Biomedical Engineering Reference
In-Depth Information
would rarely see trichomonas. A tricky question raised by my informants
was whether today's common existence of HPV was a 'real' increase, or if it
had been present earlier. Some said it was possible that HPV had been there
for a long time, but that the role of HPV, some types of which are strongly
associated with cervical cancer, and its effects in on cells had not become
part of their knowledge and their visual repertoire until recently.
The cytodiagnosticians' work with the Pap smear thus involves, and indeed
presupposes, knowledge about the 'biological order' of cells. A central feature
of screening and assessing the Pap smear involves positively matching that
which was seen on the slide to predetermined classifi cations. That which can
be classifi ed with little interpretative efforts can also be 'un-seen', rendered
part of the background and thus enable the cytodiagnostician to proceed
with screening. Whereas the relationship between cells and classifi cations
seems to be circular: the cytodiagnosticians classify the cells that they see
on the slide, and they see that which they are able to classify, neither the
classifi cations used for classifying cells nor the cells present on the slide
have been stable over time. However, there is more to say about cells and
classifi cations in a cytology laboratory context.
Enculturalising cells
Thus far, I have described the (biological) mapping of cells, that is, the
interpretative process whereby the predetermined classifi cations - the
biological map of cells - were applied onto cells on the microscope slides.
I will continue to describe
notions that exist in addition to the biological
mapping of cells related to: (i) cells that are diffi cult or impossible to classify
- cells that are at the margins of classifi cations; and (ii) the perfect match,
which is rare, between cells and classifi cations.
Cells at the margins of classifi cations
In daily practice the cells of cytology samples may also be unclear, diffi cult
and at times even impossible to classify, which is the focus of this section.
During the demm [the labs vernacular for the joint diagnostic session
in the multi-headed microscope] a cytologist, a cytodiagnostician, and
a physician in training are assessing cervical cytology. The cytologist
scrutinizes the dots on the slide marked by the cytodiagnostician. He
then says 'this is a slight CIN I'. He explains that he has to choose
something that is clear and concise for the clinicians, or else they would
be confused. The next sample is suggested by the cytodiagnostician to
be a CIN III. The cytologist considers it however to be a CIN II. He also
says that when a cytologist's and a cytodiagnostician's assessment differ
by two steps, another cytologist would be asked to assess the sample.
