Cervical screening histology slide review process
Updated 26 September 2024
Applies to England
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The flowchart below outlines the process for reviewing cervical histology 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 histology slide review process
Starting point: a specimen is identified for review
Decision point 1: is the specimen suitable for review?
Yes: assess the histological appearances of the specimen. Go to decision point 2.
No: reject the specimen (note that slides may become technically inadequate for diagnostic use, for example a broken slide, ‘dry back’ of mountant with age, or an air bubble. 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 issued histology report?
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:
- under or over use of stains, levels or other ancillary techniques
- inappropriate use of stains, levels or other ancillary techniques
- clarity of pathological information could have been better
- inappropriate stage based on pathology report information (which would have been clarified and resolved at colposcopy multi-disciplinary team (MDT) meeting discussion)
- a difficult case where there is acceptable and appropriate professional disagreement
- adequacy of specimen not considered suitable for diagnostic purposes
Yes: categorise the slide as ‘satisfactory with learning points’. End of pathway.
No: the slide contains a missed abnormality of overcall leading to unnecessary treatment. Categorise the slide as ‘unsatisfactory’ and apply duty of candour. End of pathway.