Atlas of Gynecologic Cytology Ossama Tawfik, Marilee Means
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1ATLAS OF GYNECOLOGIC CYTOLOGY2
3ATLAS OF GYNECOLOGIC CYTOLOGY
Editors Ossama Tawfik MD PhD Professor of Pathology Department of Pathology and Laboratory Medicine The University of Kansas School of Medicine Kansas City, Kansas, USA Marilee Means PhD SCT (ASCP) Clinical Associate Professor Department of Cytotechnology The University of Kansas School of Health Professions Kansas City, Kansas, USA
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Atlas of Gynecologic Cytology
First Edition: 2014
9789350907757
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5CONTRIBUTORS
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7PREFACE
As pathologists, we are faced with numerous complex challenges. We constantly strive to improve our diagnostic ability, the performance and standardization of our tests, and our communication with other health care professionals. New technologies are dramatically changing the modern practice of pathology and assisting us in these endeavors. This atlas was written, in large part, to illustrate the immense practical utility of implementing widely available technologies in mainstream pathology practice.
Communication technologies have already begun to permeate common practice. The pathologist is now capable of contributing his/her expertise in diagnosis even when far away from the hospital. As a secondary benefit, image processing technologies also endow the pathologist with more flexibility at the workplace. Before long, we may see pathologists reading their patients' slides from across the country and across the world. We may also see more collaboration between pathologists at different institutions. This capability is obviously conducive to the timely delivery of patient care. The technology to do this already exists, we only need to implement it to reap its benefits.
Whereas communication technologies continue to change the way we exchange information not only at work but also as members of contemporary society, technological advancements are occurring in spheres more local to our field as well. There is ongoing and promising work in areas of tissue processing and pathological slide database development. These capabilities are of obvious utility in improving the timeliness of specimen processing workflows and compiling data for future research (to name a few benefits), but they are also interesting insofar as they are points of contention for those who fear that technology's growing role in our field will expand until pathologists become secondary or obsolete. We believe, on the contrary, it is an exciting time to be a pathologist, and the duty befalls us to continue to attract creative and progressive leaders to address the challenges we face, and we should not underestimate the obvious value of our contribution to patient care.
Ossama Tawfik
Marilee Means
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9ACKNOWLEDGMENTS
The authors would like to thank several individuals and organizations, who have made this atlas possible. We thank the leadership and members of the Institute for Advancing Medical Innovation (IAMI) at the University of Kansas, who saw the potential usefulness of such concept in our quest against cervical cancer. We also thank them for their guidance and financial support. Their vision and willingness to experiment are tremendously appreciated.
Special thanks to Ms Robyn Wood, for her dedication and administrative skills; Ms Marsha Danley, for her dedication and her outstanding technical skills in preparing cellblocks and slides; Ms Susan Dillon, for the countless hours spent reviewing glass and digital slides, and Mr Dennis Friesen, for his superb technical imaging skills. We would also especially like to thank all who have worked with us over the years: colleagues, cytotechnologists, fellows, residents, students, family and friends. Their insight, encouragement, criticism and advice are much appreciated. We would like to thank Dr Pablo Hernandez-Rios at MAWD Pathology Laboratory, North Kansas City, Missouri and Dr Eric Glassy at Pathology, Inc, Los Angeles, California and their teams, for their willingness to share with us the many samples for the study and the atlas.
Finally, we hope our readers find this atlas a practical source of useful information in their practice.
13SCOPE
Cervical cancer is one of the most common malignancies worldwide, yet it is clearly preventable by population screening. The significant decline in both the incidence and mortality of cervical cancer is attributed to the Papanicolaou (Pap) test. At least 85% of cervical cancer cases occur in underdeveloped countries. It is the most common cancer in women in Africa. It has been reported that less than 5% of women in underdeveloped countries have ever received a Pap test. Many argue that the disease has reached epidemic proportions, but few have proposed practical solutions. Innovations in cervical cancer screening have focused on automation of liquid-based samples, HPV testing and vaccination. Even with the hope of human papillomavirus (HPV) vaccination and with new expansive efforts to adopt HPV testing as a tool in primary screening, the Pap test remains the best cancer screening tool available.
A team of cytopathologists and cytotechnologists at the University of Kansas Medical Center has been working for 2 years to evaluate the feasibility of utilizing imaging technology (digital pathology) of cellblock (CB) preparations from Pap samples. Our intended goal is to establish a digitally assisted remote (web-based) complete, expedited and integrated platform for review of Pap CB samples for global cytologic consultation. TelePAPology is a novel method of using automated CB preparations of liquid-based (ThinPrep + SurePath) and conventional samples to produce virtual slides. This can be accomplished by scanning images using one of the commercially available digital systems to detect various neoplastic and preneoplastic lesions, organisms and other non-neoplastic findings. It is intended to conform with the Bethesda interpretive system and to communicate cytologic interpretations to other health care providers in a clear, reproducible and standardized fashion. The atlas is divided into 8 short chapters. The introductory chapters discuss the historical background and future of the Pap test and the potential impact of automation and digitization on the field. This is followed by a detailed description of the advantages of TelePAPology. In particular, we argue that this automated Internet-based platform may assist both the developed and underdeveloped world in addressing the problem of cervical cancer screening.
The subsequent chapters discuss the various cytologic changes that are seen in CB preparations and their counterparts in liquid-based or conventional material. A large number of images are presented with descriptions of cytologic and histologic criteria for the corresponding pathologic/cytologic entities along with explanatory notes.
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15ABBREVIATIONA AGUS
Atypical Glandular Cells of Undetermined Significance
AIS
Adenocarcinoma In Situ
AP
Anatomic Pathology
ASC
American Society of Cytopathology
ASCCP
American Society for Colposcopy and Cervical Pathology
ASC-H
Atypical Squamous Cells, cannot Exclude High-Grade Squamous Intraepithelial Lesion
ASCP
American Society for Clinical Pathology
ASCUS
Atypical Squamous Cells of Undetermined Significance
BV
Bacterial Vaginosis
CAP
College of American Pathologists
CB
Cellblock
CIN
Cervical Intraepithelial Neoplasia
CMV
Cytomegalovirus
FNA
Fine Needle Aspiration
HC2
Hybrid Capture 2
HPV
Human Papillomavirus
HSIL
High-Grade Squamous Intraepithelial Lesion
LSIL
Low-Grade Squamous Intraepithelial Lesion
NOS
Not Otherwise Specified
Pap Test
Papanicolaou Test
SCJ
Squamocolumnar Junction
SVMs
Support Vector Machines
TBS
The Bethesda System
US
United States