We examine conventional smears (Pap smears) from the cervix, vagina and vulva as part of cancer screening or curative treatment. If requested, e.g. HPV diagnostics, immunocytology p16/Ki67, liquid-based or thin-layer cytology) is performed by our collaboration partners.
Routine screening of smears is performed by fully trained technicians who have completed their training as cytology assistants (CTA/CT-Gyn) and have many years of professional experience. The final responsibility for the cytological diagnostics lies with the consultants licenced to carry out gynaecological cytology by the Hamburg Association of Statutory Health Insurance Physicians. The organisation and operation of the laboratory satisfy the criteria of the cervical cytology quality assurance agreement of the German National Association of Statutory Health Insurance Physicians. The licenced cytologists and the doctors regularly attend internal and external continuing education programmes to maintain a high standard of diagnostics.
As part of our quality control measures, the results of the diagnostics are subject to ongoing checks using routine statistical analyses and internal evaluation and audits. A computer-based reminder system informs the referring gynaecologists each quarter about any outstanding repeat or clarifying examinations required for cytologically questionable results and about the results of interim histological workup. Re-screening is also conducted in line with the requirements of the cervical cytology quality assurance agreement. All cytologists working in our department have access to a slide collection of rare cases and those of difficult differential diagnosis.
Smears are processed after their receipt in the laboratory using a standardised procedure. To prevent any mix-ups, each smear is allocated a number with identification of both the smear and the accompanying request form or referral slip using a barcode label. The patients’ and case data is entered into the computer system. The smears are treated using the Papanicolaou stain and slides are sealed using cover film or cover slips.
After linking the smears and their request forms, microscopic analyses and final evaluations of group I are carried out independently by the cytologists. Previous cytological findings are retrieved and, where necessary, included in the evaluation. Given the setup of our cytology office, fast and easy consultation between the cytologists is always possible. Positive and unclear findings and those recommended for repeat analysis (Groups 0, II-a/p/g/e, III-p/g/e/x, IIID1/2, IVa-p/g, IVb-p/g, V-p/g/e/x) are finally reported by the consultant and the cytologist after having reviewed the case using the multi-headed microscope. The report is based on the Munich Nomenclature III and in accordance with the guidelines of the German Society for Gynaecology and Obstetrics (“Prevention, diagnosis and treatment of HPV infection and pre-invasive lesions of the female genitals”). Any previous cytology and/or histology as well as previous HPV status will be considered for the final report and for recommendations for subsequent diagnostic or therapeutic measures. The slides of the smears are physically archived and the reports including the referral letters are electronically stored.
The turnaround time of gynaecological smears is up to two working days. In urgent cases the report is faxed by noon of the following working day.
Cytology is primarily used to detect cancer cells, classify cysts and solid masses from various organs and soft tissue as well as confirm inflammatory changes. Fluids from cavities such as pleural and pericardial effusions, ascites and joint effusions as well as content from cysts and pseudocysts, lavages, urine and smears collected from the nipples or the oral or oesophageal mucosa are examined. Fine-needle aspirates from the thyroid, internal organs, lymph nodes and soft tissue are diagnosed by our consultants.
The technical processing, registration and reporting of the extragynaecological cytology is similar to the procedures described for gynaecological cytology and require one business day from the receipt of material. In addition to the Papanicolaou stain other techniques like Pappenheim (May-Grünwald-Giemsa), Giemsa, PAS or iron stain can be performed and immunocytochemistry can be done if required. The microscopy and reporting is carried out by consultants only.
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