A feasibility study for the reporting of cervical large loop excisions of the transformation zone (LLETZ) biopsies by consultant biomedical scientists in the UK

Abstract

Objective – A previous pilot study had shown that there was potential to extend the roles of advanced biomedical scientist practitioner (ABMSPs) now referred to as Consultant Biomedical Scientists (BMS) to report the histology of large loop excision biopsies of the cervical transformation zone (LLETZ) within the NHS Cervical Screening Programme (NHSCSP). Methods - 157 consecutive LLETZ specimens reported by four experienced Gynae-specialist Consultant Histopathologists at Sheffield Teaching Hospitals NHS Foundation Trust, were also reported by six Consultant BMS, and compared against the final issued report. Neoplastic abnormalities were reported to NHSCSP standards as well as the Bethesda system. Completeness of excision and histological features associated with the presence of human papillomavirus (HPV) infection were also assessed. The reporting of HPV is part of the proforma for reporting cervical samples, it does not affect the patient management but allows for correlation with the cervical cytology report and hence was included as part of the study. Results - There was overall good inter-observer agreement for both the three tier and two tier system of grading squamous lesions plus good agreement for glandular and invasive carcinomas identified by the Consultant BMS. There was variable inter-observer agreement for the completeness of the excision of the margins and the presence of HPV. Conclusions - This report provides evidence that suitably experienced Consultant BMS can be ‘fast-tracked’ through an approved training programme of selected specimens to meet the needs of the Histopathology service that is facing a chronic shortage of Histopathologists in a timely manner and provide a cost-effective solution.