalf of the participants of the UEMS Section/Board of Pathology meeting in Paris 2012
The UEMS Section/Board of Pathology, Chapter 6: Requirement for Recognition of Postgraduate Training in Pathology: a presentation of the Paris Document After more than five years discussion the UEMS Section/Board of Pathology agreed a specification of requirements for recognition of post‐graduate training in pathology, which is the key to the future of our discipline. The document published here, subject to ratification by UEMS Council, was voted on and accepted by the Pathology Board at the UEMS Paris meeting of 9 June 2012. Cytopathology is regarded as integral part of pathology: in general, training in pathology takes five years and maintains a common trunk of four (minimum three) years where surgical pathology, autopsy pathology and basic knowledge of neuropathology, dermatopathology and cytopathology are adequately trained and assessed. Training in so‐called ‘areas of interests’ covers the remaining 12–24 months. Certificates of ‘advanced level of competence’ remain within the authority of national boards. As senior members of its Executive Board, we believe that the European Federation of Cytology Societies (EFCS) should take responsibility for establishing 1) standards in the quality of cytopathology training, 2) training guidelines and qualification for advanced levels of competence in cytopathology, 3) manpower planning, 4) tutorials for pathologists and cytotechnologists and 4) standards of cytotechnologist training.     

Applications of fluorescence in situ hybridization in cytopathology: a review

Fluorescence in situ hybridization (FISH) is a molecular cytogenetic technique that is a powerful and versatile research tool and an important adjunct to tumor diagnosis and prognosis. Akin to the recent role of immunohistochemistry, research and clinical applications of FISH in cytopathology have been growing enormously over the last few years. Furthermore, due to its feasibility for virtually all types of cytologic specimens, a new and exciting era in both investigative and clinical cytopathology is expected.     

CytoJournal joins 'open access' philosophy

Welcome to CytoJournal! We would like to introduce you to your journal, one that is run by and for the scientific cytopathology community with incontestable benefits of Open Access, and support from Cytopathology Fondation, Inc http://www.cytopathology-foundation.org/index.html. CytoJournal is a peer-reviewed, PubMed indexed, online journal, publishing research in the field of cytopathology and related areas, with world wide free access. Authors submitting to CutoJournal retain the copyright to their hard earned work.     

Telepathology: a tool to aid in diagnosis and quality assurance in cervicovaginal cytology

Telepathology: a tool to aid in diagnosis and quality assurance in cenicovaginal cytology
The purpose of this study is to evaluate the use of a Teletransmission System with regard to quality of diagnosis and screening so as to establish its potential role in gynaecological cytology. Three aspects of its use in cytopathology have been considered: diagnosis, training, and quality control. The circumstances in which the system may be used for diagnosis, together with its advantages and disadvantages, are examined and discussed. In general, the costbenefit in diagnostic use related to the experience of both the expert and the peripheral pathologist. The system may also contribute to training and quality assessment, particularly if combined with other automated services, such as an image data bank.     

Cell blocks in cytopathology: a review of preparative methods,utility in diagnosis and role in ancillary studies

The cell block (CB) is a routine procedure in cytopathology that has gained importance because of its pivotal role in diagnosis and ancillary studies. There is no precise review in the published literature that deals with the various methods of preparation of CB, its utility in diagnosis, immunocytochemistry (ICC) or molecular testing, and its drawbacks. An extensive literature search on CB in cytology using internet search engines was performed for this review employing the following keywords: cell block, cytoblock, cytology, cytopathology, methods, preparation, fixatives, diagnostic yield, ancillary and molecular studies. Ever since its introduction more than a century ago, the CB technique has undergone numerous modifications to improve the quality of the procedure; however, the overall principle remains the same in each method. CBs can be prepared from virtually all varieties of cytological samples. In today's era of personalized medicine, cytological specimens, including CBs, augment the utility of cytological samples in analysing the molecular alterations as effectively as surgical biopsies or resection specimens. With the availability of molecular targeted therapy for many cancers, a large number of recent studies have used cytological material or CBs for molecular characterization. The various techniques of CB preparation with different fixatives, their advantages and limitations, and issues of diagnostic yield are discussed in this review.     

Ethical problems in cytology

Great advances in medical science have raised a number of ethical issues, many of which affect cytopathology. Some of the main issues addressed in this paper relate to the organization of a cytology laboratory: internal and external quality control, adequate staffing levels and staff education, cytopathology reporting format and contents, confidentiality issues, relationship with the clinicians and involvement of cytopathologists in clinical management teams. Quality control has to be provided within cytology departments but external quality assurance is also essential, with national monitoring. New technologies should be used according to the best scientific methods, following cytological analysis. Scientific work in cytology has to respect the general principles of scientific ethics. The patient's interest has to be the main reason for such work.     

Functional immunocytopathology and the diagnosis of bone marrow micrometastases

Immunocytochemical methods offer a new dimension for cytopathology in the diagnosis, prognosis and biology of neoplastic diseases. This concept is illustrated with particular respect to the immunodetection of bone marrow micrometastases and the role of cytologically demonstrable functional parameters in prognosis and therapy planning. A future role for the polymerase chain reaction (PCR) in this diagnostic sphere is proposed.     

Intracellular Complexes of Viral Spike and Cellular Receptor Accumulate during Cytopathic Murine Coronavirus Infections

Murine hepatitis virus (MHV) infections exhibit remarkable variability in cytopathology, ranging from acutely cytolytic to essentially asymptomatic levels. In this report, we assess the role of the MHV receptor (MHVR) in controlling this variable virus-induced cytopathology. We developed human (HeLa) cell lines in which the MHVR was produced in a regulated fashion by placing MHVR cDNA under the control of an inducible promoter. Depending on the extent of induction, MHVR levels ranged from less than ~1,500 molecules per cell (designated R^lo) to ~300,000 molecules per cell (designated R^hi). Throughout this range, the otherwise MHV-resistant HeLa cells were rendered susceptible to infection. However, infection in the R^lo cells occurred without any overt evidence of cytopathology, while the corresponding R^hi cells died within 14 h after infection. When the HeLa-MHVR cells were infected with vaccinia virus recombinants encoding MHV spike (S) proteins, the R^hi cells succumbed within 12 h postinfection; R^lo cells infected in parallel were intact, as judged by trypan blue exclusion. This acute cytopathology was not due solely to syncytium formation between the cells producing S and MHVR, because fusion-blocking antiviral antibodies did not prevent it. These findings raised the possibility of an intracellular interaction between S and MHVR in the acute cell death. Indeed, we identified intracellular complexes of S and MHVR via coimmunoprecipitation of endoglycosidase H-sensitive forms of the two proteins. We suggest that MHV infections can become acutely cytopathic once these intracellular complexes rise above a critical threshold level.     

The century for cytopathology

By the end of the 19th century, exfoliated cancer cells had been described in all of the types of specimen in which we find them today. However, it was not until Drs. Papanicolaou and Traut published their account of the diagnosis of uterine cancer from exfoliated cells (1941 and 1943) that cytopathology acquired the momentum to develop into the powerful presence that it has in human medicine today. These and the subsequent publications by Papanicolaou stimulated the development and application of cytopathology worldwide, resulting in abundant literature on the subject and a galaxy of outstanding practitioners. The 1980s saw the development and widespread use of aspiration cytology. This was followed in the 1990s by the development of automated screening systems, marking the latest stage in the evolution of cytopathology. These and other events and achievements in cytopathology, from its meager beginnings in the early 20th century to its worldwide use and acceptance today, mark this century as the "century for cytopathology."     

天津市自然保护地与区域生境质量的时空演变格局

生境质量是反映区域生物多样性水平的重要指标,而规划科学、管理有效的自然保护地对于维护生境质量、巩固区域生态安全具有重要作用。以天津市为例,运用InVEST模型Habitat Quality模块评估了天津市2000、2005、2010、2015、2018年生境质量时空变化格局,基于叠加分析自然保护地内外生境质量变化探讨自然保护地对维护区域生境质量发挥的作用。结果表明：(1)2000—2018年间天津市生境质量总体下降了13.18%,并呈现出明显的由中心城区向环城四区扩散的趋势,高质量区域仅占天津陆域国土面积的4%,主要分布在天津北部山区和于桥水库、团泊洼、北大港、大黄堡等湿地。(2)天津保护地空间分布上呈集中分布态势,覆盖了天津市约75%的高质量生境区域和25%的较高质量生境区域。(3)从整体上看不同类型的自然保护地内生境质量保护效果不同,自然保护区优于其它类保护地,其生境质量明显得到提升。所有保护地中有10处保护地生境质量略有下降,但低于全域下降水平,只有盘山风景名胜区和古海岸与湿地自然保护区生境质量下降高于全域平均水平。(4)自然保护地对天津市生境质量下降的趋势起到了一定缓冲作用,其...     

Survey of medical training in cytopathology carried out by the journal Cytopathology

Anshu, A. Herbert, B. Cochand‐Priollet, P. Cross, M. Desai, R. Dina, J. Duskova, A. Evered, A. Farnsworth, W. Gray, S. S. Gupta, K. Kapila, I. Kardum‐Skelin, V. Kloboves‐Prevodnik, T. K. Kobayashi, H. Koutselini, W. Olszewski, B. Onal, M. B. Pitman, ?. Marin?ek, T. Sauer, U. Schenck, F. Schmitt, I. Shabalova, J. H. F. Smith, E. Tani, L. Vass, P. Vielh and H. Wiener
Survey of medical training in cytopathology carried out by the journal Cytopathology This report of the Editorial Advisory Board of Cytopathology gives the results of a survey of medical practitioners in cytopathology, which aimed to find out their views on the current situation in undergraduate and postgraduate training in their institutions and countries. The results show that training in cytopathology and histopathology are largely carried out at postgraduate level and tend to be organized nationally rather than locally. Histopathology was regarded as essential for training in cytopathology by 89.5% of respondents and was mandatory according to 83.1%. Mandatory cytopathology sections of histopathology were reported by 67.3% and specific examinations in cytopathology by 55.4%. The main deficiencies in training were due to its variability; there were insufficient numbers of pathologists interested in cytology and a consequent lack of training to a high level of competence. Pathologists without specific training in cytopathology signed out cytology reports according to 54.7% of responses, more often in centres where training was 3–6 months or less duration. Although 92.2% of respondents thought that specialist cytology should not be reported by pathologists without experience in general cytopathology, that practice was reported by 30.9%, more often in centres with small workloads. The survey report recommends that 6–12 months should be dedicated to cytopathology during histopathology training, with optional additional training for those wanting to carry out independent practice in cytopathology. Formal accreditation should be mandatory for independent practice in cytopathology. When necessary, temporary placements to centres of good practice should be available for trainees intending to practise independently in cytopathology. There should be adequate numbers of pathologists trained in cytopathology to a high level of competence; some of their time could be released by training cytotechnologists and trainee pathologists to prescreen cytology slides and assess adequacy of fine‐needle aspiration samples when immediate diagnosis was not required. The survey demonstrated a clear need for European and international guidelines for training in cytopathology.     

Dedicating specific sessions of cytopathology courses to medical students. A survey/consensus study

OBJECTIVE: To establish a consensus among medical schools in North America on whether to dedicate specific sessions to teaching cytopathology to medical students. STUDY DESIGN: A list of all the medical schools in the United States, Canada and Puerto Rico was retrieved from the American Association of Medical Colleges Web site in conjunction with the information provided by the 33rd edition of the Directory of Pathology Training Programs, published by the Intersociety Committee on Pathology Information. A total of 147 schools were found. A questionnaire was designed to include 7 questions addressing this issue and was sent to each medical student pathology course director. RESULTS: Of the 147 questionnaires, 65 (44%) responses were received. Fifty-four (83%) indicated the total number of pathology lectures given to medical students in each course. The number of lectures ranged between 19 and 201, with a mean of 85. Seven (11%) stated that their systems used problem based learning and that therefore a specific number of pathology lectures could not be given accurately. Sixteen (25%) have cytology sessions incorporated in their pathology courses. Thirteen (20%) prefer to include cytopathology sessions in the course and are committed to doing so. Therefore, 29 (45%) institutions either have or prefer to have specific sessions dedicated to cytopathology education. CONCLUSION: Incorporating specific sessions dedicated to cytopathology education in the medical student curriculum is highly recommended. Using new educational techniques, including computer-based methods with real case studies, would add more educational value.     

BSCC Code of Practice – fine needle aspiration cytology

The British Society for Clinical Cytology Code of Practice on fine needle aspiration cytology complements that on exfoliative cytopathology, which was published in the last issue ( Cytopathology 2009; 20 :211–23). Both have been prepared with wide consultation within and outside the BSCC and have been endorsed by the Royal College of Pathologists. A separate code of practice for gynaecological cytopathology is in preparation. Fine needle aspiration (FNA) cytology is an accepted first line investigation for mass lesions, which may be targeted by palpation or a variety of imaging methods. Although FNA cytology has been shown to be a cost-effective, reliable technique its accurate interpretation depends on obtaining adequately cellular samples prepared to a high standard. Its accuracy and cost-effectiveness can be seriously compromised by inadequate samples. Although cytopathologists, radiologists, nurses or clinicians may take FNAs, they must be adequately trained, experienced and subject to regular audit. The best results are obtained when a pathologist or an experienced and trained biomedical scientist (cytotechnologist) provides immediate on-site assessment of sample adequacy whether or not the FNA requires image-guidance. This COP provides evidence-based recommendations for setting up FNA services, managing the patients, taking the samples, preparing the slides, collecting material for ancillary tests, providing rapid on-site assessment, classifying the diagnosis and providing a final report. Costs, cost-effectiveness and rare complications are taken into account as well as the time and resources required for quality control, audit and correlation of cytology with histology and outcome. Laboratories are expected to have an effective quality management system conforming to the requirements of a recognised accreditation scheme such as Clinical Pathology Accreditation (UK) Ltd.