Achievable standards, Benchmarks for reporting, and Criteria for evaluating cervical cytopathologySecond edition including revised performance indicators

Editors: J. Johnson and J. Patnick MEMBERSHIP OF THE WORKING PARTY Dr J Johnson Chairman (Royal College of Pathologists) Mrs J Patnick NHS Cervical Screening Programme Mr N Dudding Institute of Biomedical Science Dr A Herbert St Thomas’ Hospital (Chairman, Working Party, first edition) Mrs E M Hewer National Association of Cytologists Professor H J Kitchener Royal College of Obstetricians and Gynaecologists Mr L Lancucki Department of Health, Statistics Division Dr E McGoogan University of Edinburgh Dr D N Slater Association of Clinical Pathologists Dr P A Smith British Society for Clinical Cytology The working party acknowledge the assistance of: Mr M Davidge Inter‐Authority Comparisons Consultancy, University of Birmingham Miss A L Pearson NHS Cervical Screening Programme Mrs P Craddock Primary care members of Advisory Committee on Cervical Screening Dr A McPherson Primary care members of Advisory Committee on Cervical Screening Dr A Rodway Primary care members of Advisory Committee on Cervical Screening The Regional Quality Assurance Directors for Cervical Screening The National Co‐ordinating Group for Quality Assurance in Cervical Screening, Laboratories SUMMARY OF CHANGES TO SECOND EDITION • Endocervical cells are not essential for an adequate smear, except where the previous abnormality was seen in endocervical cells. • When three consecutive smears are reported as inadequate, the recommendation for colposcopy should be made at the discretion of the pathologist in the light of a review of the relevant slides and the clinical history of the woman concerned. • The cellularity of previous sequential smears should not be combined in order to judge the present smear test as negative. • There should be no more than three abnormal smears (including borderline) over any 10‐year period without a recommendation for colposcopy. • At least three negative smears, at least 6 months apart, should be reported before a woman is returned to routine recall following a smear showing mild dyskaryosis or borderline nuclear change. • There is no evidence that demonstrates that selective double screening is any more effective in preventing false‐negatives than rapid review and this practice cannot therefore be justified. • Sensitivity should be based on all abnormalities detected on primary screening rather than on moderate dyskaryosis or worse. • Ranges for reporting rates are based on the 10‐90th percentiles of the range for laboratories reporting over 10 000 screening smears per year in KC61 returns, but apply to all laboratories reporting screening smears. This edition supersedes and replaces the first edition which should now be considered out of date and should no longer be used. This section applies to the Exeter system as operated in England only.