Gynecological Cytopathology

Module details

Title

Gynecological Cytopathology

Type

Specialist

Module code

SLS326

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the aetiology, pathogenesis and main clinical features of cervical and other gynaecological cancers. They will understand and gain experience of the role of the cervical cytology laboratory in the diagnosis of gynaecological malignancy. 

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Analyse cervical samples to identify normal morphology, inflammation and dyskaryosis.	Action View
# 2	Learning outcome 1,2,4	Competency Prepare a diagnostic pathway, from diagnosis to treatment for gynaecological cancers, to include: cervical pathology cervical intraepithelial neoplasia (CIN) cervical glandular intraepithelial neoplasia (CGIN) cervical cancer ovarian cancer endometrial cancer extrauterine malignancies.	Action View
# 3	Learning outcome 2	Competency Perform the reception and preparation cytopathological specimens for the investigation of cervical pre-cancer.	Action View
# 4	Learning outcome 3,4	Competency Perform to quality standards, basic and appropriate specialised cytopathological techniques as part of the systematic investigation of gynaecological malignancy.	Action View
# 5	Learning outcome 5	Competency Use and evaluate new equipment relevant to the cytological investigation of gynaecological cancer.	Action View
# 6	Learning outcome 6	Competency Present the evidence base for the effectiveness and limitations of the NHS Cervical Screening Programme.	Action View
# 7	Learning outcome 7	Competency In discussion with a histopathologist, interpret in the correct clinical context the histopathology of: cervical intraepithelial neoplasia (CIN) cervical glandular intraepithelial neoplasia (CGIN) cervical cancer ovarian cancer endometrial cancer extrauterine malignancies.	Action View
# 8	Learning outcome 7,8	Competency In discussion with a histopathologist, prepare and issue reports from the selected cases of gynaecological malignancy.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Process from receipt to cover slipping 4 batches of LBC samples according to laboratory SOP.	DOPS
Perform quality control assessment of Papanicolaou staining on four different occasions using NHSCSP document number as guidance	DOPS
Under supervision perform HPV testing on batch of LBC samples. May require attending off testing centre.	DOPS
Using appropriate IT systems look up patient screening history. Miminimum of 20.	DOPS
Using IT system extract relevant patient data for the invasive cancer or other clinical audit.	DOPS
Perform an analysis of work flow in the cervical cytology lab and summarise your findings in work flow diagram.	DOPS
From evidence gathered and discussions with relevant clinical colleagues, produce a clinical pathway document detailing the impact of the cervical screening on overall patient pathway.	OCE
From evidence gathered at cytology and colposcopy MDTs and discussions with relevant clinical colleagues, produce a reflective account of the learning acquired including differential diagnosis and treatment options.	OCE
Perform microscopical interpretation of Papanicolaou stained slides from 50 samples with range of cytological abnormalities and discuss the features of normal and abnormal morphology with consultant cytologist.	OCE
Carry out an audit of 20 cases reported as borderline glandular and analyse the outcome and produce short report and discuss finding with a consultant cytologist. This will require microscopic review of the original slides.	OCE
Attend a primary care based smear taking clinic and observe 5 patients and write reflective notes.	OCE
Attend colposcopy clinic and observe colposcopic assessment diagnosis and biopsy procedure in 5 patients and write reflective notes.	OCE
Attend colposcopy clinic and observe colposcopic treatment procedure in 5 patients and write reflective notes including the role of HPV testing in patient treatment.	OCE
Attend an invasive cancer audit meeting and write reflective notes including strengths and weaknesses of the screening programme.	OCE

Learning outcomes

1. Recognise and interpret the microscopical appearance of cells and relate to the pathobiological process.
2. Recognise the clinical presentation of a range of gynaecological malignancies.
3. Screen and interpret cervical cytology samples to quality standards.
4. Advise on or request appropriate additional tests to aid in the diagnosis of disease.
5. Identify and evaluate new equipment, methods, or procedures to enhance the contribution of the cytopathology laboratory to the prevention, diagnosis and management of gynaecological malignancies.
6. Analyse national and international data on the incidence, screening, diagnosis, management and survival of gynaecological malignancies.
7. Draft interpretative reports that involve cytopathological findings as part of the investigation of gynaecological malignancies.
8. Work in partnership with other clinical specialisms as part of the diagnosis and review of gynaecological malignancies.

Learning outcomes

1. Explain the aetiology, pathogenesis and main clinical features of cervical cancer.
2. Discuss and evaluate the role of the cervical cytology laboratory in the prevention of cervical cancer.
3. Describe the national screening programme for cervical cancer.
4. Explain the aetiology, pathogenesis and main clinical features of endometrial cancer.
5. Discuss and evaluate the role of the cytology laboratory in the diagnosis of non-cervical malignancies.
6. Explain and critically evaluate the importance of new technologies, automation and ancillary techniques in cervical cancer screening and the investigation of other gynaecological cancers.
7. Discuss the role of the cytopathological report and the multidisciplinary team in the management of gynaecological cancer and patient care.

Indicative content

• Aetiology, pathogenesis and main clinical features of cervical cancer
  • The role of HPV in cervical carcinogenesis
  • The role of HPV vaccination
  • The role of HPV testing in the UK screening programmes
  • The role of colposcopy in the diagnosis of CIN, cervical glandular intra- epithelial neoplasia (CGIN) and cervical cancer
• The role of the cervical cytology laboratory in the prevention of cervical cancer
  • Primary screening
  • Internal quality control
  • Patient management
  • Performance monitoring of individuals, laboratories and screening programmes
  • Quality assurance
  • Invasive cancer audit
  • Cytology: biopsy correlation
  • Role of the hospital-based programme coordinator
  • Management of the cervical cytology laboratory
• The role of the cytology laboratory in the reporting of microorganisms
• Treatment of CIN, CGIN and cervical cancer
• Aetiology, pathogenesis and main clinical features of endometrial cancer
• The role of the cervical cytology laboratory in the diagnosis of non-cervical malignancies
  • Endometrial carcinoma
  • Ovarian carcinoma
  • Extra-uterine malignancies
• New technologies, automation and ancillary techniques in cervical screening

Activities

• Attend and participate in multidisciplinary review meetings at which cytopathology results from cases of gynaecological cancer are presented as part of the clinical record. Wherever possible include those cases in your portfolio of named cancers. Record the outcomes of the multidisciplinary review meetings.
• Include details of investigations undertaken, including molecular techniques, with explanations, in the portfolio of cases prepared for learning outcome 2
• Review prepared microscope slides on a double-headed microscope with a supervisor and draft a diagnosis taking into account all relevant clinical details.
• Perform an audit on a specific topic analysing the morphological findings and clinical outcomes.
• Perform a detailed evaluation of one new piece of equipment, method or procedure. Critically appraise the results of the evaluation and produce a report with recommendations.
• Describe the operation of the NHS Cervical Screening Programme and indicate your role in the programme.
• Write a cytopathology report on a range of gynaecological cancers, appreciating the partnership between the cytopathology laboratory and other clinical specialisms.
• Suggest ways in which improved diagnostics could lead to better clinical outcomes in gynaecological malignancy.
• Prepare a portfolio of a minimum of 10 illustrative cases of gynaecological malignancies where you have played a significant role in the investigation. Include the plan of laboratory investigation.