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. 2004 Apr;57(4):388-93.
doi: 10.1136/jcp.2003.011841.

The Dutch CISOE-A framework for cytology reporting increases efficacy of screening upon standardisation since 1996

S Bulk  1 , F J Van Kemenade, L Rozendaal, C J L M Meijer
Affiliations

The Dutch CISOE-A framework for cytology reporting increases efficacy of screening upon standardisation since 1996

S Bulk et al. J Clin Pathol. 2004 Apr.

Abstract

Aim: To describe the effect of introducing the CISOE-A framework for reporting cervical cytology results, including changes in repeat and referral advice in the Netherlands, on the efficacy of the screening programme. Changes in the distribution of cytological results, the detection rate of cervical intraepithelial neoplasia (CIN) lesions, and the detection rate of squamous cervical carcinoma are reported.

Methods: The results of all gynaecology cytological and histological examinations, as registered in the nationwide database for histopathology and cytopathology (PALGA) from 1990 to 2000, were retrieved from seven laboratories in the greater Amsterdam area.

Results: After the introduction of the CISOE-A classification, cytological results with equivocal diagnoses decreased significantly from 11.3% to 2.6%, without an increase in the percentages of moderate dyskaryosis or worse. During the study period, the detection rate of histologically diagnosed high grade CIN lesions increased significantly from 4.1 to 6.4/1000 smears, whereas there was no change in the detection rates of low grade lesions or invasive cervical cancer.

Conclusions: The introduction of the new CISOE-A classification system resulted in a substantial decrease of equivocal results and repeat recommendations, without a decrease in the detection rate of high grade lesions, making the screening programme more efficacious.

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Figures

Figure 1
Figure 1
Pap smear diagnosed as “Pap 2” before the introduction of CISOE-A, showing reactive atypia caused by infection. The CISOE-A scores would be 8 for composition (on the basis of cells in this picture), 9 for inflammation, and 1, 1, and 1 for normal squamous cells, other cells, and endocervical cells (not visible in this picture), respectively. Conclusion: Pap 1, no abnormal epithelial cells present. Advice: repeat after five years.
Figure 2
Figure 2
Pap smear diagnosed as “Pap 2” after the introduction of CISOE-A, showing abnormal squamous cells. The CISOE-A scores would be 8 for composition (on the basis of cells in this picture), 2 for infection (trichomonial), 2 for abnormal squamous cells (enlarged nucleus with irregular contours), 1 for normal other cells, and 1 for normal endocervical cells (not visible in this picture). Conclusion: Pap 2, abnormal epithelial cells present. Advice: repeat after six months.
Figure 3
Figure 3
Dedicated software ensures automated reporting with minimal dataset as required for proper CISOE-A reports. Both the descriptive part and the conclusive part of the diagnosis are prompted (shown right) on the basis of the CISOE-A score (shown left). All language in Dutch (the acronym CISOE-A is KOPAC-B in Dutch; the two last sentences in the conclusion were for research purpose only and are outside CISOE-A).
Figure 4
Figure 4
Decrease of cumulative percentages of equivocal cervical smear results. The arrow denotes the introduction and implementation of the CISOE-A classification and transition from a three year interval between screening to a five year screening interval.
See this image and copyright information in PMC

References

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