CD-ROM transnational training program in cervical cytology (CYTOTRAIN).

The Transnational Training Programme in Cervical Cytology (CYTOTRAIN) is a 3-yr project funded by the European Commission to harmonize training and quality standards in cervical screening across the European Union. The aim of the program is to develop new approaches in initial and continuing vocational training, particularly in the area of life-long learning with the aim of meeting national, regional, and local needs. We present a new approach to training in cervical cytology, using an interactive program of cytological images. The method used to prepare the program and the problems encountered are described. The authors have the feeling that giving details of the organizational and management structure adopted for the project implementation might help other pathologists realize more or less similar CD-ROM training programs in their own field of activity.

Quality control in cytodiagnosis of carcinoma of the cervix.

In many European countries the morbidity and mortality due to cancer of the cervix are too high. Even in countries, where smears have been taken at regular intervals for many years, the percentage of new cases does not decrease as much as it was expected. There are several reasons that may explain this situation. At least two of them can be solved by pathologists: quality control (QC) system and organization of a school of gynaecological cytopathology for pathologists and cytotechnicians. Here we focus on the main aspects of External and Internal QC and new approaches to QC, including new methods and stricter control of the professional level of all persons involved in the screening and diagnosis of cervical cancer.

Expert consultation for cervical carcinoma smears. Reliability of selected-field videomicroscopy.

OBJECTIVE: To evaluate the diagnostic accuracy of videomicroscopy image selection for expert consultation in cervical cytology. STUDY DESIGN: One hundred diagnostically difficult cervical cytologic smears were selected and rescreened by a general pathologist who chose, from each slide, four or five fields featuring abnormal cells. Video images were digitized and stored on a 512 x 512-pixel matrix using an image acquisition and transmission system. Five experts each reviewed 20 of the 100 cases, and a sixth reviewed all 100 cases. Diagnoses based on selected digitized images were compared to those based on conventional examination of whole slides. RESULTS: Intraobserver agreement was fair to excellent for all six experts (kappa value: 0.47-0.81); it was complete or acceptable in 68.4-85% of cases. Compared to the reference diagnosis, interobserver agreement was not significantly different whether cases were examined by screening the entire slide or by videomicroscopy of selected fields. The marked discordance in four cases concerned very small cells the significance of which was misinterpreted on videomicroscopy because of poor image quality due to lack of focus setting. CONCLUSION: This exploratory study showed that selection of videomicroscopy images seems as reliable as conventional examination of slides for expert consultation on diagnostically difficult cervical cytologic smear cases.

[Value of a computer-assisted screening method (PAPNET) for the detection of infectious cervico-uterine smears]. / Intérêt du système de lecture assistée par ordinateur (PAPNET) pour la détection des frottis cervico-utérins infectieux.

There have been several reports regarding the accuracy of the PAPNET system applied to the screening for cancerous and precancerous lesions. Based on neuronal networks, this computerized tool was initially trained to select atypical cells. It has been approved in the USA for the re-screening of cervical smears for quality assurance. However, its particular behaviour has not been frequently studied when the system is designed to detect frequent infectious organisms. We report the results of re-screening of 42 inflammatory cervico-uterine smears by the PAPNET system. The computerized images were reviewed by two different pathologists, with complete agreement between the two observers in 39 cases. Infectious organisms were detected in only 66% of cases. Trichomonas, mycoses and Gardnerella were diagnosed in 63%, 56% and 87% of cases respectively. No herpetic lesions were identified. The low accuracy of the PAPNET system in the diagnosis of infectious cervico-uterine smears should be taken into account if this system is developed as an exclusive pre-screening method.

[Guidelines for the evaluation of internal quality control of smears for screening of uterine cancer in France in the structures of Pathologic Anatomy and Cytology. French Association for Quality Assurance in Pathologic Anatomy and Cytology (AFAQAP)--Commission for cervical smears]. / Recommandations pour l'évaluation de qualité interne des frottis de dépistage du cancer du col utérin en France dans les structures d'Anatomie et Cytologie Pathologiques. Association Française pour l'Assurance de Qualité en Anatomie et Cytologie Pathologiques (AFAQAP)-Commission Frottis du col utérin.

A national organized mass-screening effective programme is the only way to reduce the risk of cervical cancer, if properly organized and correlated with a system of Quality Assurance. Since 1900, an Association for Quality Assurance was created by the French pathologists, named "AFAQAP". These pathologists thus demonstrated their interest in this kind of action that should be effective if women and clinicians are also implied. The pathologists have concluded the first part of their programme with these French guidelines for internal quality control of pap smears.

[Telepathology and "small cells" in cervical-vaginal smears: a new tool for diagnosis and teaching?]. / Télépathologie et "petites cellules" des frottis cervico-vaginaux: nouvel outil d'aide au diagnostic et à l'enseignement?

The identification of small cells in cervical/vaginal smears is usually considered as a difficult task, as well when they are examined through a classical light microscope or thanks to a teletransmission system. In this paper, we have compared both methods. 53 cases of smears with small cells were examined by two pathologists. The different types of small cells were described. The results and the discrepancies were studied. The reliability was rather good (45/53 cases, 84.6%). The main images were recorded onto a videotape for teaching purposes.

[The cervico-vaginal smear. What is new with the Papanicolaou method in 1996?]. / Le frottis cervico-vaginal. Qu'est devenue la méthode de Papanicolaou en 1996?

Recently, quality control became one of the priorities of cytopathology applied to screening for carcinoma of the uterine cervix. Taking into account the evolution of our knowledge and the progress of telematics in medicine, several new methods provided a potential benefit. The main ones were the following : telepathology, making distant transmission of microscope images possible, in order to require the opinion or advice of a more experienced colleague; an image data bank, illustrating typical or unusual images, as an aid to diagnosis and to teaching; computer assisted systems, able to process conventional smears and to optimize the detection of atypical cells, in order to reduce the number of false negatives. These methods are tools at the clinician's disposal- and not the contrary -bearing in mind the idea that cytodiagnosis is, and must remain, a medical labour.

Telepathology: a tool to aid in diagnosis and quality assurance in cervicovaginal cytology.

The purpose of this study is to evaluate the use of a Teletransmission System with regard to quality of diagnosis and screening so as to establish its potential role in gynaecological cytology. Three aspects of its use in cytopathology have been considered: diagnosis, training, and quality control. The circumstances in which the system may be used for diagnosis, together with its advantages and disadvantages, are examined and discussed. In general, the cost/benefit in diagnostic use related to the experience of both the expert and the peripheral pathologist. The system may also contribute to training and quality assessment, particularly if combined with other automated services, such as image data bank.

[Telecytoconsultation: application of the TRANSPATH system to the cervicovaginal pathology]. / Télécytoconsultation: application du système TRANSPATH à la pathologie cervico-vaginale.

Telediagnosis in Cytology is possible and useful. As for histology it requires education to use this new tool and a new method to make a diagnosis, but also a rigorous behaviour. But for cytology, technical restrictions are more important: selection of adequate fields, magnification (a 60 x objective is necessary), illumination (specially for little round cells, in fact spheric ones), and a good knowledge of cytology of both partners to be used with accuracy. This method offers no real access to smear's background and false negatives are impossible to exclude. Moreover it is difficult to differentiate between endocervical and endometrial cells and competence in cytology is much more necessary than for histology. A more detailed evaluation is therefore required.

[Lymphadenopathy of dermatosis in the course of drug hypersensitivity. Cytologic, immunohisto- and immunocytologic, ultrastructural aspects. Report of a case]. / Lymphadénopathie des dermatoses au cours d'une hypersensibilité médicamenteuse. Aspect cytologique, immunohisto et immunocytologique, ultrastructural. A propos d'une observation.

In addition to the morphological details obtained from the imprints, a simple immunocytological study allowed us to diagnose one case of a dermopathic lymphadenopathy simulating a T cell lymphoma, following a drug-induced erythrodermia. We were able to identify the increase of CD1a+ and Prot. S100+ cells on acetone fixed imprints. The histological, immunohistological and ultrastructural investigations confirmed the value of the cytological study and that the dendritic cells were Langerhans cells (Birbeck granules+). Most of them were considered as migrating from the dermal lesions.

Quality control in cytopathology applied to screening for cervical carcinoma.

When screening for cervical carcinoma became one of the priorities of the European Community (1992), the "European Guidelines for Quality Assurance in Cervical Cancer Screening" proposed an organisation of the screening program. In the following years, Quality Assurance/Quality Control (QC) was organized in many countries. The whole staff of the laboratory has to participate in the organization of Internal QC programs: errors must be detected in all categories of smears and the same terminology has to be adopted. External QC is well accepted when organized by the pathologists themselves. The French program is presented. In the near future, pathologists should take into account the evolution of QC, and the role of modern methods such as telecytopathology and computer-assisted screening devices.

[Computer-assisted rescreening of cervicovaginal smears stained by the Papanicolaou method. Evaluation of the PAPNET system apropos of 225 cases]. / Relecture assistée par ordinateur des frottis cervico-vaginaux colorés par la méthode de Papanicolaou. Evaluation du système PAPNET à propos de 225 cas.

The risk of false-negative smears is currently the main criticism of conventional cytological diagnosis of cervical cancer. None of the palliative methods (rescreening of a certain number of smears, external and internal laboratory controls, screener's training, European recommendations for Quality Assurance ...) are completely accurate. This explains the attempt to use automated screening of smears. The PAPNET screening system which allows recognition of possibly abnormal smears appears to be sufficiently effective. In this study, the authors report their personal experience based on a series of 225 cases. Moreover, when used wisely, this system may represent a useful teaching tool as well as a means of cytopathology Quality Assurance.