Guidelines for cervical cytology practice
Mary R. Schwartz, MD
The American Society of Cytopathology has developed Cervical Cytology Practice Guidelines, the aim of which is to optimize patient care. The comprehensive consensus document is intended for use primarily by pathologists and cytotechnologists who perform cervical cytologic analyses.
The guidelines summarize a large body of information on cervical cancer screening and cytology laboratory processes, including epidemiology, specimen procurement, analysis, reporting, and laboratory management. They are directed at U.S. laboratories, but they may serve as a reference for clinicians and patients. Specific microscopic interpretive criteria and detailed patient care algorithms are not included. The format and content of the guidelines are based on generally accepted standards for medical practice guidelines.
The guidelines got their start in 1997 when the ASC president charged two ASC committees—Cytopathology Practice and Quality Assurance—with creating a cervical cytology practice guideline. The committees were composed of expert pathologists and cytotechnologists, and they had input from many others, including the ASC Executive Board, general membership, and legal counsel. The contributors to this document reflected a cross-section of practices—hospital laboratories of all sizes and large commercial laboratories. After an intensive three-year labor of love, the document was approved by the ASC Executive Board in November 2000. The CAP Cytopathology Committee reviewed the guidelines and strongly supported them. (Several past and present members of the CAP Cytopathology Committee played a key role in their development.) The document has been made available to other professional organizations.
The Cervical Cytology Practice Guidelines are a compilation of current practices, the laboratory accreditation standards of various professional organizations, and U.S. regulatory requirements. The document is divided into multiple sections: epidemiology and public health; specimen collection, adequacy, and requisition; sample processing; cervical cytology analysis; reporting; quality control and quality assurance practices; data management and laboratory information systems; archiving and interlaboratory slide review; cost accounting and financial management; and the role of the guidelines. There is a section on enhancements to conventional cervical cytology testing, that is, new technologies including liquid-based methods, automated screening devices, microscope process control systems, and molecular and immunologic techniques. One hundred thirty-nine references are included, as well as Web sites for national regulatory requirements (CLIA '88), accrediting bodies (CAP, JCAHO), and NCCLS.
The guidelines are for educational purposes. They are not meant to serve as dictates; rather, they are a means to promote standardized practices and continuous quality improvement. The guidelines draw from relevant literature and important elements in daily clinical practice. They carefully reflect regulatory guidelines and consider risk management. They address procedural and interpretive variations in practice and areas where there is consensus for "best practices." Recommendations are generally evidence-based. The detailed and referenced discussions should be beneficial in developing policies and procedures, preparing for laboratory inspections, and optimizing patient care.
The ASC Cervical Cytology Practice Guidelines can be downloaded from the ASC Web site at www.cytopathology.org. The guidelines have been added to the National Guideline Clearinghouse and are available on that Web site also (www.guideline.gov). They have been published in Acta Cytologica (2001; 45:201-226).
Dr. Schwartz, director of surgical pathology at The Methodist Hospital in Houston, is American Society of Cytopathology liaison to the CAP Cytopathology Committee.