Biomedical Engineering Reference
In-Depth Information
The classifi catory system was generally believed to cover almost all cases.
No one wanted another system or wanted to add new classifi cations when
I asked them about it. Thus, the system used at the labs in terms of pre-
determined diagnoses was seen as a valuable tool, but was not claimed to
perfectly or unambiguously mirror and represent the entire variation of cells
on the slides. The predetermined classifi cations and the picture of cells under
the microscope were not always possible to match.
Sometimes there were pragmatic reasons for the inability to classify cells,
e.g. that the cells were of bad quality or destroyed. However, when the
assessment did not match any of the classifi cations, or when the diagnosticians
were unable to determine type of cell and/or degree of deviance, they could
write a classifi catory suggestion accompanied with a question mark. As
exemplifi ed below by Andrea at Cyto lab, they could also suggest a specifi c
classifi cation for cells that were unclear, diffi cult, or impossible to classify:
But you see, there is a lot that is unclear: 'unclear squamous atypia',
'squamous atypia of indeterminate signifi cance'. There are a lot that
doesn't work to put in, if there were only those three groups [CIN I, II, III]
it would be
really
good. But there is always (…) here you have 'glandular
atypia', '
suspicious
of adenocarcinoma', and 'adenocarcinoma', 'unclear
atypia', 'unclear' (…) but you can always put it into one of those groups,
I think …
Diagnosticians at both labs had particular names for these classifi cations:
It is part of the training that we, you must decide. There are diagnoses
which are sort of a 'no-mans-land', 'unclear changes', yes some of those
'slops cases'. Some maybe feel more for them than others do.
(Alice, Cyto lab)
Sometimes it can be very diffi cult to determine a diagnosis. It's incredibly
diffi cult, it's diffi cult for everyone. Then you have that little slops group,
diffi cult to assess (laughs) … Or, atypia of uncertain signifi cance. You
don't really know …
(Diana, City lab)
… there are many such unclear cases. It can be glandular cells that are
lying on top of each other so that they look a little darker. Then you
have all those that are (…) aren't simple. They end up in unclear, in the
slops pail and in that [group] there are the completely benign and there
are the really bad. Then it is so (…) that the doctor treating them doesn't
ignore (…) There are a lot of very diffi cult cases. There is an awful lot
of rubbish there that are completely benign but there are also a lot that
are cancer …
(Hillevi, Cyto lab)
