Biomedical Engineering Reference
In-Depth Information
The cytodiagnosticians above claimed that fi nding deviant cells and
differentiating between normal and atypical cells was something they
saw,
but how they knew by seeing was diffi cult to verbalise. The manner in which
the cytodiagnosticians identifi ed and distinguished between normal and non-
normal cells in daily practice was said to be diffi cult to put into words. Thus,
my informants' visual repertoire of cytology was more extended than their
verbal repertoire.
Assessments and classifi cation of normal cytology were not made from one
single standard of normality for all samples. Instead, the cytodiagnosticians
assessed normality in regard to several standards. The standards for classifying
cells as normal varied and were dependent on type of series:
… you must, in some way, re-arrange your thinking then, that the bladder
is different from ascites for example. If you take a bladder sample and
look at it and believe that this is ehh a gynaecological sample. Then you
just put malignant on it (...) What you are
looking
at and what is it that
you are going to look for (…) and how the normal in just this type of
sample looks.
(Rose, Cyto lab)
Besides conceiving of normalities in the plural, the diagnostician below
also defi ned non-normal cells as a kind of normality, that is, when for
example CIN I cells unequivocally belonged to, or could be fi tted into that
particular classifi cation - typical CIN I cells, where thus those cells could
positively be identifi ed and assigned as 'normal CIN I cells', as described by
Hedvig at Cyto lab:
So there are certain criteria (…) and then certain types of cell that have
a particular look. You recognise that there are certain cells you will fi nd
here, you look at a cancer for example, and those cells are normal when
you look at a mild dysplasia. Normal, so to speak, ordinary you can say
maybe. They are not normal. In mild dysplasia, it is so that there are no
normal cells, there are atypical cells but they are normal for this picture.
That is, so that you assess, 'aha this is a typical CIN I', or, 'these are
mildly dysplastic cells'.
To positively fi t the cells on the slide into one of the predetermined
classifi cations was a crucial part of the assessment process. When the
cytodiagnosticians assessed cytology as 'typical', classifi cation went smoothly
as the cells with little doubt positively fi tted into a particular classifi cation.
To assess whether cells positively fi tted into one of the classifi cations was a
core feature in daily screening. A salient feature of the uses of classifi cations
was that the cytodiagnosticians were able to 'sift away' all cells, bacteria,
artefacts, and so on, as soon as these had been classifi ed. Identifying
particular bacteria or cervical glandular cells made it possible to 'disregard'
