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Cover 23 2 ver1 Draft cover OCT 2012 17/10/2012 12:08 Page 1SCANISSN 2050–8891SCAN is published bythe British Associationfor Cytopathology (BAC)in England andproduced by theMedical Informatics Unit,NDCLS, University ofOxford. BAC MMXII No part ofthis publication may bereproduced in any formwithout the priorpermission in writing ofthe Editor. Editorialprerogative to shortenor amend material maybe exercised wherenecessary. The Editorand the ExecutiveCommittee do notaccept responsibility foropinions expressed bycontributors orcorrespondents.Material for publicationshould be sent direct tothe Editor; all othercorrespondence withthe Association shouldbe addressed to theSecretary.Cover Image:mesothelioma giemsaCONTENTSVol 23 No 2 2012EDITORIALSharon Roberts-Gant1PRESIDENT’S COLUMNKarin Denton2CHAIRMAN’S REPORTAllan Wilson2EUROGIN 2012Dr Karin Denton3DR PETER A SMITH — AN APPRECIATIONDr T Giles4MEET THE EXEC.Melanie Buchan5SO TELL US WHAT YOU WANT, WHAT YOU REALLY, REALLY WANT!Meetings of the sub-committees5BAC SUBCOMMITTEES UPDATES6AN UPDATE FROM SCOTLAND ON THE ROLE OF HPV TESTINGAllan Wilson9HPV – THE GLOBAL BATTLE, ROME 2012 (11TH INTERNATIONALWORKSHOP ON LOWER GENITAL DISEASE)Louise Smart11BAC OLYMPIC TORCH BEARERDr Mina Desai13REGISTERED SCIENCE TECHNICIANS & REGISTERED SCIENTISTS:Two New Voluntary Registers for Institute Members14CROSSWORDMelanie Buchan15LOCAL OFFICERS16CEC NEWSJenny Davies17CEC JOURNAL BASED LEARNING18CASE STUDY: MALIGNANT MELANOMABobbie Thompson21THE GOOD OLD DAYS?Melanie Buchan23A BIG LAB UNDER THE MICROSCOPE — DERBYMelanie Buchan24QUICK QUIZZESSue Mehew and Diane Hemming28CYTOLOGY HOROSCOPESMystic Mel29Website now available: www.britishcytology.org.uk

Cover 23 2 ver1 Draft cover OCT 2012 17/10/2012 12:08 Page 2BAC Executive CommitteePresidentChairGeneral SecretaryDr Karin DentonConsultant Pathologist, Lime Walk building, Southmead Hospital, Bristol.BS10 5NBTel: 0117 323 5645Email: karin.denton@nhs.netMr Allan WilsonPathology Department, Monklands Hospital, Monkscourt Avenue, Airdrie.ML6 0JSTel: 01236 e MehewCytology Laboratory and Scottish Cytology Training School. PathologyDepartment, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh. EH16 4SA.Tel: 0131 2427149 Fax: 0131 2427169.E-mail: Sue.Mehew@luht.scot.nhs.ukTreasurerKay EllisABMSP/Cytology Manager, Cytology Department, Floor E, Royal HallamshireHospital, Glossop Road, Sheffield S10 2JFTel: 01142 713697 Fax: 01142 261213.Email:kay.ellis@sth.nhs.ukMembersMelanie BuchanDepartment of Cytology, Level 5, Pathology, Royal Derby HospitalsFoundation Trust, Uttoxeter Road, Derby, DE22 3NE,Tel: 01332 789390Email: melanie.buchan@nhs.netAlison CropperCytology Department, 5th Floor, Derby Hospitals NHS Foundation Trust,Derby City General Hospital, Uttoxeter Road, Derby DE22 3NETel: 01332 789327Email: Alison.Cropper@derbyhospitals.nhs.ukDr Paul CrossDepart of Pathology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear.NE9 SXTel: 0191 445 2603Email: paul.cross@ghnt.nhs.ukJenny DaviesManchester Cytology Training Centre, Cytology Department, P.O. Box 208,Manchester Royal Infirmary, Oxford Road, Manchester M13 9WWTel : 0161 276 5114Email : jenny.davies@cmft.nhs.ukDr Mina DesaiManchester Cytology Centre, Clinical Sciences Building 2, Manchester RoyalInfirmary, Oxford Road, Manchester M13 9WWTel: 0161 276 5099 Fax: 0161 276 5113Email: mina.desai@cmft.nhs.ukDr Thomas GilesDept of Pathology, Royal Liverpool University Hospital, Prescot Street,Liverpool L7 8XPEmail: Thomas.giles@rlbuht.nhs.ukDr Fraser MutchDept of Cellular Pathology, Bedford Hospital NHS Trust, Kempston Road,Bedford, MK42 9DJTel: 01234 792325Email: fraser.mutch@bedfordhospital.nhs.ukDr Louise SmartDepartment of Pathology, Medical School Building, Foresterhill, Aberdeen.AB25 2ZDTel: 01224 553794Email: louise.smart@nhs.net

SCAN 23 2 OCT 12 VER changedPP SCAN OCT 12 17/10/2012 11:24 Page 1EditorialSharon Roberts-GantHere we are again the pre-Chrismas edition of SCAN! Inthis edition I hope we have something for everyone.There are updates from the subcommittees, conferencesreports / feedback (although not our own), some ‘coffeebreak’ reading with horoscopes, crossword and an insightinto the workings of a large laboratory.Jenny Davies continues to organise CPD for us and wehave a couple of quizzes and a case study. The IBMS havekindly agreed to the reproduction of their registeredscience technicians and registered scientists article whichintroduces the new voluntary registers for these staff andexplains their purpose.The Olympics did not pass us by — Dr Mina Desai was atorch bearer. Mina was recognised for her contribution tothe NHS Cervical Screening and her work in raisingawareness of cancer prevention amongst womenparticularly from minority ethnic communities.I hope you enjoy this issue. Any suggestions for futurearticles are welcome. Articles for the next edition of SCANshould be sent to Andrew Evered.SharonCopy date for April 2013: 5th February 2013, EditorAndrew Evered.Co-opted membersCytopathology EditorAmanda Herbert. Guys & St Thomas’s NHS Foundation Trust, London.Company RepresentativeDavid Carter CSci FIBMS DMS. Territory Manager, CellPath Ltd, 80 Mochdre Enterprise Park,Newtown Powys SY16 4LETel: 01686 611333 Fax: 01686 622946 Work phone contact: 07506 717695Email: david.carter@cellpath.co.ukWebmaster and SCAN EditorAndrew Evered. Welsh Cytology Training School, Cytopathology Department,Llandough Hospital, Penarth CD64 2XX.Tel: 029 20715596.E-mail: andrew.evered@wales.nhs.ukSCAN EditorSharon Roberts-Gant. Cellular Pathology, The John Radcliffe Hospital, Headley Way,Headington, Oxford OX3 9DUEmail: Sharon.roberts-gant@ouh.nhs.ukNQAAP RepresentativeRosie ClarkeINFORMATION FOR CONTRIBUTORSArticles for inclusion in SCAN can be emailed to the editor if less than 1MB in size or supplied on CD/DVDor memory stick. Text should be in a standard text format such as a Word document or Rich Text Format(rtf file). Please supply images as separate files in tiff or high quality jpeg files at a resolution of not lessthan 300 dpi (600 dpi if the image includes text). 35mm slides and other hard copy can be supplied forscanning if no electronic version is available. Graphs are acceptable in Excel format.If you are unable to supply files in the above formats or would like advice on preparing your files,please contact Robin Roberts-Gant on 01865 222746 or email: robin.roberts-gant@ndcls.ox.ac.uk1

SCAN 23 2 OCT 12 VER changedPP SCAN OCT 12 17/10/2012 11:24 Page 2President’s columnKarin DentonBy the time you read this the annual scientific meeting willhave been and gone, and I hope those of you whoattended will have enjoyed it and found it interesting. Weknow that attendance at the meeting will be lower than inthe past, and we know there are many and complexreasons for this. In particular, the number of cytoscreenersregistered is particularly low. This is a concern because theBAC is fully committed to serving the interests of theprofession as a whole, including all grades of staff. But weknow these are challenging times in cytology. BACmembers are stressed by the prospect of mergers,competitive tenders, TUPE, and redundancy. Even forthose working where service configuration is notchanging, there is often a problem with funding training.One of the main drivers for the merger of the BSCC and theNAC was to form a single Association which could bestrong in the face of these and other challenges — so to allthose members feeling stressed I would say please stayengaged with the Association, tell us how we can help,and we will attempt to do so.There is a lot for the executive to work on over the comingmonths, and its not just keeping an eye on quality duringthe process of mergers. In cervical cytology, there is theissue of major changes to commissioning in England, apossible HPV primary screening pilot, and potentialchanges to programmes involving automation and HPVtesting in Wales and Scotland. In diagnostic cytology, we arestill trying to address the falling profile of this work in theUK, which is so out of step with the rest of the world, as wellas working with others to look at further extended roles.So have a look at what the BAC is doing, and if we aren’tdoing something you think we should be, let us know!Chairman’s ReportAllan WilsonArithmetic was never one of my strengths but as this is mythird report for SCAN I must now have been in the chair forone year. It has been an eventful year in the world ofcytology as the pace of change continues to gather speed.The previously static or slowly evolving profession that weall knew and loved is now embracing changes that wecould not have contemplated a few years ago.Our Association must adapt quickly to meet thechallenges that have emerged from changes in thescreening programme and scientific advances. Therecently published 3rd edition of the ABC documentreflects the changes that we are facing and I suspect a 4thedition will be required sooner than the 11 year gapbetween the 2nd and 3rd editions.By the time this issue of SCAN is circulated, the 1st BACscientific meeting which was held last month will be adistant memory. I hope those of you who attendedenjoyed the conference and left feeling informed andenthusiastic to face the challenges ahead. It is fair to saythat we have struggled to attract delegates to cytologymeetings over the last few years. Falling delegate numbersat BSCC and NAC meetings was a driver for merger and theformation of the BAC. At the time of writing delegatenumbers for Keele are not yet as great as we had hoped,but I am sure that the usual late booking surge will nodoubt have produced a healthier figure. This has been thecause of much head scratching among the executive. At arecent teleconference we identified many reasons forfalling delegate numbers including lack of funding,2meeting venue, uncertainty about the future of cytologyand refusal to release staff to attend meetings. However,we need to hear the thoughts of our members; yourexecutive genuinely wants to design a meeting that isattractive to all members, feedback from our membershipis essential to this process.Partly based on falling delegate numbers, theExecutive has decided to move to holding scientificmeetings every two years rather than annually. Thisdecision was not made lightly but based on ourexperience of organising both NAC and BSCC ASM’s andthe potential clash every second year with IBMS congress.The plan is to alternate annually between a 2-3 dayscientific meeting and two tutorials held in the spring andautumn. Our next scientific meeting will be in 2014. AlisonCropper will provide more information in her report in thisissue of SCANElsewhere in this issue of SCAN, Paul Cross willsummarise the results of our first on-line survey. This hasbeen a great success and will be used to inform decisionmaking within the executive. As I indicated in my lastreport in SCAN there will be more web based surveys aswe try and build a database that reflects the practice andpractitioners of Cytopathology in the UK.A group chaired by Louise Smart has been establishedto review the BSCC code of practice for cervical cytology.One of the issues identified when writing the first versionof this document was the lack of an evidence base forsome of the guidance. Where evidence is found to be

SCAN 23 2 OCT 12 VER changedPP SCAN OCT 12 17/10/2012 11:24 Page 3lacking in the review, website surveys will be used toprovide evidence of professional practice. We are relianton our membership to respond to these requests and helpproduce an updated code of practice that is based onwhat is actually happening in cytology labs. It is indicativeof the changing times we are facing when we must reviewthe code of practice only two years after Nick Duddingchaired the group who wrote the last edition, perhaps weshould pencil in the next revision to start in 2014.Members of the executive have been speaking atregional cytology meetings over the last year. I attendedthe Scottish meeting in May and Fraser Mutch attendedthe Southern Society meeting in June. This provides anopportunity to report on BAC executive activities and toget feedback from local delegates. I am keen to build onthese links and to hear how the BAC can help ensure theycontinue to thrive and to investigate the possibility ofbreathing life into dormant societies around the countryas there are now only four active regional societies. Yourexecutive is particularly keen to hear from anyone whowas previously involved in a now dormant regional societywho is interested in re-launching the society; we willprovide whatever support we can.Steady progress has been made to launch a non-gynaecytology EQA scheme and to develop an “AP” style examfor non-gynae. The information gathered from the websitesurvey will establish the demand for the EQA scheme anda full proposal to establish the new exam will be submittedto the conjoint board for discussion at the next meeting inJanuary 2013.The BAC has had a challenging first year, we continue toevolve as a professional body but the changes facing ourprofession require a different approach form the executiveand from our membership. Decision making must be rapidand more than ever we must be proactive. We continue touse teleconferencing to make decisions between scheduledexecutive meetings but it is vital that we communicatethese decisions effectively within the executive and to allour membership. It is equally important that ourmembership is confident that any questions or concernswill be speedily addressed. The membership emaildistribution list is now live and if anyone is not receivingemails from the BAC please contact Christian Burt onchristianburt@ibms.org. The website is now well establishedand will be used in conjunction with email to communicatefrequently and effectively with our membership.Eurogin 2012Dr Karin DentonIn July, a small contingent of cytology from UK cytologyattended Eurogin, an annual conference held in variousattractive European venues, and traditionally heavily drivenby the HPV agenda. On this occasion the conference was inPrague, which was hot and sunny at a time when the UKwas neither, though with sessions running from 8 am to 7pm there wasn’t a lot of time to see it.This year, there was a lot of time devoted to HPV relateddisease elsewhere in the body, emphasising the fact thatthis is a conference about HPV rather than just aboutcervical cancer prevention.I was there with my colleague Kath Hunt, and enjoyedwatching her give a presentation on our experience withthe Cervista HPV platform in Bristol. I was slightlyconcerned because in the programme I was listed asgiving the talk, and Kath said she would turn up dressedoutrageously and say anything she wanted, safe in theknowledge that both the appearance and content wouldbe attributed to me. In the event they got her name right,but I would have been quite happy either way.We both thought it was important to have a cytologypresence there, because too often HPV experts forget thatin the UK at least, cytology remains a very effective means ofpreventing cervical cancer. Having said that, it is depressingto hear sensitivity of cytology quoted as less than 50% insome other European countries. We desperately need toensure we are not dragged down by this kind of statement.I learnt about the big high profile studies, like Athena inthe US, and the useful information it has given us on forexample the significance of HPV genotyping, and therewere the beginnings of some useful thoughts about HPVtypes and effect on colposcopy outcomes.Much of the rest of the world has a very different approach.It was fascinating to hear that in Brazil, colposcopy is cheapbut cytology is very expensive, and we were franklyappalled at a talk about a project offering HPV testing towomen in Mexico, finding lots were positive, but having noinfrastructure to identify those who needed treatment.The manufacturers of HPV testing platforms were able topresent all their latest research but sadly the piece of workwhich everyone in the UK will be looking out for, thedetailed outcomes from the comparative study ofGenprobe, Abbott, Roche Cerivsta and HC2, wasn’t ready.This will be published at IPV, the next big HPV meeting tobe held in Costa Rica in December. Sadly, I’ll have to givethat one a miss.3

SCAN 23 2 OCT 12 VER changedPP SCAN OCT 12 17/10/2012 11:24 Page 4Dr Peter A Smith – An AppreciationDr T GilesDr Peter Smith has been elected as the first Honorarymember of the British Association for Cytology, the highesthonour which the society can bestow. In celebration of thisI present a personal view on the exceptional contributionhe has made to cytology in the United Kingdom.Peter developed an interest in cytology early in his careeras a result of a training attachment to Australia duringwhich he worked with recognised giants in the country,such as Greg Sterrett and Svante Orell. Almost to the dayhe retired he would still quote lessons he had learnt fromthese teachers, ‘don’t call things cancer unless you have areason to call them cancer!’ being a typical example. Thisexperience put him in a strong position to begin hisConsultant career and so it was with confidence andenthusiasm that he commenced in Liverpool in 1985.Most of us look forward to a settled period to establishourselves when we first start a new job, but Peter was notto get this luxury. It was soon apparent that there weresignificant problems in the cervical screening departmentand Peter had the unenviable job of tackling this, whichwould turn out to be the first major cervical cytologyscandal the country had seen. Not only did this result in aformal enquiry, but also an appearance in the nationalpress. One article reported that Peter had personallyreviewed 40 000 cervical smears. Clearly not everythingwritten in the press is accurate, but Peter’s superhumanreputation was already becoming established.The work involved in sorting out this problem put anunderstandable strain on Peter, and I am sure at times thebarbed wire fence outside his office felt more like a meansof keeping him in rather than keeping local criminals out,but we can now recognise that this gave Peter many of theskills that he used to drive cytology forward. Certainlywhen another major scandal emerged in the Kent andCanterbury laboratories, there really was only one man tocall and Peter found himself investigating his secondmajor cervical cytology failure. In many ways, theexperiences in Australia and the turmoil he arrived to inLiverpool are the bedrock on which his career are built.I first came to know Peter when I was a trainee in Liverpoolin 1994. At this time Peter showed himself to be incrediblyknowledgeable and approachable, always willing to sharehis skills and enthusiasm for the subject. The legacy Peterleaves is not only the standard now expected in cytology,but the enthusiasm and skills which the next generationpossess to allow cytology to continue as a core disciplinein the diagnosis and management of patients.4Peter offered his time freely to the BSCC, rising to beChairman of the society between 1998 and 2001 andsubsequently President. He lead the society withauthority and determination and again faced troubles.Once again he found himself in the national press, havingthe stressful experience of appearing before cameras onthe BBC defending the society. This was not the first timehe had appeared before camera, though. Any of you whostill have the original BSCC video on taking cervicalsmears will see Peter performing professionally at thestart of this.Peter still had one major contribution to cytology tomake. When medical politics started to seriously considerbreaking down professional boundaries, one of the firstareas to consider was the reporting of cervical cytology.The Institute of Biomedical Science and Royal College ofPathologists were charged with working together tode

screening programme and scientific advances. The recently published 3rd edition of the ABC document reflects the changes that we are facing and I suspect a 4th edition will be required sooner than the 11 year gap between the 2nd and 3rd editions. By the time this issue of SCAN is circulated, the 1st BAC

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