PATHOLOGY LABORATORIES - CERVICAL CYTOLOGY KC61

AND OUTCOME OF GYNAECOLOGICAL REFERRALS.

This return has been approved previously by the Review of Central Returns
Steering Committee - ROCR. Reference ROCR/OR/0076/FT6/004MAND

Year ending 31 March 2016 (1)

Trust Name Trust Code (2)

A separate return is required for

each pathology laboratory that
carries out gynaecological cytology

Pathology Laboratory Code (3)

Pathology Laboratory Name

Name of contact

Telephone

If you have any queries regarding completion of this form, please contact the Health and Social Care Information Centre

Telephone: 0300 303 5678

Return to: Screening and Immunisations

Health and Social Care Information Centre
Floor 4 North East
1 Trevelyan Square
Leeds
LS1 6AE

For NHS use. Please use this space to record anything relevant to the quality or consistency of the data.

I confirm that these data are, to the best of my knowledge, an accurate representation
of the results obtained from the cervical screening carried out at this laboratory.

Signed Date

Consultant Pathologist
 PART A1 NUMBER OF SMEARS EXAMINED BY SOURCE OF SMEAR KC61

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Results of test (See categories in box 22 of form HMR 101/5)
Line Source of smear Severe
No. (Box 9 of form Inadequate Negative Borderline Mild Moderate Severe dyskaryosis/ ?Glandular Total
HMR 101/5) changes dyskaryosis dyskaryosis dyskaryosis ?Invasive neoplasia number
(cat. 1) (cat. 2) (cat. 8) (cat. 3) (cat. 7) (cat. 4) carcinoma (cat. 6) examined
(cat. 5)

0001 GP

0002 NHS Community

Clinic

0003 GUM

0004 NHS Hospital

0005 Private

0006 Other

Total of GP and NHS

0007 Community Clinics
Line 0001 + 0002

0008 Grand Total

More detailed instructions on the completion of this return can be found in the
NHS Data Dictionary & Manual
 PART A2 LABORATORY PROCESSING: FROM RECEIPT OF SMEAR TO AUTHORIZATION OF REPORT

(1) (2) (3) (4) (5) (6) (7)

Number within
Line
No. Total number
QUARTER of smears 0-2 weeks 3-4 weeks 5-6 weeks 7-8 weeks 9-10 weeks
registered (0 -14 days)(1) (15 - 28 days) (29 - 42 days) (43 - 56 days) (57 - 70 days)

0001 QUARTER 1
30-Jun-15

0002 QUARTER 2
30-Sep-15

0003 QUARTER 3
31-Dec-15

0004 QUARTER 4
31-Mar-16

0005 TOTAL

PART A3

REQUESTS SCREENED FOR/BY ANOTHER LABORATORY SENT TO/RECEIVED FROM (please give details)

NUMBER
SENT TO/RECEIVED FROM
(please give details)

0001 REQUESTS SENT TO ANOTHER

LABORATORY FOR

SCREENING

0002 REQUESTS RECEIVED FROM ANOTHER

LABORATORY FOR

SCREENING

Note: The laboratory which receives the original request should issue the report and include the information within this return.

WHERE MORE THAN ONE SMEAR IS TAKEN

0003 NUMBER OF INSTANCES WHERE A SINGLE REPORT IS

DERIVED FROM MORE THAN ONE SAMPLE (3)

(1)
Days - relate to calendar days
(2)
Other may include rapid review, checking, abnormal or clinical reporting etc.
(3)
Full details should be available on request
More detailed instructions on the completion of this return can be found in the NHS Data Dictionary & Manual
 KC61

(8)

over 10 weeks
(over 70 days)

ROM (please give details)

PRIMARY
SCREENING
OR OTHER
(please specify)(2)
 PART B RESULTS OF SMEARS FROM GP AND NHS COMMUNITY KC61
CLINICS ONLY BY AGE GROUP OF WOMEN

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Results of test (See categories in box 22 of form HMR 101/5)
Line Severe
No. Age Inadequate Negative Borderline Mild Moderate Severe dyskaryosis/ ?Glandular Total
changes dyskaryosis dyskaryosis dyskaryosis ?Invasive neoplasia number
(cat 1) (cat 2) (cat 8) (cat 3) (cat 7) (cat 4) carcinoma (cat 6) examined
(cat 5)

0001 Under 20

0002 20-24

0003 25-29

0004 30-34

0005 35-39

0006 40-44

0007 45-49

0008 50-54

0009 55-59

0010 60-64

0011 65-69

0012 70-74

0013 75 and over

0014 Total 20-64

Lines 0002 - 0010

0015 Grand Total

More detailed instructions on the completion of this return can be found in the
NHS Data Dictionary & Manual

NB: Total number examined as recorded in Part B should equal row 0007 in Part A1
 PART C1 OUTCOME BY 31 MARCH 2016 FOR WOMEN RECOMMENDED FOR GYNAECOLOGICAL REFERRAL KC61
WHERE THE SAMPLE WAS REGISTERED DURING APRIL - JUNE 2015

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Most significant result (See categories in box 22 of form HMR 101/5)
Line
(1)
No. Outcome of referral Borderline Mild Moderate Severe Severe dyskaryosis/ ?Glandular Total
Inadequate changes dyskaryosis dyskaryosis dyskaryosis ?Invasive carcinoma neoplasia
(cat. 1) (cat. 8) (cat. 3) (cat. 7) (cat. 4) (cat. 5) (cat. 6)

Cervical cancer -
0001 stage 1B or worse
x x x x

Cervical cancer -
0002 stage 1A
x x x x

Adenocarcinoma in situ
0003 /CGIN
x x x x

0004 CIN3
x x x x

0005 CIN2
x x x x

0006 CIN1
y y y y

0007 HPV only

y y y y

0008 No CIN / No HPV

y y y y

Seen in Colposcopy (2)

-
0009 NAD/no biopsy taken
y y y y

Outcome known -(3)

(3)
00010 none of the above

Seen in Colposcopy -
(4)
0011 result not known
a

(5)
0012 No outcome available
a

0013 Inadequate biopsy

Non cervical cancers

0014 detected

0015 Total
b

(1) Where more than one specimen is taken from the same women, the most severe result only should be recorded
(2) Include colposcopy assessment only, smear taken only, cytological surveillance in colposcopy, ablation (see guidance notes)
(3) Include deceased,community smear surveillance, colposcopy delayed for known reason eg pregnancy, currently in failsafe system following non attendance at colposcopy, patient refusal, referral to
other specialty for non-cervical disease, patient moved away (notification through 'Exeter system')
(4) Include biopsy taken but result not yet known
(5) Include outcome unknown to laboratory, no record of referral and/or patient, patient moved away (no information) private/other NHS hospital referral (if outcome unknown), incorrect patient details,
patient lost to system

Positive Predictive Value (PPV) Lost to follow-up

Total x
x 100 = %
Total x + y Total a
x 100 = %
Total b
PPV should be regarded as a guide for the audit of histology and
cytology and is not a precise measure of accuracy (This figure should be less than 5%)

Details of non cervical cancers (row 0014)

 RETROSPECTIVE COLLECTION
PART C2 OUTCOME BY 31 MARCH 2016 FOR WOMEN RECOMMENDED FOR GYNAECOLOGICAL REFERRAL KC61
WHERE THE SAMPLE WAS REGISTERED DURING APRIL 2014 - MARCH 2015

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)
Most significant result (See categories in box 22 of form HMR 101/5)
Line
(1)
No. Outcome of referral Borderline Mild Moderate Severe Severe dyskaryosis/ ?Glandular Total
Inadequate changes dyskaryosis dyskaryosis dyskaryosis ?Invasive carcinoma neoplasia
(cat. 1) (cat. 8) (cat. 3) (cat. 7) (cat. 4) (cat. 5) (cat. 6)

Cervical cancer -
0001 stage 1B or worse
x x x x

Cervical cancer -
0002 stage 1A
x x x x

Adenocarcinoma in situ
0003 /CGIN
x x x x

0004 CIN3
x x x x

0005 CIN2
x x x x

0006 CIN1
y y y y

0007 HPV only

y y y y

0008 No CIN / No HPV

y y y y

Seen in Colposcopy (2)

-
0009 NAD/no biopsy taken
y y y y

Outcome known (3)

-
(3)
00010 none of the above

Seen in Colposcopy(4)-
0011 result not known
a
(5)
0012 No outcome available
a

0013 Inadequate biopsy

Non cervical cancers

0014 detected

0015 Total
b

(1) Where more than one specimen is taken from the same women, the most severe result only should be recorded
(2) Include colposcopy assessment only, smear taken only, cytological surveillance in colposcopy, ablation (see guidance notes)
(3) Include deceased,community smear surveillance, colposcopy delayed for known reason eg pregnancy, currently in failsafe system following non attendance at colposcopy, patient refusal, referral to
other specialty for non-cervical disease, patient moved away (notification through 'Exeter system')
(4) Include biopsy taken but result not yet known
(5) Include outcome unknown to laboratory, no record of referral and/or patient, patient moved away (no information) private/other NHS hospital referral (if outcome unknown), incorrect patient details,
patient lost to system

Positive Predictive Value (PPV) Lost to follow-up

Total x
x 100 = %
Total x + y Total a
x 100 = %
Total b
PPV should be regarded as a guide for the audit of histology and
cytology and is not a precise measure of accuracy (This figure should be less than 5%)

Details of non cervical cancers (row 0014)