The Pap Smear: Controversies in Practice

Edited by Barbara S. Ducatman and Helen H. Wang, 222 pp, with illus, London, England, Arnold Publishers, 2002.This is a comprehensive, well-written textbook that tells you everything you wanted to know about the Papanicolaou (Pap) smear. Besides the usual diagnostic criteria that are found in most textbooks, this book deals with all aspects of the Pap smear/Pap test.The introductory chapter and the chapter on clinical decision making are a must read not only for those in the cytology profession, but even for clinicians and nonphysicians. They represent a very good overview of the Pap smear from its historical perspective to its current status, its high points, and its successes, as well as its failures and limitations. The chapter on automation deals with all of the available technologies, including those that have gone off the market or that are available overseas. The chapter on quality assurance is thorough and well referenced.The medicolegal issues pertaining to medicine and the Pap smear are well explained. The trials and tribulations of the Pap smear, including unrealistic expectations from the public and the legal profession, are presented. The laboratory's approach to risk management is discussed. The chapter on human papillomaviruses is very thorough and current. All of the diagnostic chapters on benign and atypical squamous and glandular lesions, as well as those covering endometrial cells and extrauterine carcinoma, provide not only the usual diagnostic criteria, but also the appropriate references to include newer liquid-based technologies. The only drawback is that the discussion does not include Bethesda 2001 and American Society for Colposcopy and Cervical Pathology guidelines. However, all of the references that went into the developing the guidelines and the decision algorithms are actually presented in the book, although not under that heading.The 222 pages of this book were easy to read and understand. The statistics and the studies presented are well documented both in graphic format and in the references. This certainly is the most comprehensive book on the Pap test, dealing with all aspects of this test, from its inception to its current status, its successes, and its warts. This book would be very valuable not just for those in the cytology profession or for clinicians, but also for incoming residents in all fields of medicine, as it explains the limitations and the results of the Pap test. The latter half of the book deals with diagnostic criteria, which are well demonstrated, although the first half of the book could be read by everyone in the medical and in nonmedical professions.