Koss LG, Gompel C: Introduction to Gynecologic Cytology with Histologic and Clinical Correlations, 205 pp, Baltimore, Lippincott Williams & Wilkins, 1999 ($129).

This English translation of Cytologie Gynecologique: Et Ses Bases Anatomo-cliniques is an introductory text for students of cytopathology, for clinicians, and as well I suspect for lawyers. Contents include nice overviews of the Papanicolaou smear in historical perspective, basic concepts of cytology, principles of cell function, anatomy and histology of the female genital tract, techniques of sampling and preparation, normal cytology, hormonal changes, inflammatory changes, and neoplastic changes. Two chapters were newly written to address U.S. concerns with CLIA88 regulations, false-negative smears, and new preparation methods as noted in the preface.

Photos and illustrations overall are of good quality and are of sufficient size and placement in the text to be helpful as one reads through the text. Most of the photos are in color and utilize Papanicolaou stain for cytology and hematoxylin and eosin stain of tissues with rare exceptions. The text covers both common and uncommon lesions and serves as a good guide for a cytologist instructional course. Pitfalls are addressed not only in each diagnostic chapter to some degree but also in a separate chapter covering false-positive and false-negative errors. Those concerned that an adaptation of a European text may not adequately emphasize the Bethesda System terminology need not worry. Terminology is consistent throughout the text, and Chapter 9 does a good job of describing The Bethesda System and placing it in historical perspective with prior terminology.

A minor criticism is that the discussion of CLIA88 and legal liability states, “In light of these developments, it is clearly necessary for the laboratories of cytology to achieve the highest possible level of performance,” as if a cytology laboratory is more concerned about staying out of legal trouble than about the well-being of its patients. I do not believe that the author intended to insinuate this for the majority of cytotechnologists and cytology laboratories, but I believe that some in the legal profession will interpret it as such and use it to endorse their methods.

One could ask, “Why another introductory gynecologic cytologic text in an already crowded field?” but one can quickly see why it has been such a popular introductory teaching text in Europe. With its English translation and additions, it could become a popular text in the United States as well. I am aware that Dr. DeMay and the American Society Clinical Pathology are readying what will probably be a popular CD-ROM formatted self-study introductory program for gynecologic cytopathology. However, there will probably always remain a need for an inexpensive, portable text for the student of cytopathology to use.