Cervical screening cytology slide review process
Updated 20 October 2021
Applies to England
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The flowchart below outlines the process for reviewing cervical cytology slides.
Note that the text description beneath the flowchart includes the list of categories which cause a slide to be classified as ‘difficult to identify’ (see ‘Decision point 3).
The cervical cytology slide review process
Starting point: a slide is identified for review.
Decision point 1: is the slide suitable for review?
Yes: assess the cytological appearances of the slide. Go to decision point 2.
No: reject the slide (note that slides may become faded or suffer ‘dry back’ of mountant with age. Unsuitable slides do not necessarily reflect the technical quality of the slide at the time of the original reporting, but they may materially affect the review process). End of pathway.
Decision point 2: does the review agree with the original cytology report as issued?
Yes: categorise the slide as ‘satisfactory’. End of pathway.
No: comment on whether the sample is adequate or not, and the degree and type of any abnormality present. Go to decision point 3.
Decision point 3: Does the slide fall into one of the ‘difficult to identify’ categories (bearing in mind knowledge at the time of the original report)?
The categories are:
- borderline changes only
- low abnormal cell numbers (less than 50 cells in liquid-based cytology (LBC) sample)
- hyperchromatic crowded groups (HCGs)
- small cell dyskaryosis
- pale cell dyskaryosis
- bland cell dyskaryosis
- small keratinised cells
- glandular abnormalities of low number and/or subtle architectural/cytological changes
- poorly preserved abnormal cells
- obviously technically inadequate that should not have been reported
Yes: categorise the slide as ‘satisfactory with learning points’. End of pathway.
No: the slide contains an obvious missed dyskaryotic abnormality. Categorise the slide as ‘unsatisfactory’ and apply duty of candour. End of pathway.