Liquidbased cytology

Liquid-based cytology (LBC) is a technology whereby a cervix brush sample is suspended in buffer and processed so that a thin layer of cells is produced on a slide without contamination by blood cells and debris. This results in preparations that are generally easier to read. Its advantage is in a reduction in inadequate samples from 9 per cent to 1-2 per cent, and there may be gains in reducing borderline results and increasing sensitivity.



Table 15


No abnormalities detected

Cellular appearances which cannot be described as normal

Endocervical cell changes Squamous cell changes

Cellular appearances consistent with CIN 1

Cellular appearances consistent with CIN 2 Celluar appearances consistent with CIN 3 Possibility of invasive cancer



Abnormal Borderline changes

Mild dyskaryosis

Moderate dyskaryosis

Severe dyskaryosis

Suspected invasive cancer


The test cannot be interpreted. It may be too thick or too thin, obscured by inflammatory cells or blood, or incorrectly labeled; or it does not contain the right type of cell.


Routine recall after three to five years

Refer for colposcopy after one borderline change or three abnormal tests at any grade in a ten-year period

Refer for colposcopy after one test is reported as borderline.

Refer for colposcopy after three tests in a series are reported as borderline.

Ideally refer for colposcopy, but it remains acceptable to recommend a repeat test after one test reported as mild dyskaryosis. If two tests are reported as mild dysdaryosis refer for colposcopy.

Refer for colposcopy

Refer for colposcopy

Refer for colposcopy Women should be seen urgently within two weeks of referral.

Repeat the best. Refer for colposcopy after three consecutive inadequate samples.

Source: NHS Publication No. 20: Colposcopy and Programme Management Guidelines for the NHS Cervical Screening Programmes.


  • There are two main methods of treatment. The abnormal cells in the cervix may be destroyed using laser ablation or cold coagulation treatments, or the abnormality may be excised using a loop diathermy or laser excision. Loop diathermy is the most common and effective treatment, and is used by 71 per cent of clinics.
  • Hysterectomy is not usually necessary for CIN, as treatment aims to preserve a woman's fertility.
  • Surgery is the main form of treatment for localised cases for the few women who have cancer, while radiotherapy and chemotherapy may be used for more extensive disease.

SPECIAL CONSIDERATIONS (NHSCSP (2004)): Cervical cytology in GUM Clinics

The NHS Cervical Screening Programme (2004), suggests that cervical cytology in GUM clinics should be reserved for those with a cytological indication or those who have not been screened in previous routine screening at the appropriate interval.

Cervical screening in pregnancy

Unless a pregnant woman with a negative history has gone beyond three years without having a cervical screening then the test should be postponed. If a woman has been called for routine screening and she is pregnant then the test should be deferred. If an earlier test was abnormal, and in the interim the woman becomes pregnant, then the test should not be delayed, but should be taken in the middle trimester unless there is a clinical indication.

HIV-positive women

All women newly diagnosed with HIV should have cervical surveillance performed by, or in conjunction with, the medical team managing the HIV infection. Annual cytology may be indicated depending on disease progression, refer to local guidelines. Colposcopy for cytological abnormality should follow national/local guidelines. As there is a lack of information on the management of women from the age of 65 who are HIV-positive, it is advisable to seek local guidance in these cases.

Women who have sex with women

There is no mention of management of smears for women who have sex with women in the national screening guidelines. They do recommend that women who are not sexually active, but have had sex with men in the past, continue with the screening programme. There appears to be an overall lack of information on the cervical screening needs of women who have sex with women. It is worth noting, however, that Fethers et al. (2000) highlight no difference in the prevalence of abnormal cervical cytology and of changes suggestive of cervical intraepithelial neoplasia (CIN 1,2, or 3) in women who have sex with women as against women who have sex with men.


Endometriosis may be defined as a disease characterized by the presence of functioning endometrial tissue, normally situated in the uterine cavity, outside the uterus. It is most commonly found in the pelvis, but can also be present in areas such as the abdominal cavity and the pleura (Thomas and Rock, 1997).


Endometriosis is more commonly seen in women being investigated for infertility (21%) than among those undergoing sterilization (6%). The incidence of endometriosis in women being examined for chronic abdominal pain is 15% and, for those undergoing abdominal hysterectomy, 25% (Green Top Guidelines, 2000).


Thomas and Rock (1997) indicate that factors that increase the exposure to menstruation increase the likelihood of the disease occurring, whereas those that decrease the exposure protect against it.

Aetiological factors influencing endometriosis

• Age

  • Family history
  • Heavy periods
  • Frequent cycles
  • Pregnancy protects
  • Oral contraceptives protect

Menstruum not only flows down the vagina but can also reflux along the fallopian tubes and into the pelvis. It is this refluxed menstruum that is thought to be the cause of endometriosis, though the mechanism remains unknown. However, there are various suggested theories (Thomas and Rock, 1997):


Minute fragments of endometrium pass along the fallopian tubes during menstruation and spill into the pelvic part of the peritoneal cavity; this becomes implanted on another pelvic structure such as the ovary, and develops into endometriosis. While shed endometrium is generally necrotic, living fragments have also been found.

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