Thinking in cytology key

Dear Sir/ Editor

As pathologists, cytotechnologists, and professors of pathology and cytology, we find ourselves disconcerted because we turn, in disbelief, to an unprecedented situation that could affect patient care and we refer to the exact opposite of that which could be considered in any medical treatise or scientific article from the 20th century.

In our setting (Spain), there are fewer and fewer pathologists interested in cytology, fewer and fewer cytologists and cytotechnicians well prepared to assume the new role that this key test is called to play, less and less training in cytology in teaching centers, and university, and a large part of the problem is the absence of well-endowed budgets for training, the conception that cytology is an outdated diagnostic tool and the greater interest and fascination of the new generations for Molecular Biology.

False. Completely false.

We agree that cytological interpretation is an art highly dependent on training and experience, both factors that increase the sensitivity and specificity of the test to the limits that are allowed, but the simplicity, price, and immediacy will always play favor of this innocent and unjustly judged diagnostic test.

If Papanicolaou could speak, if he could analyze the panorama that we bring to the debate, he would tell us about his own experience and would advise us to be constant and firm in our beliefs. With all that it took for the rest of the medical specialties to recognize the value of cytology.

We live in a present in which technification has penetrated in a hitherto unknown way, a thankless process with useful tests that only need to adapt to the times as they are doing, at an increasingly frenetic pace, yes, proving day by day day-to-day and recognizing its limitations. But these limitations are not going to disappear or be displaced by the simple fact that other diagnostic tests with more technical names have received more publicity, have received the support of the industry, and have attracted the attention of specialists, tending to jump on the bandwagon of the latest technological advances.

In the field of Gynecology, which is the one that concerns us now, cytology continues to advance but the question always arises related to the training of those who practice it.

The literature concerning the application of immunocytochemistry and molecular biology in cytological diagnosis is extensive and it should not surprise us that it is precisely the naked cell that can give the best DNA to those who need its essence to, precisely, elaborate diagnoses in the field of Precision Medicine in the greatest attempt to achieve what is already known as Personalized Medicine.

Should we then defend the cytology? We think so. We know that it is our obligation to do so.

How can we achieve our goal with the highest level of effectiveness and efficiency?

Training, training, and more training, together with experience.

Defending cytology, fighting to adapt it to the times, explaining its usefulness, its simplicity, its low cost, its good results in the right hands, and encouraging new generations to participate in the commitment to raise Cytology to the high levels it deserves.

Even so, the target population does not recognize the advantages of having such an important ally in their health care.

Historically, cytology has been neglected. It has been so by clinical colleagues as well as by insurance companies and even by the patients themselves in a vicious circle that has not only meant that the work of the pathologist, cytologist, and cytotechnician is not recognized but also the reluctance to pay has helped to devalue this essential diagnostic act to such an extent that its exercise has come to be of no interest.

Let us think in cytological key. Replacing cytology with more sophisticated and much more expensive tests is like doing away with the figures of the cytologist and the cytotechnician, eliminating them and replacing them with robots that, ultimately, should be advised by... guess who?

Let’s trust in cytology, spend money on preparing cytologists and cytotechnicians, pay a fair price for a cytological diagnosis, modernize cytology, let cytology speak and express itself and enter with guarantees in this new era that they sell us as present even though we have one foot in the future. Because if all else fails, we need the solid pillars of the usual tests to ensure our health.

Time will judge us...