Beatrix Cochand-Priollet. An overview of terminologies in cervical cytology in Europe
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1 Beatrix Cochand-Priollet An overview of terminologies in cervical cytology in Europe
2 Inquiry 1) Do you have in your country a national terminology used for the cervical cancer screening? 2) What is the name of your national terminology? 3) Is this terminology officially recommended in your country? 4) Do you know if other terminologies are used and/or also recommended 7) In case you are using in your country an International Terminology, could you specify the one is used 8) If this terminology is written in another language than your national language, have you proposed an official translation 9) Have you organized some trainings to explain this terminology? 5) If the answer is yes for the previous question, then please could you specify the other recommended/used terminologies 6) If the answer is no for the previous question, then please could you specify why?
3 EFCS-23 affiliated active members M Tötsch/H Wiener L Vaas B Weynand A Fassina I Kardum-Skelin/D Vrdoljak-Mozetic J Duskova I Kholova M Strojan-Flezar M Natziousiki B Onäl
4 EFCS-18 answers P Cross J Bonde/D Ejersbo M Bongiovanni/Pache R Fonseca M Fisher/Ph Vielh B Lloveras B Cochand-Priollet H Griesser
5 Countries International Terminology Translation Training Comments Belgium Bethesda 2014 No Continuing education Czech Republik Bethesda 2014 No Continuing education/ National cytology day2016 No problem with English language Some publications in Czech language Denmark Bethesda 2014 Yes For CT, CP SNOMED Finland Bethesda 2014 No Continuing education by SKSY France Bethesda 2014 Yes Continuing education by SFCC Greece Bethesda 2014 Yes Continuing education by HSCC Hungary Bethesda 2014 Yes Board certification for National screening Finnish /english terms used Official French translated terminology Official Greek translated terminology Translation 2014 under way Some individual changes In all these countries Bethesda 2014 is officially recommanded either by the Ministry of health or by the National Societies of Cytology
6 Countries International Terminology Translation Training Comments Italy Bethesda 2014 No Yes Luxembourg Bethesda 2014 No For CT One lab The french translation is used Portugal Bethesda 2014 No Yes Slovenia Bethesda 2014 Yes For CT, CP and gynaecologists Includes management guidelines Spain Bethesda 2014 No No Switzerland Bethesda 2014 No For CT Turkey Bethesda 2014 Yes Training and SS during national congresses Publications
7 Countries National Terminology Reference Comments Austria Austrian Nomenclature Gynaekologische n Zytologie 2013 Bethesda also recommended Croatia Zagreb 2002 Terminology Medicina fluminensis 2016, Vol. 52, No. 3, p Very close to the BTS using the same abbreviations Officially recommended Germany Münich Nomenclature III Geburtshilfe Frauenheilkunde 2015; Transposable to BTS Officially recommended Required for national CC screening UK BSCC Terminology 2008 (last version) Cytopathology 2008; 19: Transposable to BTS Officially recommended Used for national CC screening
8 Munich Nomenclature III/II officially
9 Reasons for this new nomenclature Nomenclature II : 5 groups I to V Nomenclature III: 6 groups 21 subgroups mentionned with suffixes Creation of a group II a Normal cell pattern but suspicious patient history Group III divided into IIID1 and IIID2 (CIN1 and CIN2) Around 16 millions of papsmears/year Possibility to carry out statistical analysis
10 Groupe II a Represents 0.91% of the papsmears; it is a heterogneous group with varying oncogenic potential; does not exist in the Bethesda system
11 Group IIa Conization with dysplasia-free resection margins Vaginal cancer HR-HPV positive testing Do not justify an assignment to griia
12 Group III: IIID1 and IIID2 CIN1 and CIN2/ LG and HGSIL Group IIID1: 36% low grade but 32% negative and High grade Group IIID2: 76% of High grade Gr IIID1/D2: 0.53% and 0.61%; for the German gynaecologists distinction of CIN2 seems to be essential; better for correlation with the 2011 colposcopic terminology; CIN1 often correlated with no abnormalities; for CIN2 and CIN3 major changes; furthermore for CIN2 surgery can be avoided
13 Group II/II-p
14 Comments Quite relevant from a scientific point of view Likely influenced by colposcopists vision More precise than the BTS 2014 Not transposable to BTS Difficult to understand for non aware CP and CT
15 The revised BSCC terminology for abnormal cervical cytology Cytopathology 2008 K Denton et al BSCC Revision of the version used since 1986
16 Dyskaryosis Chromatin pattern and hyperchromasia do not influence grading of dyskaryosis Adequate assessment of chromatin depends on satisfactory staining In UK there is a national technical external quality assurance scheme
17 Changes Adoption of a two-tiered system instead of a threetiered system Division of the borderline changes into 3 subcategories: 1. Borderline change, HG dyskaryosis not excluded 2. Borderline change in EC 3. Borderline change squamous but NOS
18 Croatia Very close to the BTS 2001 Used in all national labs
19 Austrian Terminology Austrian categories Comments Bethesda Pap 0 Bethesda 1991/3 categories Pap I Pap II Pap III Normal/metaplasia/ light inflammation Metaplasia:inflammation with reactive cells; nl EM; atrophie; PK; mild HPV associated changes All changes difficult to classify as benign or cancer /2 catégories NIL NIL Reactive changes ASC-US ASC-H Pap IIID CIN1-2 LSIL Pap IIIG Endocervical; EM; glandular Atypia AGC- NOS Pap IV Pap V Squamous HG or carcinoma or adenocarcinoma in situ; criteria for invasion Invasive carcinoma: squamous or glandular or other invasive tumors HSIL AIS Squamous carcinoma, adenocarcinoma; others
20 Bethesda 2001/14 Concept that LSIL represents an infection and that HSIL which includes CIN2-3 represent a potential evolutive lesion Same management for the same lesions
21 Take Home messages Bethesda 2014 is widely used in Europe Trainings are performed Official translations are rare and should be done 2 main European countries use a national Terminology : UK and Germany BSCC terminology relatively close to the BTS with a concept of a two-tiered system but the terms are quite different The German terminology is based on another concept closer to the colposcopic practice difficult to transpose to the BTS
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