Difficult high-grade cytology, how to avoid false negatives

In just over 20 years the Australian Cervical Screening Program (CSP) has achieved a significant reduction in the incidence and mortality from cervical cancer. One of the cornerstones of the CSP has been the high quality of Australian cervical cytology reporting. This has been achieved by strict and at times onerous quality standards as well as extensive education as to recognition of difficult high grade lesions. The NSW CSP developed a specific educational program for these lesions which included workshops throughout Australia. The crux of this program, developed in conjunction with Mr Ron Bowditch was the concept of screening for certain high-risk patterns. These included single cell populations as well as crowded sheets. In light of new recommendations for cervical screening and also in light of the success of the vaccination program for high-risk human papillomavirus, the role of cytology will change. Liquid-based cytology is set to replace conventional cytology. Cytology may be used for triage and ongoing follow-up of lesions rather than as the primary screening test. Recognition of specific cytological abnormalities, however, will still be crucial. Given the high level of expertise in cytology, this same level of expertise will be adapted to interpret cytological findings under these new circumstances.