Chapter 15 Answers to discussion questions

Advances in cytopathology

15.1 Do automated screening systems have a role to play in a modern cytology laboratory? If so explain.

Consider benefits and limitations of automated screening either as a quality control or a primary screening tool. Conduct a literature search and compare sensitivities and specificities with manual screening. Include productivity, cost effectiveness, and the move to larger centralized laboratories. Best to approach as a SWOT (strengths, weaknesses, opportunities, and threats) analysis.


15.2 What will be the impact on the NHS Cervical Screening Programme of vaccinating young girls?

Outline the Department of Health policy on immunizing against high-risk HPV in the UK. Explain the rationale of vaccination and the expected long-term effect on incidence of cervical cancer in the UK and number of cervical tests. Describe the limitations of a bivalent virus. Consider the role of cytology as the NHSCSP develops a strategy to screen the vaccinated and unvaccinated population. Consider age of first test, screening intervals, and cost effectiveness (refer to Chapter 3 for current practice).


15.3 What benefit can molecular testing bring to cytological practice?

Explain why molecular testing is necessary from a clinical perspective? Consider diagnostics and predictor information. Consider each of the following areas of cytological practice: urine, lung, cervical, eff usion, and FNA, citing examples of molecular tests which can be used, paying particular attention to benefits such as targeted therapy


15.4 What are the biggest challenges in introducing molecular testing in a clinical laboratory?

There are both technical and clinical challenges. The technical challenges involves good understanding of techniques and training of staff. Of particular note is design of the technique, understanding sensitivity and specificity and troubleshooting.


15.5 What are the limitations of molecular testing in clinical practice?

The main limitation is that any result for a patient needs to be interpreted in the context of that particular patient. The final decision to actionable therapy based on genetic data lies with the clinician.