Table 2 Adherence of the organised cervical screening programme in Poland to European Guidelines for Quality Assurance in Cervical Cancer Screening [7,8,27-32] – guidelines for cytology laboratories, histopathology, management of screen-positive women

Collection, preparation, handling, staining, screening of samples and reporting of the results

Guidelines must be followed to assure adequate collection and preparation of the samples. The quality of the cytology laboratory depends on adequate handling, staining, screening of slides and reporting of results.

Grading of cytological abnormalities

Uniform grading of cellular abnormalities is an essential condition for registration and comparisons. Laboratories should apply only a nationally agreed terminology for cytology which is translatable into the Bethesda Reporting System

The grading system is not fully compatible with the Bethesda 2001 terminology and requires modification (see Additional file 1)

Full adherence to established grading system

Histopathology as the gold standard and its terminology

Histopathology provides the final diagnosis for treatment, is the gold standard for quality control of cytology and colposcopy and is the source of data for cancer registry. Histopathology standards should be monitored and are on the basis of CIN or other internationally agreed-upon terminology.

There is no electronic database of cervical histology results obtained outside the programme. No systematic quality control for histopathology is implemented into the screening programme. There is no automatic or obligatory reporting of histology from the labs to cancer registry.

Only partial data on histopathology of invasive cancers are collected in NCR.

Availability of cytological results for pathologists, accuracy of histological diagnosis, correlation with cytological results.

Histopathologists should be aware and familiar with, the nature of cytological changes that may be relevant to their reports. The accuracy of histopathological diagnosis depends on adequate samples, obtained by colposcopically directed biopsies (with endocervical curettage when necessary) or excision of the transformation zone or conisation, macroscopic description, processing, microscopic interpretation and quality management correlating cytological and histological diagnosis.

There is no central histopathology database and therefore cervical histology results obtained outside the programme are not readily available for analyses and cyto-histological correlations.

Tissue material from biopsies is often assessed at different laboratories than the ones assessing the cytological slides. The availability of data on cytological abnormalities to the pathologists is partial^a. Only single local reports exist [51] on local correlations between cytology and histopathology.

Management of screen-positive women

A women with a high-grade cytological lesion, a repeated low-grade lesion or an equivocal cytology results and a positive HPV test should be referred for colposcopy. Guidelines are provided for the management of ASC-US and HSIL. For LSIL repeat cytology or colposcopy are acceptable options and HPV testing in older women can be considered. Quality assurance and collection of data on patient management and follow-up are important in women with abnormal cytology.

HPV testing is not reimbursed within the programme for triage of abnormal Pap results. Only partial data on management of women with abnormal smears are available in SIMP.

Repeat cytology and other triage procedures are commonly performed outside the programme and their results are not registered. Data on triage, management and follow-up are not evaluated and not analysed on regular bases.