{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:35:52Z","timestamp":1791297352350,"version":"4.1.0"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2005,7,25]],"date-time":"2005-07-25T00:00:00Z","timestamp":1122249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cytopathology"],"published-print":{"date-parts":[[2005,8]]},"abstract":"<jats:p><jats:bold>Objective:\u2002<\/jats:bold> In 1986, the British Society for Clinical Cytology (BSCC) published quantitative criteria to assist diagnosis in a three\u2010tier grading system of squamous cell dyskaryosis. In dyskaryotic cells, area nuclear to cytoplasmic (NC) ratios below 50%, between 50% and 66% and over 66% were defined as equating with mild, moderate and severe grades respectively. Following the Terminology Conference in 2002, however, the BSCC recommended on their website that the three\u2010tier model should be replaced by a new two\u2010tier system of low\u2010 and high\u2010grade squamous abnormalities. The latter broadly equate with the two\u2010grade Bethesda System (TBS) for reporting squamous intraepithelial lesions. The purpose of this study was to assess the accuracy and reproducibility of the BSCC three\u2010tier quantitative definitions, to investigate if they were applicable to liquid\u2010based cytology (LBC) and to see how they related to the proposed new two\u2010tier BSCC system.<\/jats:p><jats:p><jats:bold>Methods:\u2002<\/jats:bold> Quantitative image analysis was undertaken on illustrations from the 1986 BSCC terminology publication and on microscope slides from external quality assessment and Cytology Training Centre teaching sets.<\/jats:p><jats:p><jats:bold>Results:\u2002<\/jats:bold> Analysis of mean NC ratios showed that mild, moderate and severe dyskaryosis exist as statistically different populations. Overlap of NC ratio ranges, however, limits their practical application in the three\u2010tier model, although interestingly no overlap was noted between mild and severe dyskaryosis. No grade of dyskaryosis had a mean area NC ratio over 50%, indicating that the BSCC quantitative definitions are incorrect. The mean diameter NC ratios for mild, moderate and severe dyskaryosis were found to be 40%, 49% and 66% respectively. Accordingly it is possible that those reporting cervical cytology could be interpreting the BSCC NC ratios as meaning diameter rather than area. Amalgamation of the three\u2010tier results into the proposed two\u2010tier model shows that the resulting mean NC area and diameter ratios identify statistically different low\u2010 and high\u2010grade populations. The reduced degree of overlap, however, of NC ratio ranges in the two\u2010tier model implies that NC ratios could have a useful practical role in the separation of the low\u2010 and high\u2010grade categories. The two categories were reasonably well separated by mean area and diameter NC ratios of 25% and 50% respectively. A two\u2010tier model combining mild with moderate rather than severe dyskaryosis was found to be a statistically valid alternative but gave rise to NC ratios that would be difficult to use in practice. Except for moderate dyskaryosis, no significant differences were identified between the mean NC ratios of either conventional and LBC preparations or LBC preparations using two different commercial methodologies (SurePath<jats:sup>TM<\/jats:sup> and ThinPrep<jats:sup>\u00ae<\/jats:sup>). Differences, however, were noted in area measurements between SurePath<jats:sup>TM<\/jats:sup> and ThinPrep<jats:sup>\u00ae<\/jats:sup> and this has potential implications for classifications (such as TBS) using area comparisons as their basis. In addition, it was found that the increased NC ratio, associated with higher grades of dyskaryosis is more a consequence of progressive cytoplasmic area reduction rather than nuclear area increase. The similar NC ratios of borderline nuclear changes associated with human papilloma virus and mild dyskaryosis support the BSCC proposal that these can be combined to constitute a low\u2010grade category. This study shows that the BSCC area NC ratio criteria of grading squamous cell dyskaryosis require amendment. In addition, this study supports the new BSCC recommendation of low\u2010 and high\u2010grade squamous cell categories.<\/jats:p><jats:p><jats:bold>Conclusions:\u2002<\/jats:bold> The study proposes Sheffield quantitative criteria to assist the grading of squamous cell abnormalities. Quantitative diameter NC ratio measurements, however, must always be accompanied by detailed assessment of qualitative morphological features and in particular those relating to nuclear chromatin. This is equally relevant to both two\u2010 and three\u2010tier models.<\/jats:p>","DOI":"10.1111\/j.1365-2303.2005.00271.x","type":"journal-article","created":{"date-parts":[[2005,7,25]],"date-time":"2005-07-25T14:54:25Z","timestamp":1122303265000},"page":"179-192","source":"Crossref","is-referenced-by-count":39,"title":["Proposed Sheffield quantitative criteria in cervical cytology to assist the grading of squamous cell dyskaryosis, as the British Society for Clinical Cytology definitions require amendment"],"prefix":"10.1111","volume":"16","author":[{"given":"D. N.","family":"Slater","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Stewart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. E.","family":"Melling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. M.","family":"Hewer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. H. 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