(rtf file). please supply images as separate files in tiff
TRANSCRIPT
President
Chair
Honorary Secretary
Treasurer
Membership
Meetings SubCommittee Chair
CEC
Members
BAC Executive Committee Dr Paul Cross Consultant Cellular Pathologist, Queen Elizabeth Hospital, Gateshead HealthNHS Foundation Trust, Tyne and Wear, NE9 6SXTel: 0191 445 6551 Email: [email protected]
Alison Cropper Cytology Department, 5th Floor, Derby Hospitals NHS Foundation Trust,Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NETel: 01332 789327Email: [email protected]
Sue Mehew Consultant Healthcare Scientist in Cytology, Cytology Laboratory,Pathology Department, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh. EH16 4SA. Tel: 0131 2427149 E-mail: [email protected]
Kay Ellis ABMSP/Cytology Manager and HBPC, Cytology Department, Floor E, RoyalHallamshire Hospital, Glossop Road, Sheffield S10 2JF Tel: 0114 271 3697 Email: [email protected]
Dr Louise Smart Department of Pathology, Laboratory Link Building, Foresterhill, Aberdeen.AB25 2ZDTel: 01224 552836 Work Fax 01224 663002 Email: [email protected]
Alison Malkin Lecturer in Biomedical Science (Cytology and Cellular Pathology), Schoolof Biological Science, Dublin Institute of Technology, Kevin Street, Dublin 8, IrelandTel. 00 353 1 4022835Email: [email protected]
Helen Burrell Consultant Biomedical Scientist & Manager, South West Regional CytologyTraining Centre, Lime Walk Building, Southmead Hospital, Bristol BS10 5NBTel: 0117 323 2704Email: [email protected]
Dr Ash Chandra MD FRCPath DipRCPath (Cytol) Consultant Pathologist, Cellular Pathology,2nd floor North wing, St. Thomas' Hospital, London SE1 7EHTel: 0207 188 2946 Fax: +44 207 188 2948 Email: [email protected]
Hedley Glencross Advanced Specialist Biomedical Scientist, Cytology Department,Queen Alexandra Hospital, Southwick Hill Road, Portsmouth PO6 3LYTel: 023 9228 6700Email: [email protected]
Dr Anthony Maddox Department of Cytology, Watford General Hospital, Vicarage Road,Watford, WD18 0HBTel: 01923 217349Email: [email protected]
Dr. Yurina Miki Consultant HistopathologistCellular Pathology, 2nd floor, North wing, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EHTel: 020 7188 7188 ext. 56514 Email: [email protected] | [email protected]
Dr Miguel A. Perez Consultant HistopathologistRoyal Free Hampstead NHS Trust, Department of Cellular Pathology, Pond Street. London NW3 2QGTel: 0207 7940500 ext 33615Email: [email protected]
Allan Wilson Lead Biomedical Scientist in Cellular Pathology and Advanced Practitioner inCervical Cytology, Pathology Department, Monklands Hospital, Monkscourt Avenue, Airdrie. ML6 0JSTel: 01236 712087 Email: [email protected]
please see inside back cover for co-opted members
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Our new President and Chairman have taken up their places on their pedestals; you can read theiropening columns on pages two and three. We also welcome two new members to the Executive –Dr Yurina Miki and Dr Miguel Perez.
Catherine Witney has explained the role and current work streams of CSET, the ClinicalProfessional Group for Cervical Screening Education and Training. This piece did send me downmemory lane and, alas, I am one of those old enough to remember NAG - see page nine forenlightenment! The proposed UK NEQAS CPT scheme for Interpretative Digital Diagnostic NonGynaecological Cytology is introduced by Chantell Hodgson. The laboratory I’m working in isembarking on a histology digital pilot (hub and spoke model) as such verification and validation ofnot only the equipment but also the reporting is a vital part of the process, we have neverconsidered diagnostic cytology as we are unaware of any documentation on it. I’ll be watching thisiEQA scheme with interest.
Jo’s Cervical Cancer Trust shares some of the initiatives from Cervical Cancer Prevention Week inJanuary. There is an interesting biscuit quiz which was designed by the Royal Victoria Infirmary inNewcastle-upon-Tyne – so that you can have a shot I’ve put the answers on the inside back cover(no peeking!).
I think this edition shows us that Cytology is moving forward, we may not know where we will allbe at the end of 2019 (although personally I’m not convinced that date will hold and have takenthe precaution of renewing the LBC contract for three years from 1st April, with a break out clause!)but it is clear that the Cytology discipline will continue to provide a diagnostic service and careeropportunities for many years to come.
The next edition of SCAN is October 2018. Please may I have copy by August 6th 2018.
Sharon
Editor: Sharon Roberts-Gant
INFORMATION FOR CONTRIBUTORSArticles for inclusion in SCAN can be emailed to the editor if less than 1MB in size or supplied on CD/DVDor memory stick. Text should be in a standard text format such as a Word document or Rich Text Format(rtf file). Please supply images as separate files in tiff or high quality jpeg files at a resolution of not lessthan 300 dpi (600 dpi if the image includes text). 35mm slides and other hard copy can be supplied forscanning if no electronic version is available. Graphs are acceptable in Excel format.
If you are unable to supply files in the above formats or would like advice on preparing your files,please contact Robin Roberts-Gant on 01865 222746 or email: [email protected]
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Editorial
Sharon Roberts-Gant
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I am writing this as my first President’s piece, and Ilook back with much pride at the way the BAC hasdeveloped and become more and more accepted asa responsible professional body in matterscytological. It always takes time as a new association,even if formed from two previous professionalbodies, to be recognised and taken notice of. I writethis as I head to London as a BAC representative to ameeting at the DoH about Primary HPV matters. Thefact that we are involved in this, and many othergroups and bodies nationally, is testament to howmuch we have progressed in being recognised as abody representing cytology nationally. Being askedto take part is the first step, being listened to andhaving an effect is another. We can but raise theissues that we as cytologists want raising, and tryand ensure we represent cytology the best way wecan. We rely on members to raise issues, and we also,given the executive members all of whom areinvolved in delivering cytology around the country,can pick up on the zeitgeist within cytology. Wewon’t always have success, we won’t always pleaseeveryone, but we will always do our best. As they sayin my neck of the wood, “shy bairns get no sweets”.
This is a time of much change. The plans toimplement primary HPV cervical screening seem toloom large in any discussions these days. Whilst thisis hugely important for cytology nationally, it is notthe only driver for change. In England the delivery ofSTP (sustainability and transformation plans) mayalso impact on lab configuration. Many labs are intalks to rationalise services and potentially merge inthe great NHS drive to deliver efficiency savings. As atax payer I do not object to the best use of my taxmoney, but likewise I also want the best quality of
services across the public sector. Cost savings can gotoo far, and the need for quality and the right serviceat the right time can be lost in the push to delivermore and more pound signs.
Changes in service is also affecting the staff at allgrades in cytology. Cytology staff are nearly alwaysalso part of the general histology services, and thetwo are intimately mixed. We must maintain servicesduring these changes, and develop them for thefuture. We must ensure those that want to train incytology and those that want to retain cytology skillscan be accommodated. Whatever our originalprofessional roots, we must work together to deliverthe clinical service. This must be collaboratively,ensuring best use of professional skills and expertise.We are working with the RCPath and IBMS in manyareas, but one is to ensure that staff are suitablytrained and competent now and for the future. Thismay result in changes to historic roles, but if thoughtthrough they can benefit us all, and maintain ourservices in the long run.
I must thank two members of the Executive whohave stood down, Dave Nuttall and Jackie Jamieson,for all their work and contributions. I must alsowelcome our two new members, Yurina Miki andMiguel Perez-Michado. I am sure they will carry onthe contribution of all the Executive members inpromoting and developing cytology in Britain. Theexecutive must change and new blood and ideasintroduced if we are to take cytology forward. Mythanks go to all the Executive members, past andpresent, for all they have done and are doing. It is apleasure working with them, and seeing the passionand drive they have for cytology.
President’s PiecePaul Cross
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Membership DetailsPlease email or write to Christian Burt if any of your contact details change.
Email: [email protected]
Christian BurtBAC Administrator Institute of Biomedical Science12 Coldbath Square LONDON EC1R 5HL
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It is not without a little trepidation I write my firstChairman’s Column! Having been on the Executiveof the BAC since its inception in 2011, and previouslythe NAC for nearly 10 years, it is still a dauntingprospect to be Chairman, but it is a role I amhonoured to hold and thank the rest of theexecutive members for having the confidence in meto undertake the role. It’s one thing beingconference and meetings organiser for theassociation but Chairman is a totally different ball-game!
I must also thank the out-going Chairman (nowPresident) Paul Cross and President (but still on theexecutive as a re-elected member) Allan Wilson, forall their support and encouragement and I lookforward to continued working with them as we enterwhat must one of the most difficult and challengingtimes for everyone involved in cervical cytology inthe UK. As Paul has already mentioned in hisPresident’s Piece, it is great news that we also havetwo new executive members bringing enthusiasmand new ideas to the team – welcome on boardYurina and Miguel!
Being BAC Chairman means I am no longer Chair ofthe Meetings Sub Committee, a role which has beentaken over by Alison Malkin, who introduces herselflater on, and is already getting involved in theplanning of future BAC educational events – detailsof what’s happening in 2018 can also be foundelsewhere in this edition. One of these is the ECC inMadrid, June 10-13th, last hosted by BAC inLiverpool in 2016, which seems so long ago now butwhich made a lasting impression on the EFCS whohave invited us to hold a symposium in Madrid toshowcase all that is good about cytology in the UK –and there’s so much we could include!
Cytology in the UK has much to be proud of. Forexample, we now have BMS reporting of bothabnormal gynae and non-gynaecological cytology
and certain histopathological samples, enabled bythe ever evolving and expanding examinationstructure of the conjoint board of the RCPath andIBMS, and this is a situation aspired to by many othercountries, and will be highlighted in Madrid.
However, at the time of writing this article thecervical cytology workload across the UK hasrocketed, and whilst we usually see an increaseduring Quarter 4 each year I have heard fromcolleagues who are reporting up to 35% increases inworkload compared to the same period last year!Whether the well-publicised Jo’s Cervical CancerTrust campaign, which I have described in anotherarticle, has had a causative effect on this it isprobably too early to tell, but the hike in work hascome at a time when many labs can least do withoutit, and are struggling to keep on top of the 14 dayTAT as it is.
The impending procurement of a HPV primaryscreening service by NHS England in 2018/19 hascreated a tension and climate of change within ourprofession, unlike anything I have known in my 35years working in cytology, and the future isuncertain for all of us involved in the CSP.
Without doubt there are going to be challengingtimes ahead, and to quote one of the mostmisquoted movie lines of all time (Bette Davis, ‘Allabout Eve’, 1950) - "fasten your seatbelts, it's goingto be a bumpy ride (night)”!
It will be difficult for many of us to remember andfocus on the positives of our profession, but I canassure you that BAC will certainly continue to try andhelp support everyone, in whichever way we can, inthe coming months. Please get in touch with anyconcerns you want us to raise and we will keepbanging on doors and ensure that our voice keepsbeing heard.
Chairman’s ColumnAlison Cropper
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Reflections on the BAC ASM and AGM York, 4th November 2017Dr Paul Cross
The scientific meeting is detailed elsewhere, andwas well attended, of great interest and finishedon time – always a bonus on a weekend meeting!Feedback after the meeting has been incrediblypositive, with all talks scoring well. The majorproblem during the day had been the IT and itsunreliability certainly did not help at times.Despite this, the meeting seemed a success. A bigthanks to all those involved in helping organise it,especially Alison Cropper, Kay Ellis, Ash Chandraand David Carter. As with all meetings we mustalso thank our commercial partners and theirsupport for it. The commercial stands were wellattended and popular, and most delegates tookthe opportunity to engage with them. A bigthanks to all involved.
The meeting also included the BAC AGM, whichwas also well attended. General updates on BACmatters were discussed, and some changes to theBAC Constitution were passed by the AGM. AllanWilson stood down as President (having alreadybeen instantly re-elected back onto the Exec!) andwas warmly thanked for all his work, and given asmall gift, including a model of the FlyingScotsman – what else!
Planning for BAC meetings in 2018 and beyondare already well underway, and details of thesecan be found on the website and elsewhere inSCAN. The talks from this year’s ASM will beavailable on the members’ side of the BACwebsite, so log on and them.
Allan Wilson receiving his gift
BAC AGM, 4th November 2017, National Railway Museum, YorkA post conference reflection by Jenny Davies, FIBMS
Although I have retired, I like to keep up with whatis happening in my “old” profession and wasenticed to attend this meeting by such a greatlooking programme. I did arrive in York earlythough to get my brain fired up with a full Englishbreakfast!
When I started working in cytology there were nocomputerised records, reports were typed using atypewriter (and quite a bit of Tippex), nocall/recall and immuno-histo/cytochemistry wasin its infancy. How things have moved on at analmost exponential rate!
After meeting the all-important commercialpartners, the scientific programme began with
National Railway Museum, York
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Professor Andrew Fischer from USA telling usnot to throw away out microscopes (as if wewould). It was quite evident that moleculartesting is not a cheap alternative to visualmicroscopic screening and evaluation, given thecost of machines and sequencing/visualisationreagents, but some criteria for malignancy couldbe linked to the function of certain oncogenes.96.5% of driver genes have been detected forPapillary Thyroid Carcinoma, but some 36 yearslater, the activity of RAS oncogene is still not fullyunderstood. Using analogies to nature andDarwin’s Finches, he explained that structure isdefinitely related to function, but it is difficult todetermine at which point an important geneticevent/modification occurred. The cell to cellvariation seen in cancers reflects geneticinstability, but there must be something in thetransformations which increase cellular fitnessthat allows the cancer to continue to grow.Although all of this is at molecular level, thetesting needs to have an assessment of inputmaterial, ie, an affirmation that “cells of interest”are present in the samples to be tested. This iswhere he said that there was still a place formorphological assessment using a microscope. Aplatform is being developed so that live cellimaging can be viewed in real time, and mayreveal new sets of dynamic structural changeswith a diagnostic utility surpassing that ofclassical static imaging. It was a shame that the ITsystem did not allow for the running of embeddedvideos showing the nuclei in motion. Such afascinating way forward for cytology staff.
Dr Sally Hales and Dr Paul Cross gave anoverview of the Interpretive Diagnostic CytologyEQA scheme, from its beginnings in the NW regionin 1993, through the modifications within the NWto going national. The last sputum case wasincluded in 2004, and the first Trans-bronchialFNA was introduced in 2010. Slides are used fromsubmitting laboratories, and the cases should beunequivocal and preferably have a known clinicaloutcome (not always the case), as results will onlybe included in end of round reports for individualsif slides have reached consensus. A few examplesof case performance were shown as examples.Because of the difficulty in obtaining goodexamples and the logistics of circulating fragileslides, digital forms of EQA have been trailed, butso far with limited success. The major advantagesof digital images being no loss of slides, andeveryone sees the same thing. A new 2 stage pilotwill begin in Spring/Easter 2018 , with theintention of going live in 2019. A steering group isbeing formed and protocols are already beingdeveloped. H&E stained slides will not be allowed,but the scheme should be flexible enough to
allow for different preparation types, bearing inmind that LBC does not allow for Giemsa stainedpreparations. Having done EQA in Gynae foryears, after having a moan about doing it onoccasion when you are busy, it is actuallyeducational in the long run and keeps you on yourtoes. The same applies for non-gynae, andparticipation should be encouraged for personalCPD and patient interest.
After break, Jackie Jamison gave an interestingand amusing overview of the Molecular Pathologyservice offered in Northern Ireland. She explainedthat it is possible to have a fully integrated serviceincorporating Cytopathology, Histopathology andMolecular testing. She made the transition to themolecular age seem not quite so daunting, byoutlining the evaluation of material, DNAextraction and the stages of PCR. On top of this,she pointed out the limitations (eg cellularity,presence of malignant cells, pre & post analysis)and inhibitors (eg fixation, necrosis, polymorphs)to successful molecular testing which linked tothe title of her talk “what cytologists must know”.To get the best results, there must be a goodunderstanding of the principles, andcytologists/BMS staff are well set up for this. Sheshowed a few cases, a sample request form andhighlighted the importance of selection,verification and validation. In summary, teamworkis all important, and clinicians should be included.To be a successful service, staff must know:Cytology, how to maximise material, adequacy,limitations/inhibitors, timescales, moleculartechnology and finally how to formulate a fullyintegrated interpretative report.
Cytopathology has been at the forefront for thefurther development of the role of the BiomedicalScientist (BMS), not least with the introduction ofthe Consultant Biomedical Scientist; a well-recognised and respected post. It is further beingextended with the introduction of BMS cut-up andhistopathology reporting. Although I knew aboutit, I have had no first-hand experience of thisdevelopment in my time on committees or astraining manager, so it was with interest that Ilistened to Dr Angus McGregor as he talked usthrough the background of the need for this roleto be introduced. It has been a long time indevelopment, but results from a pressurisedexpensive workforce, increased volume andcomplexity of workload, cancer agenda andfinancial efficiency; more medical pathologists isnot necessarily the answer. Also, careeradvancement for BMS staff in Cellular pathologyhas been limited, and this is a huge opportunity.The first proposal was given to Histopathologytraining committee and SAC in 2010; a conjoint
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board was formed with IBMS and RCPath with thefirst exam being held in 2013. This is not intendedto qualify for RCPath, even though the curriculumis largely the same, but leads to a role forConsultant BMS staff to work alongsideHistopathologist colleagues. Unfortunately, atthis moment in time, there are no resources tosupport the project and training, and there is noformal recognition in workforce planning. KarenEzard, Consultant BMS, bravely (and proudly)went through her personal experience of theprocess, explaining that anyone who wishes toundertake this training should be aware of what itentails and not enter lightly. There was a highdrop-out rate in the first two years, and the studypath is different to that required by IBMSqualifications. The curriculum has expandedthroughout the pilots, and she described it aschallenging, intensive and all consuming. Shegave advice about access to histopathology andthe correct range of specimens, and to consider arota and secondments to achieve it. Candidateshave to be self-motivated; don’t underestimatethe time input, learn dissection to an appropriatestandard and read around the subject. Protectedtime is very important, which I understand frommany years delivering training. It can be difficult,so candidates should have support frommanagers, colleagues and family. There wereconcerns that, after formal selection, if this is astand-alone role “what if I fail”. However, it doesdemand a separate job description that reflectsthe complexities of the role. I wish anyone whogoes down these routes to extended roles everysuccess, and thank Karen for the tips!
After lunch in the trade exhibition and visits to thetrain museum, the scientific programme resumedwith Professors Fischer and Vaux talking aboutThe Cell Biology of Cancer, but “not as we knowit”. They showed the dynamic changes in cells asthey altered shape, highlighting alterations inappearance of the nuclear lamina. Post
translational modifications can alter the functionof the nuclear envelope and regulation of geneexpression, and may be a target for cancer relatedproteins. They also showed that nuclei are notstatic within the cell, but move back and forth inthe cytoplasm, or with a rolling motion. Nuclearmovement related to cell division tends to occurbefore the metaphase plate is laid down. Theseobservations in cells cultured on a plastic platemay occur to a greater extent being outside thenatural environment. It was very disappointingfor delegates, and frustrating for the speakers,that the IT facilities failed to cope with the videoclips, which showed the dynamic images of cells.It is hoped that these new imaging techniques willexpand the current criteria for malignancy toinclude the dynamic features. In some respects, itis hard to believe how cell imaging and researchhas moved on since I started my career. Thoseentering our profession now could bear witnessto, and play a part in, a fascinating future.
The penultimate session saw the audience bebrought up to date on HPV Primary Screeningfrom a Five Nations Perspective.
Alison Malkin reported that the screeningprogramme is still very young in Southern Ireland,having started in 2008. At that time the cervicalscreening was out-sourced to the USA, butapprox. 50% has now returned to Ireland.Currently, data shows 88 deaths per year fromcervical cancer and 79.6% coverage. The HPVvaccination programme began in 2010, HPV Testof Cure 2012, and HPV triage for low grade diseasebegan in May 2015. Following the HIQA HTAreport on HPV testing as the primary screeningmethod for prevention of cervical cancer , it isprojected that €35 million will be saved in the first8 years 2018 – 2025 (€3m in vaccinated women,€32m in non-vaccinated women). The reportsupports implementation of primary HPV testingat 5yr intervals at ages 25 – 60yrs, with Cytology astriage for HR-HPV positive women, and states thisshould improve efficacy of CervicalCheck. Twosubgroups of women were also considered; wherewomen that were 50 year or older in 2008,screening will be extended to age 65, and non-vaccinated women under age 30 will be offeredprimary HPV screening at 3 yearly intervals. Alisonsays she is optimistic that there is now anopportunity for cervical cancer screening servicesto be returned and provided within SouthernIreland. Their website is www.cervicalcheck.ie
Jackie Jamison gave a brief report from NorthernIreland. Currently there are five Trusts and fourcytology laboratories covering a population of 1.6million. As yet there is no policy decision, but it is
Trade Show
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most likely that one laboratory will ultimatelyprovide this service. Reasons for delay includeExeter call/recall system, LIMS and risk balance.The lack of policy backing and computer supportmeans that NI cannot move forward. However, anHPV planning group has been established, with aview to beginning in 2019. At the moment theyare watching progress in the UK.
Steve Court updated everyone on the situation inWales. Cervical Screening Wales (CSW) has beenrunning since 1999. 236,000 women are invitedwith an uptake of 77%. CSW rolled out TOC in2014, and in 2015 an all Wales decision led thescreening service to move from Surepath toThinPrep, with a requirement for conversiontraining of staff across the cervicalscreening/primary care sectors, with 2500 sampletakers needing training. 2016 saw theintroduction of Triage and TOC, and theintroduction of a pilot 20% primary HPV testing inApril 2017. Results from the pilot showed a +verate of 12%, referral rate of 4.2%, with 42.5% ofHPV +ve tests having abnormal cytology.Logistically, there are 4 laboratories operating ahub and spoke model; 1 processing site based inSouth Wales, and 3 screening laboratories, withtransport occurring daily. Wales is currentlyworking with Thinprep LBC + Aptima. It wasanticipated that there would be full roll out of HPVtesting by October. Challenges to face include asingle processing centre serving the whole ofWales, a reduction in sample numbers due to HPVvaccination and extended recall and resultinglaboratory mergers leading to the loss ofexperienced staff.
Allan Wilson reported on the current status inScotland. There are 7 laboratories offering acervical cytology service, but this does not includeTriage; 2 of these should be ready for HPV primaryscreening with Cytology Triage from 2019/early2020. Working towards this has meant thedevelopment of a project plan with 5 work-streams, and monitoring impact on SCCRS.Laboratory selection criteria have been produced;labs will have to satisfy the required entry criteriabefore they can bid for the service of one of thetwo afore mentioned labs. Problems which willhave to be faced are limited HPV experience, andthe service is already working at full capacity. BySpring 2018, it should be announced whichlaboratories will deliver the service.
Kay Ellis reported for England. There is currentlyan emphasis on the management of turn-aroundtimes (TAT), and HPV screening is being expandedto non-pilot sites. Hot off the Press and withperfect timing, an announcement was made on
3rd November by NHS England, on laboratoryconfiguration for Primary HPV screening.Notification was sent to heads of Public Healthcommissioning, with a letter to the Chair of theBAC. An update of key decisions includedcentralisation of between 10-15 laboratories, witha maximum of 13 being selected by the end of2019. Information about this announcement isavailable on the BAC website. This will be a twostage process up to the selection of the maximum13 labs, but it is on a very short timescale withweek by week progression. Timeframes will becommunicated throughout.
Following the afternoon break, the finale of themeeting was the Erica Wachtel Lecture, this yeardelivered by Professor Julietta Patnick – a verywell-known and admired figure in the field ofcytology. Many delegates were interested to hearher experiences during her time with thescreening programmes from 1979 to 2015, takingthe banner of cervical screening in 1994. She hasseen many staff and structural changes, withdifficult internal markets and competition ratherthan co-operation all having an impact on theservice, and she thought that the Cervical CancerAudit actually became a major trauma for theservice. She has also witnessed hugedevelopments:
Progress in cancer management includesimprovements in prevention, early detection, painmanagement and palliative care. Some cancersare being treated more successfully, and there areno more frozen section mastectomies. Bowelscreening has seen the introduction of the flexiblesigmoidoscope, and prostate and ovarian cancerscreening are at the research stage.
Revolutions in cervical screening includeoptimum coverslip sizes (she didn’t get involved),and guidance on sample adequacy. LBC broughtan improvement in productivity and
Erica Wachtel Lecture
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The BAC ASM 2017 and my new role as Chair of theBAC Scientific Meetings CommitteeAlison Malkin
I knew the BAC ASM in York was going to be a verydifferent meeting for me, in comparison to previousyears, for a number of reasons. Not only was this myfirst ASM as a member of the BAC Executive, I waspresenting in the afternoon session on the status ofHPV primary screening in Ireland, and I was alsoaware that, after the AGM, I would be taking over therole of Chair of the Scientific Meeting Committee. Iam glad to say that the day went well and was agreat experience, providing me with an opportunityto learn from the Scientific Meetings Committee firsthand as well as from the speaker’s perspective.
It does help that I know and previously worked withsome of the members of the BAC Executive,although that was over 20 years ago (where did thetime go?). My cytology career started in 1992 when Imoved from the Histology Department, NorthernGeneral Hospital, Sheffield, to a full-time post incytology, at what is now Burton Hospitals NHSFoundation Trust. This is where I developed my loveof cytology and when I became a member of theNAC. My time in Burton was short lived however, asin 1995 I moved to Dublin, first in a locum positionfor 2 months in the Royal College of Surgeons,Ireland and then as a ’Senior Technologist’ in StJames’s Hospital, managing a busy clinical cytologylaboratory. During this time I became a member and
then Chair of the Irish Association for ClinicalCytology (IACC) and was involved in organisingmany of their Annual Scientific Meetings. I movedinto my current position as Lecturer in BiomedicalScience in the Dublin Institute of Technology,Ireland, in 2005, specialising in Clinical Cytology andCellular Pathology. I am a member of the Academyof Clinical Science and Laboratory Medicine, theprofessional body for Medical Scientists in Irelandand am currently on the ACSLM Cellular PathologyAdvisory Body, promoting education and continualdevelopment in both cytology and histology byorganising and facilitating scientific conferences,educational workshops and seminars.
While I look forward to my role as Chair of theScientific Meetings Committee, it does feel slightlydaunting especially as I am following in thefootsteps of the past Chair, Alison Cropper, whoalongside the other members of the ScientificMeetings Committee has done a fantastic job oforganising many successful BAC ASM’s and BACaffiliated events over many years. These will be bigshoes to fill, however I am hoping that my pastexperience will help me to continue the good work.
Thankfully, I am happy to say that much of theorganising and planning for this year is underway.
reproducibility and 2003 saw changes to age andfrequency of screening; and audit was carried outto standardise the frequency and “conspiracytheories abounded”!
Other major milestones include HPV testing andvaccination, and changes to RCPath examinations.She thinks that cervical cytology is becomingmore isolated, and the “need for expertise isincreasing”.
Management of the programme has undergonemassive change, from National Co-ordination andNational Office to incorporation into Public HealthEngland and restructuring. She thought itimportant that the BAC should have a large part toplay going forward. As a final note, she thinks theNHS is under severe financial strain, and problemsto be faced include the outcome of Brexit and theprogramme being within the remit of PHE which isa civil service setting.
The meeting closed after after questions, andpresentation of the Erica Wachtel medal. All in allthis was a very well organised and well attendedmeeting, for which the organisers are to becongratulated.
Julietta Patnick being presented with Erica Wachtel medal
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The Cytology Study Day will be held on Monday 16thApril in Guy’s Hospital, London. Registration for thisevent is now open with links to registration andprogramme information on the BAC, Royal College ofPathologists and IBMS websites. Programme detailsare also published in this edition of SCAN and as youcan see is particularly focused on FNA and ROSE.
The BAC is also delighted to have a symposiumsession at the ECC 2018 in Madrid. This conference ison from Sunday 10th to Wednesday 13th June andthe BAC Symposium will be held in the afternoon ofMonday 11th June. The programme for the BACSymposium is currently being finalised and will becirculated to members and posted on the BAC
website once finalised. The programme andregistration links for ECC 2018 are available on theBAC website and on the ECC 2018 website –
www.cytology2018.
Another date for your diary is the IAC Tutorial whichwill be on the 3rd – 5th December, in London. I knowI am early with this notice; however the BAC AGM islikely to be held sometime during this meeting.Details will be released nearer the time.
Finally, I would like to thank the BAC Executive forwelcoming me on to the team and I look forward toworking with the Scientific Meetings Committee.
Education and training in the Cervical ScreeningProgrammeCatherine Witney, National Education and Training Manager Cancer Screening Programmes
A biomedical scientist by profession, I’m qualified inboth cytopathology and histopathology with over30 years of experience in the NHS. My lastoperational post was Cellular Pathology DeputyManager at the Queen Elizabeth Hospital NHS Trustin Norfolk. Before taking up my current post with thePHE Screening Information Education for Public andProfessionals (IEPP) team, I was a member of theNHSCSP national team working as joint laboratorycoordinator for the cervical and bowel screeningprogrammes before their transition to PHE.
I now hold the post of National Education andTraining Manager for the Breast, Bowel and CervicalCancer Screening Programmes. This is still arelatively new role and I work closely with the 3programme managers to make sure the educationand training needs of all staff groups in thescreening pathways are met. The IEPP team supportsall 11 screening programmes covering educationand training, producing patient information leafletsand letters, professional guidance, writing blogs andproviding the screening helpdesk.
The expertise of clinical groups has always been akey strength in supporting the Cervical ScreeningProgramme (CSP). PHE screening was keen to retainand channel this valuable resource and set upnational clinical professional groups (CPGs) tostreamline governance, advice and stakeholderinput to the Programme. The CPGs for the laboratoryand colposcopy networks were the first to be
established. Their membership is drawn from theclinical and scientific professional organisations, thenational Programme, SQAS and colleagues in Wales,Scotland and Northern Ireland. Members use theirindividual professional expertise and experience toadvise the CPG. The CPG chairs are appointed byPHE and offer practical and clinical advice to theProgramme on current issues and guidance on howbest to achieve its overall aims.
The CPG model was adopted to establish the ClinicalProfessional Group for Cervical Screening Educationand Training (CSET). CSET aims to build on the workof the former National Cervical Cytology Educationand Training Committee (NCCETC) and has extendedboth its remit and membership to reflect theeducational needs and training pathway for sampletakers. The group includes representation from PHE,BAC, IBMS, RCGP, RC Path, RCN, UK Cytology trainingcentres, and cervical sample takers/trainers.
Many of you will be familiar with NCCETC, and someof you will be old enough to remember itspredecessor - national advisory group on cervicalcytology education and training (affectionatelyknown as NAG). Initially set up in 1995, NAG broughttogether for the first time the 3 main professionalcervical cytopathology organisations of that era todevelop a single examination for cytology screeners.
Under Richard Winder’s chairmanship, that groupevolved to form NCCETC and went on to accomplish
10
many initiatives all of which contributed to the highstandard of education, training and its deliveryacross the UK. The committee produced severallaboratory resources, including an educationworkbook and a log book aimed at trainee cytologyscreeners. A bench top atlas was produced tosupplement the national roll out of LBC conversiontraining. National guidance was developed and setout job profiles, qualifications and trainingrequirements for non-medical laboratory staffworking in the Programme. This also includedstandards for the cytology training centres and in2003 a three-yearly programme of assessments wasrolled out.
The cytology training centres are managed by highlyqualified specialists and they provide training whichallows the Programme to maintain a highly skilledcompetent workforce. Compulsory core training andregular update sessions for staff working in theNHSCSP ensure they can carry out their professionalresponsibilities. In 2007, one of the most notableachievements was for the cervical cytology trainingprogramme to successfully transfer to a formalqualification. This became the benchmark for all staffscreening and signing out negative samples for theCSP.
In 2014 Karin Denton became the interim chair ofNCCETC following Richard Winder’s retirement. On apersonal note, I’d like to thank Karin for her support andadvice in setting up CSET. I have much to live up to.
There’s lots of work going on at the moment, and asthe newly appointed Chair of CSET, I’m confidentthat with the continued support of our cervicalscreening colleagues, CSET can emulate NCCETCand build on its achievements to date.
Sharon Whitehurst, Cytology Education Manager,supports and co-ordinates the work of CSET and itssubgroups and is ably assisted by Kirsty Bennett.CSET members bring a wealth of knowledge andexperience to the table, and for an up-to-date list ofwho’s who, please email [email protected] .CSET has been around now for just over a year andhas a busy work schedule.
The following are examples of some of the workstreams we are undertaking.• A national eLearning resource for sample takers
was successfully launched in October 2017 andCSET is responsible for keeping it updated in linewith professional guidance. The resource isdesigned to meet the 3 yearly update trainingrequirement for sample takers working in theCSP. The module is free to access and is hostedon the E Learning for Health websitehttps://www.e-lfh.org.uk/ .
Since the module was launched it has been themost visited of all the PHE screening eLearningresources. User feedback has been very positive.
• As a first step towards meeting the requirementsof the national sample taker training guidanceissued in December 2016, 4 of the cytologytraining centres providing theoretical training forsample takers collaborated to standardise themain components of this course. As the maindelegates are nurses, the Royal College ofNursing (RCN) was the obvious organisation toapproach for accreditation. The application wassuccessful and accreditation of the training wasachieved in August last year.
• Concerns about the lack of access to andavailability of sample taker training for generalpractitioners (GPs) have been raised, as well asdifficulties in keeping informed and findingrelevant update courses. CSET has embarked ona number of initiatives to try and address theseconcerns.
One of our CSET members has been includingsample taker training for local GPs at ST2 levelusing a modified model of the nationalProgramme guidance allowing training to beaccessed in higher numbers and over a shorterduration at an earlier stage of their training. Thismodel is due to be evaluated in spring and theoutcome will inform the review of currentProgramme guidance.
• CSET will be reviewing the assessment criteriaand process for cytology training centreapproval. It’s anticipated that there will be somekey changes in view of the future developmentsin the cervical screening programme. This is amajor piece of work and will start in the springahead of the next round of assessments which isdue to start in 2019.
• We’re working with the cytology training centreson a number of training projects. High on the listof priorities is making sure staff are updated onthe primary HPV screening pathway andsupported to maintain high quality andefficiency in an HPV primary screeningenvironment.
• A training course for the new cervical screeningprovider lead (currently hospital-basedprogramme coordinator) will be required to bemodelled on the new guidance being developedfor this role. Individuals are likely to have a morecomplex role than previously and appropriatetraining is essential to make sure that those newto the role meet the desired competencies.
11
It’s already well documented that these are busy andchallenging times with major changes affecting thecervical screening programme. The English cervicalscreening programme is known to be one of thebest in the world and the training and education ofour workforce is a vital element. Whatever changestake place in the coming months and years, we willcontinue to deliver a highly trained and competentscreening work force.
Finally, my plug for the PHE Screening blog! This isthe best way for you to know what’s going on in thecervical programme.
Articles on the PHE Screening blog provide up todate news from all NHS screening programmes. Youcan register to receive updates direct to your inbox,so there’s no need to keep checking for new blogarticles.
Meet our new Executive members!
Miguel moved from Madrid to London after finishinghis PhD in Immunology. He studied Medicine in hiscountry of origin (Cuba) were he used to teach andlead a research group dedicated to developingmonoclonal antibodies for diagnostic purposes. InLondon he became a Histopathologist and fullmember of the Royal College of Pathology. Heunderwent a period of specialist training in FNAcytology at the Karolinska Institute in Stockholm,Sweden. He has years of experience reportinghistopathology and cytopathology specimens. Hehas published his research in international journalsand is actively involved as speaker and organizer innational and international Cytology meetings.Miguel is the lead Cytopathologist at the Royal FreeHospital where he works as a consultant; he is alsoan Honorary Senior Lecturer at University CollegeLondon. Miguel is passionate about teaching anddeveloping new diagnostic tools in the area ofCytopathology, particularly in the area of pancreasand thyroid gland.
Yurina is a Consultant Histopathologist andCytopathologist at Guy’s and St. Thomas’ NHSFoundation Trust. She has had the good fortune ofexperiencing life in various parts of the world,including Japan, Singapore, China, Hong Kong andthe USA, before finally settling in London, where sheattended Barts and The London medical school. Shecompleted her specialty training in histopathologyin London and, as a Consultant, she subspecialises innon-gynaecological cytopathology and haemato-pathology. She has a keen interest in education andtraining, delivering teaching on regionalcytopathology courses for the BAC and RCPath aswell as organising workshops and lectures at theBirmingham Cytology Training Centre. Her clinicalprojects in cytopathology have so far focused on thefield of urine cytology, and she is a peer reviewer forCytopathology. However, at present, she is a littlepreoccupied, having recently given birth to twins(shortly after the BAC ASM)! Nevertheless, she islooking forward to getting involved in the work ofthe BAC.
Miguel moved from Madrid to
We are delighted to have two new members to theBAC Executive. They are Dr Miguel Perez-Machado,and Dr Yurina Miki.
Yurina is a Consultant H
12
CEC: Journal Based LearningEvaluating the Genomic Yield of a Single Endobronchial Ultrasound-guidedTransbronchial Needle Aspiration in Lung Cancer: Meeting the Challenge of Doing More With Less
Leong, T. et al. Clinical Lung Cancer Vol 18: 6, e467-72
1. How is EBUS-TBNA used in the investigation of patients with lung cancer? (2 marks
2. What is the optimal number of passes required for a cytological diagnosis and molecular analysis? (2 marks)
3. Why is it sometimes not possible to carry out molecular analysis in some cases? (2 marks)
13
4. What were the findings of this study with regards EBUS-TBNA and molecular analysis? (2 marks)
5. List 2 limitations of the study (2 marks)
Name……………………………………… CEC Number………………
Please post or email your completed JBL to me at the email/address below
Helen Burrell (BAC CEC Officer)Consultant BMS & ManagerSouth West Regional Cytology Training CentrePathology Sciences BuildingSouthmead HospitalBristolBS10 5NB
Please remember to make a copy ofeverything before it is sent — there
have been one or two losses in the post.Thank you
14
Cervical CancerPrevention Week
This annual publicity event, run by Jo’s CervicalCancer Trust, ran earlier this year, 22 - 28th January,and saw the charity to launch its ‘#SmearforSmear’campaign to raise awareness of cervical cancer andthe cervical screening programme, and to try andencourage more women to attend for screeningwhen invited. With coverage at an all-time low in theUK, and with approximately one third of CCGs andLocal Authorities not undertaking any local activitiesto increase access and attendance, Jo’s CervicalCancer Trust are hoping the new campaign will help,especially in the lower age groups where uptake islowest.
And it looks like several Cytology and Colposcopydepartments across the UK helped promote thecampaign and raise awareness in their ownlocalities, with some really novel ideas being used -at the Royal Victoria Infirmary in Newcastle-on-Tyne,for example, the Colposcopy nursing team held a‘Guess the Cervix’ competition, using biscuits theyhad made and decorated in the shape of variousappearances of cervices!
Jilly Goodfellow and Jill Fozzard, NurseColposcopists at the RVI (seen in the picture belowwith Frances Workman), had the brilliant idea ofmaking cervix shaped shortbread biscuits and had astand at the main entrance to the hospital to engagewith staff and members of the public in the fun quizto raise awareness.
They made and decorated biscuits to representnormal and abnormal appearances and for a smalldonation people could purchase a biscuit, Jo’sCervical Cancer Trust badge or shopping trolley coinand they raised over £120. Members of staff whowere overdue their smear were also given theopportunity to have their smear taken in colposcopyat a time that suited them, and 11 staff have so farbeen screened.
Similarly, at Gloucestershire Hospitals Trust, clinicshave been set up in Colposcopy for Trust staff due oroverdue screening which means that 5000 femalestaff now have access to an on-site service ratherthan having to go to their own GP at inconvenienceto them – and the Trust!
At York Teaching Hospital NHS Foundation Trust, asocial media post was put together for the Hospital’sFacebook page, giving a little publicity to theCytology laboratory and the service provided bytheir Trust. The post also included key messagesabout the importance of cervical screening and for
The RVI Biscuit Quiz (answers inside the back cover!)ThThT RVIVIV Bi it Q i ( i id ththt b k !)!)!
15
women to ensure they made appointments wheninvited, as the biggest cause of cervical cancer isthrough failure to attend an appointment and havemissed early diagnosis. The post performed well,generated lots of engagement and can be viewedhere:
https://www.facebook.com/YorkTeachingNHS/photos/a.551226058281615.1073741827.141788145892077/1708972745840268/?type=3&theaterStaff from Cytology and Colposcopy at the RoyalDerby Hospital had a stand near the main hospitalentrance, where they gave out Jo’s Cervical CancerTrust leaflets and chatted to staff and visitors aboutscreening:
Interestingly, what they found was that manywomen, especially in the younger age groups, areembarrassed to even talk about going for a ‘smeartest’ let alone going to have one, as shown in arecent Jo’s Trust survey of non-attenders whichfound that 35% were embarrassed to attendbecause of their body shape/image or didn’t attendan appointment because they hadn’t had a bikiniwax or shave beforehand!
Jo’s Cervical Cancer Trust run an annual awardscheme, recognising excellence and innovation incervical screening across the UK, and this year’s topprize was awarded to the NHS Tayside Colposcopy
service based at the Ninewells Hospital in Dundee.The team (comprising medics, admin and cytologystaff, GPs, Cervical Cancer patients group, Macmillanstaff, the communications team) organised dailyawareness stalls and “drop in” smear sessions inhospitals, had awareness stalls around localshopping centres (with cakes, as pictured), sharedposters and posts across their social media platformsand had a cervical cancer survivor speak to the localmedia about the importance of cervical screening.
The initiative enabled NHS Tayside to secure a year’sworth of funding from Scottish government to run‘pop up’ evening clinics which saw more than 150women screened and incentivised more to attend attheir GP. They targeted areas in the Health Boardwhere cervical cancer incidence is higher and wereable to engage with more hard-to-reach groups ofwomen to increased awareness and attendance ofscreening.
Also in Scotland, a Highly Commended award wasgiven to NHS Greater Glasgow and Clyde CancerResearch UK Facilitator Programme. A second HighlyCommended was awarded to Middlesbrough andRedcar and Cleveland Councils, for their ‘ScreeningSaves Lives’ campaign. For more details see the Jo’sCervical Cancer Trust website
https://www.jostrust.org.uk/node/1073162
and if you have any local campaigns or events pleaseconsider submitting an entry for the awards next year.
I t ti l h t th f d th t
The initiative enabled NHS Tayside to secure a year’s
16
BackgroundDr Sally Ann Hales was the Scheme Organiser for aDiagnostic Non Gynaecological CytologyInterpretative EQA (iEQA) scheme run from theCountess of Chester Hospital Cellular pathologydepartment, in the North West of England, whichwas established in 1999. This scheme started as aregional scheme but developed over the followingyears as it acquired participants from additionalregions in the UK and some overseas. Due to theexpansion in the number of participants, organisingruns and providing timely feedback were becomingproblematic for the existing scheme. It becameapparent that the current scheme membership hasoutstripped its organisational capacity. Dr. Hale’sscheme had piloted a digital version alongside theslide based circulation in 2005/6 from CPA pilotfunding, to try and overcome problems such as slidebreakages and laboratory delays in circulation, butthese preparations were found unsuitable for thetechnology at that time. This was due to theproblems with visualising cytology samples,especially those with three dimensional cell clusters.
One major issue with a cytology based EQA schemeis the difficulty in producing enoughidentical/similar samples for use by participants.Many histology interpretative EQA schemes usedigitally scanned slides in their schemes, butcytology samples do not all lend themselves well tothis due to the variety of sample preparations andstaining. However the ability to be able to usedigitally scanned material would be hugelyadvantageous if technical issues can be overcome.
It must also be borne in mind that this is anindividual interpretative EQA scheme, not atechnical one and not one that represents a wholelaboratory. Such a scheme will be familiar to thosedoing cervical cytology and also histology EQAschemes.
The proposal for a revamped iEQA scheme waslaunched as part of the BAC Annual ScientificMeeting held in York on November 4th 2017, and wasalso discussed as part of the UK NEQAS CPT AnnualParticipants’ meeting in Edinburgh, 31st October2017. There was resounding support for such ascheme at both meetings. Several meetings havebeen held between UK NEQAS CPT and members ofthe original scheme committee, and other leading
experts, to help develop the ideal behind thescheme and to develop a workable protocol, whichwould use UK NEQAS CPT’s expertise and experienceto help run such a scheme.
Proposed schemeThe scheme aims to promote quality and educationfor all those involved in screening and reportingdiagnostic cytology. It will be open to all those whoscreen and report diagnostic cytology, both medicaland non-medical, as well as cytology trainees. It willprovide good examples of cytological entities whichwill allow for individual feedback and education, andpromote education within cytology.
The proposed scheme will work with UK NEQAS CPTadministrative staff who will provide office support,using the original scheme contact list with details ofthe participating consultants, biomedical scientistsand specialist trainees. Expressions of interest emailswill be sent out to all contacts for taking part in thefirst pilot.
Good case selection will be key. The criteria for caseselection MUST be:
• Good cytological examples of the conditionbeing used (normal, benign or malignant)
• Diagnosable on the material providedwithout recourse to ancillary tests/stains
• Using clinical cytological material that will beuseable to the majority/all of schemeparticipants for assessment and diagnosis
• Using cytological preparations and stains thatwill be useable to the majority/all of schemeparticipants
• Able to be scored and evaluated using themarking scheme developed
• Be suitable for digitally scanning and usewithin the scheme
• Ideally provide clinical and histologicaloutcomes for all cases to allow for participanteducation
Using the experience of the UK NEQAS CPTDiagnostic Non Gynae Technical EQA it would seemthe best material initially to use would be derivedfrom the following cytology specimen types;
• serous fluids, • respiratory, • head and neck• urine
Proposed Interpretative DigitalDiagnostic Non GynaecologicalCytology Scheme
17
From a number of surveys issued by UK NEQAS CPTthese specimen types appear to be widely preparedand diagnosed in UK and laboratories.
The UK NEQAS CPT Diagnostic Non Gyn Cytology(technical) EQA scheme assesses only Papanicolaouand Romanowsky stains, and a large proportion ofsamples are prepared as thin layer LBC samples, withsome cytospins and direct smears. H&E stainedcytology slides will not be used in the scheme.Others preparation techniques are used, but arerelatively less common.
The pilots will use 8 scored cases for individualassessment and 2 un-scored cases purely foreducation. The pilot scheme will utilise a simpleapproach initially to allow for ease of use and for testof overall proof of concept of the scheme.
It is proposed that scoring will be two tier: Benign vsmalignant, with a drop down list of possible specificdiagnoses relevant to that case. Participants willthen categorise using benign/malignant diagnosis,and can opt to give a specific diagnosis if they feelthey can.
If the scheme achieves its aims, this scoring systemcan be developed further.
The scoring system must allow for analysis andstatistical evaluation in line with the scheme aimsand objectives. This must be by case, by peerrelevant group and with feedback to eachparticipant on their own performance and ascompared to their relevant peer group. Aparticipation certificate will be produced asevidence of participation.
Development of the software will allow the digitisedmaterial to be seen by each participant on input oftheir unique access information (e.g. personalidentifications (IDs) and password). It is intended tomake the scheme as educational as possible, with online access to cases and associated details, histologyetc.
The scheme proposes to use only digitised scannedcytology slides in the scheme. The use of digitisedmaterial (scanned slides) would allow for a far easierdistribution and also allow for instant feedback andeducation if allied to a short educational package foreach case (histology, clinical background, ancillarytests etc.). This would also ensure the schemefulfilled its educational value.
Development of software will be required and willbe made to the current UK NEQAS CPT EQAprogramme management and online assessmentsystem, for data collection /analysis and productionof reports, to move away from paper based systems. The above proposals need to be discussed anddeveloped into a working protocol to be piloted in 2runs during 2018 / 19. These are proposed to beJune 2018 and Winter 2018. These dates may needto be amended if necessary based on software anddigital system development.
ConclusionThere is a great need for increased quality initiativesand monitoring within diagnostic nongynaecological cytology. This is not only forcompliance with new standards, but also to ensuregood adequate material for diagnostic purposes.The proposed scheme will be able to build on thesuccess of the existing Diagnostic NonGynaecological Cytology technical EQA scheme,which has helped promote and raise the technicalquality of diagnostic cytology, aiding the ability toassist in diagnosis. Time will tell if it works anddelivers these aims, and is accepted by the widercytology community. We work hard to try andensure it does.
Mrs Chantell HodgsonUK NEQAS CPT
Dr Paul CrossScheme Organiser
Your Role as a Cervical Screenin
Lead/Hospital Based Progra
Day one is aimed specifically at thtwo more suitable for those alre
6th
& 7th
June 2018
HPV. Its role in cervical carc
to Detect it
Aimed to give anyone involved inof basic cell biology, the role of HPV techniques used to detect it
18th
April 2018
One/Two Day Update Speci
and Experienced BMS staff
Aimed specifically at those intenas Checkers. This course is suitabSurePath™ or Thinprep®
21st
& 22nd
May 2018
Training Opportu
Non-Gynae Cytology Workshops
Ideal for non-medical staff new to diagnostic Cytology18
th– 20
thApril 2018
17th
– 19th
October 2018
Courses in Expert Practice Diagnostic Cytology
These one-day courses cover serous fluids, urine andrespiratory cytology and ideal for anyone wishing to further their experience
20th
, 21st
, 22nd
, 23rd
November 2018
Exam Practice for the Diploma of Extended
Practice in Non-Gynaecological Cytology
Ideal for anyone taking the Diploma of extended Practice in Non-gynaecological Cytology
17th
– 18th
May 2018
Cervical Scr
For further information contact our Admin Team: www.nepsec.org.uk
Non Gynaecological Cytology
creening Provider
L gramme Co-ordinator
t those new to post with daylready in post as a CSPL
I arcinogenesis and how
d in HPV testing an overviewof HPV and different
ecifically for Checkers
ff
tending to or already actinga table to those using either
rtunities 2018
BMS Reporting in Histopathology
Stage A & C GI & Gynae Exam Preparation Day
These days are specifically for those working towards stage A or C part of the BMS reporting qualification
Dates to be confirmed
Histopathology Workshop - Liver Pathology
This workshop is devised for both consultants workingoutside specialist liver centre and trainees in stage C or Dwho have an interest in Liver pathology
13th
April 2018
A Course for the Expert Role in Specimen
Dissection
This course is suitable for BMSs who intend to train ashistological tissue specimen dissectors, in particular those undertaking the RCPath/IBMS Diploma
Specialist modules scheduled throughout 2018
creeningHistopathology
Tel: 0113 2466330 [email protected]
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BIRMINGHAM CYTOLOGY TRAINING CENTRE BCTC gynaecological cytology courses are provided in SurePath and/or ThinPrep LBC
Please see our website for a full list of courses: h�ps://www.bwc.nhs.uk/cytology‐courses
Courses IBMS CPD registered as appropriate
NHSCSP TRAINING IN CERVICAL CYTOLOGY NHSCSP Training Introductory Course in SurePath LBC ‐ 8‐19 January, 5‐9 February, 26 February–2 March 2018
Follow‐on Course ‐ 12‐16 November 2018 Pre‐Exam Course ‐ dates to be confirmed
UPDATE COURSES IN GYNAECOLOGICAL CYTOLOGY 7 March 2018 (MDT Cases and Squamous Lesions) 19 April 2018 (HPV Update and Glandular Lesions) 30 May 2018 (MDT Cases and Squamous Lesions) 27 June 2018 (HPV Update and Glandular Lesions)
28 September 2018 (MDT Cases and Squamous Lesions) 22 October 2018 (HPV Update and Glandular Lesions) 23 November 2018 (MDT Cases and Squamous Lesions)
NON‐GYNAECOLOGICAL CYTOLOGY FOR CONSULTANTS, CONSULTANT BMS & BMS 2018/19 course programmes and dates to be confirmed
BIRMINGHAM HISTOPATHOLOGY COURSE 4‐15 June 2018 (FULLY BOOKED)
(plus op�onal personal revision �me during course weekends & Mon‐Tues 18‐19 June 2018) This two‐week course provides topic based lectures on systemic pathology, slide review of selected cases followed by
discussion and a revision session including mock exam in prepara�on for the FRCPath Part 2 exam.
GYNAECOLOGICAL CYTOLOGY FOR TRAINEE PATHOLOGISTS 19‐20 February 2018; 10‐11 September 2018
The programme for this course is a combina�on of lectures workshops and mul�header sessions. Includes a mock exam and is par�cularly suitable as revision for the Cer�ficate in Higher Cervical Cytology Exam
NON‐GYNAECOLOGICAL CYTOLOGY FOR TRAINEE PATHOLOGISTS 12‐16 February 2018 (FULLY BOOKED); 3‐7 September 2018 (FULLY BOOKED)
The programme for this course is comprehensive and includes the salient aspects of diagnos�c non‐gynaecological cytology. This course includes a mock exam and is par�cularly suitable as revision for the FRCPath Part 2 exam
AUTOPSY PATHOLOGY COURSE 24‐25 September 2018
This two‐day course addresses the fundamentals of the autopsy including external examina�on, dissec�on techniques, post‐mortem toxicology and suspicious deaths. The course is aimed at Stage C/D trainees in Histopathology and
Consultant Pathologists prac�cing autopsies.
INTRODUCTORY COURSE FOR ST1s November/December 2018
Introduc�on to Gynaecological and Non‐Gynaecological Cytology including Autopsy element for regional ST1s
TRAINING OFFICERS’ MEETINGS 18 May 2018; 28 November 2018
LBC Conversion Courses and ad hoc workshops can be arranged on request—please contact BCTC LBC Sample Taker Ini�al and Update Training sessions are arranged regularly throughout the year
For further details and reserva�ons please contact Amanda Lugg or Louise Bradley Birmingham Cytology Training Centre, Birmingham Women's Hospital, Birmingham, B15 2TG
Phone: 0121 472 1377 Ext 5081/5082 | Email: bctcenquiries@bwn�.nhs.uk Website: h�ps://bwc.nhs.uk/cytology‐training‐centre
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Scottish Cytology Training School !"#$"%&&'()*+,-)*+.(
No course fee is charged for Gynae cytology courses to employees of
Scottish NHS Trusts
Training School Director Sue Mehew
Tel: 0131 242 7149 Email: [email protected]
Training School Manager Fiona McQueen
Tel: 0131 242 7149 Email: [email protected]
Training School AdministratorCheryl Kisacik
Training School Administrator Pathology Department
Royal Infirmary of Edinburgh 51 Little France Crescent
Edinburgh EH16 4SA
Tel: 0131 242 7135 Email:[email protected]
Application forms available on request from:
NHSCSP Accredited Training Centre
Courses held at The Bioquarter, Royal Infirmary of Edinburgh,
1st Floor, Building 9, Edinburgh Bioquarter, 9 Little France Road, Edinburgh. EH16 4UX
Unless states (QEUH) Glasgow
Non-NHS Labs – price on applicationAll courses are Liquid Based Cytology (ThinPrep)
Courses are CPD accredited
Introductory Course +./0(1'2"3%"4(5(+6/0(7%"80()*+,(9":(5(),/0(;'</'&2'"()*+,!!"###$
Introductory Course Part 2 +./0(=#>'&2'"(5()9":(=#>'&2'"()*+,(
Update Course )+?/(7%"80(5())@:(7%"80()*+,(6/0(A3@'(5(B/0(A3@'()*+,(CDEFGH(B/0(=#>'&2'"(5(,/0(=#>'&2'"()*+,(CDEFGH(I/0(J'8'&2'"(5(6/0(J'8'&2'"()*+,(6/0(1'2"3%"4(5(B/0(1'2"3%"4()*+.(!"##$%&'$()*$
Pre-Exam Course )*/0(K3$3?/(5())@:(K3$3?/()*+,(CL#"(M8/#2'"(EN%&H(!+,#$!Workshops – BMS Medical/Consultant Staff )B/0(=#>'&2'"()*+,!"##$
ST1 Intro to Cervical Cytology 9":(;'</'&2'"(5(B/0(;'</'&2'"()*+,(!Non-Gynae Courses - for Trainee Medical ST3/BMS +,/0(;'</'&2'"(5()*/0(;'</'&2'"()*+,(C/28H(!"##$%&'$()*$
Course for Colposcopists ./0(7%4(5(+*/0(7%4()*+,(C/28H(!"##$%&'$()*$
SOUTH WEST REGIONAL CYTOLOGY TRAINING CENTRE
BRISTOL 2018 Course Schedule
South West Regional Cytology Training Centre Department of Cellular Pathology Tel: 0117 414 9808 Pathology Sciences BuildingSouthmead Hospital Email: [email protected] Bristol BS10 5NB
www.cytology-training.co.uk
Date Gynae Courses Fee 8 – 19 January 19 February – 2 March
Introductory in Gynae Cytology – Part 1 Introductory in Gynae Cytology – Part 2
NHS £1000
Other £1200
20-22 March 12-14 June4-6 September4-6 December
Three Day Update in Cervical Cytology NHS £300
Other £350
9 May 17 October
One Day Update in Cervical Cytology £100
11 April 7 November
Update in Cervical Cytology for Pathologists & Consultant BMS’s & Holders of the Advanced Specialist Diploma in Cervical Cytology
£100
24 May Cervical Histology for Technical Staff £100
9-10 October Gynae Pathology for Trainee Colposcopists £200
21-22 May17-18 September 29-30 October
Cervical Sample Taker Training £300
7 June ½ Day Update in Cervical Screening for Sample Takers £25
Date Non-Gynae Courses Fee 16 May Serous Fluid Cytology £100
25 April Respiratory Cytology £100
14 November FNA Cytology £100
4 July Urinary Tract Cytology £100
12-15 March FULL10-13 September
Non-Gynae for Trainee Pathologists £400
!
!
Commercial Liaison
SCAN Editor
Cytopathology Editor
BAC Administrator
IBMS Representative
Miscellaneous
Co-opted members:
David Carter Business Development ManagerVector Laboratories LtdTel: 07387 266734
Sharon Roberts-Gant Cellular Pathology, The John Radcliffe Hospital, Headley Way, Oxford, OX3 9DUTel: 01865 220494E-mail: [email protected]
Professor Michael Sheaff Consultant Histopathologist, Barts Health NHS Trust, 80 Newark Street, London E1 2ESEmail: [email protected]
Christian Burt BAC Administrator, Institute of Biomedical Science, 12 Coldbath Square, London, EC1R 5HLTel: 0207278 6907 or 0207713 0214 extension 141. Work Fax 0207 837 9658 Email: [email protected]
Beverley CrossleyEmail: [email protected].
Cytopathology JournalPublisher: Hollings, Danielle — Oxford Email: [email protected]: Tom Broomfield. Email: [email protected]
BE
P8E
Answers tothe BiscuitQuiz onpage 14
AtQp
SCANISSN 2050–8891
SCAN is published bythe British Association for
Cytopathology (BAC) inEngland and
produced by the MedicalInformatics Unit, NDCLS,
University of Oxford.
©BAC MMXVIII No partof this publication may
be reproduced in anyform without the prior
permission in writing ofthe Editor. Editorial
prerogative to shortenor amend material may
be exercised wherenecessary. The Editor
and the ExecutiveCommittee do not
accept responsibility foropinions expressed by
contributors orcorrespondents.
Material for publicationshould be sent direct to
the Editor; all othercorrespondence with
the Association shouldbe addressed to the
Secretary.
CONTENTS Vol 29 No 1 2018
EDITORIAL 1 Sharon Roberts-Gant
PRESIDENT’S PIECE 2 Paul Cross
CHAIRMAN’S COLUMN 3 Alison Cropper
REFLECTIONS ON THE BAC ASM AND AGM YORK, 4TH NOVEMBER 2017 4 Paul Cross
BAC AGM, 4TH NOVEMBER 2017, NATIONAL RAILWAY MUSEUM, YORK 4
THE BAC ASM 2017 AND MY NEW ROLE AS CHAIR OF THE BAC SCIENTIFIC MEETINGS COMMITTEE 8 Alison Malkin
EDUCATION AND TRAINING IN THE CERVICAL SCREENING PROGRAMME 9 Catherine Witney
MEET OUR NEW EXECUTIVE MEMBERS! 11
CEC JOURNAL BASED LEARNING 12
JO’S SERVICAL CANCER TRUST 14
PROPOSED INTERPRETATIVE DIGITAL DIAGNOSTIC NON 16 GYNAECOLOGICAL CYTOLOGY SCHEME
www.britishcytology.org.uk
Front Cover image: Severe dyskaryosis in aThinPrep cervicalspecimen.The editor is indebted toSonja Aylward, CytologyDepartment, MedlabPathology, Ireland,for the supply of the frontcover image.