Liquid Based Cytology LBC Implementation Guidance

Technical requirements for liquid based cytology systems for cervical screening

Published January 2004 - Guide no 1 - Version 1

This guide is intended to assist prospective purchasers in drawing up their equipment purchasing specification, to provide equipment assessors with a common set of recommendations against which comparisons of different LBC systems can be made and to inform equipment manufacturers of users' needs.

Advice for Cytopathology Laboratories on the Implementation of Liquid Based Cytology for Cervical Screening

Published April 2004 - Guide no 2 - Version 1

(PDF format, 485Kb)

The following advice incorporates experience gained during the UK implementation pilots and is based on guidance used in the Scottish and English LBC pilot laboratories. This has subsequently been supported in the LBC evaluation report on the English implementation pilot.2 This interim advice is produced to assist laboratories in the introduction of LBC into their routine cervical screening practice. It will be revised as wider experience becomes available.

Training Requirements for Medical Staff Working in Cervical Cytopathology

Published April 2004 - Guide no 3 - Version 1

(PDF format, 129Kb)

This guidance sets out the training requirements for medical staff working in the NHS Cervical Screening Programme as part of the implementation of the LBC methodology for the collection and preparation of cervical samples.

Training in Taking Samples for Liquid Based Cytology

Published May 2004 - Guide no 4 - Version 1

(PDF format, 477Kb)

The purpose of this document is to assist primary care trusts (PCTs) and providers of primary care nurse training in developing local training strategies for primary care sample takers who are already trained to take samples for conventional cervical cytology.

The content of an LBC taught course is given. Examples of training materials are provided as a separate PowerPoint presentation. LBC Taught Course (PPT 209KB)

In addition to the above guidance the Liquid Based Cervical Cytopathology Training Log is available to training centres only for use by staff on LBC induction courses.

Background

Approximately 4.1 million conventional smear tests are processed in laboratories each year in England as part of the NHS Cervical Screening Programme. Since the introduction of the call/recall programme in 1988, it is estimated that the programme prevents 3900 cases of invasive cervical cancer in the UK each year.¹ Approximately 1 in 10 conventional smear tests are reported as inadequate and need to be repeated.

Liquid based cytology (LBC) involves an altered slide preparation technique that has been shown to produce a representative sample of the specimen and to reduce contamination by red blood cells, polymorphs and mucus. NICE commissioned the HTA to review the evidence on LBC. The LBC report concluded that there is some evidence that liquid-based cytological methods offer the following advantages over traditional smear techniques:

a reduction in the proportion of inadequate specimens
an improvement in sensitivity
a possible reduction in specimen interpretation times

Based on this, NICE recommended "In order to establish its (LBC's) contribution, a programme of pilot implementation projects of LBC should be undertaken, accompanied by a full review of the results at each stage."

From July 2001 the NHS conducted a pilot implementation of LBC in three English laboratories. Wales and Scotland also carried out pilot implementation exercises. The tests were evaluated against historic conventional smear testing with histological reference standards.

Background reading

Moss S M, Gray A, Legood R, Henstock E. First report to the Department of Health on evaluation of LBC unpublished report December 2002).

Payne N, Chilcott J, McGoogan E. Liquid-based cytology in cervical screening: a rapid and systematic review. Health Technol Assess 2000; 4:1-73.

Guidance on the Use of Liquid Based Cytology for Cervical Screening,.NICE, London June 2000.

Feasibility of Introducing Liquid Based Cytology. Steering Group Report. Scottish Cervical Screening Programme 2002.

Liquid based cytology pilot project. Project report. Cervical Screening Wales, November 2003.

Statistical Bulletin: Cervical Screening Programme England:2001-2002. Department of Health, 2002.

[1] Sasieni, British Journal of Cancer 1996 Apr; 73(8):1001-5