BACKGROUND. Early cytologic detection and treatment of high‐grade squamous intraepithelial lesion (HSIL) is critical to cervical cancer prevention. The term atypical squamous cells (ASC), cannot exclude HSIL (ASC‐H) was introduced in 2001 in the Bethesda System (TBS 2001) to define changes suggestive, but not diagnostic, of HSIL in the absence of unequivocal squamous intraepithelial lesion (SIL). Previous studies showed that women with ASC‐H cytology are at an increased risk of harboring underlying histopathologic HSIL. TBS 2001, however, did not address the significance of finding ASC‐H changes in a background of unequivocal low‐grade SIL (LSIL). There may be a tendency for cytologists to lump these changes with either LSIL or HSIL, depending on their level of comfort. In their laboratory, the authors have referred to these changes as “LSIL, cannot exclude HSIL” (LSIL‐H). METHODS Between July 2001 and July 2003, all Papanicolaou (Pap) tests that were obtained by using the ThinPrep technique were retrieved from the computer data base at the authors' institution. All categories of squamous cell abnormalities, including LSIL‐H, were evaluated for their incidence and follow‐up diagnoses of HSIL and more severe lesions (HSIL +). All patients had a minimum of 2 year follow‐up by biopsy and cytology (range, 2–4 years). RESULTS LSIL‐H comprised 0.15% (n = 194) of all Pap tests (n = 129,911) that were evaluated during the study period. Follow‐up biopsy was available on 59 patients (30.4%), which showed HSIL + in 40.7% of patients. This rate of associated HSIL + differed significantly from that of LSIL (13%; P < .001) and HSIL (74%; P < .001), but was similar to that of ASC‐H (44.6%). CONCLUSIONS The results from this study showed that patients with cytologic diagnoses of LSIL‐H had an intermediate risk of harboring histopathologic HSIL +. This risk was similar to ASC‐H but fell between the low risk associated with ACS‐US and LSIL and the high risk associated with HSIL cytologic diagnoses. The authors believe that LSIL‐H should be considered as a distinct cytologic diagnostic interpretation and should be separated from LSIL and HSIL. Although LSIL‐H does not represent a unique biologic entity, it has clinical usefulness because of its high positive predictive value for HSIL + lesions. Cancer (Cancer Cytopathol) 2006; 108:. © 2006 American Cancer Society.

BACKGROUND: With the current and projected shortage of a cytotechnologist (CT) workforce and the desire to reduce laboratory costs, increased productivity with automated assisted primary screening has become an attractive option for many laboratories. To the best of the authors' knowledge, longitudinal studies examining the effect of increasing workload on the performance of individual CTs have not been performed previously. METHODS: Using the ThinPrep imaging system (TIS), the performance of 3 CTs with variable levels of experience were evaluated. Their productivity was noted to increase from an average of 87 to 118 slides per day. The analysis included comparisons of error rates, screening rates, and screening times, including a review of 22 fields of view (FOV). Poststudy interviews of the CTs were also performed. RESULTS: Increased workload was found to be proportional to the decreased percentage of cases that underwent full manual review (25.2% to 20.1%; P < .001), and decreased actual screening times (7.3 hours/day to 6.7 hours/day, and 5.0 minutes/slideto 3.7 minutes/slide). This resulted in a lower detection of total abnormal findings (10.4% to 8.3%; P < .001), atypical squamous cells (6.7% to 4.9%; P < .001), and high-grade squamous intraepithelial lesion (0.9 %to 0.7%; P ¼ .37), as well as an increased false-negative fraction rate (3.8% to 7.0%; P ¼ .08). CONCLUSIONS: The results of the current study indicate that an increased average CT workload >100 slides per day with the TIS appears to have been accomplished mostly through a reduction in the amount of time spent reviewing the 22 FOV and the percentage of cases that underwent full manual review, which resulted in a significantly reduced screening performance. Cancer (Cancer Cytopathol) 2010;118:75-82.

BACKGROUND: Workload is extensively regulated in gynecologic cytology. However, sensitive monitors of excessive workload are not available. METHODS: We measured the variation in abnormal (atypical squamous cells [ASC], lowgrade squamous intraepithelial lesion [LSIL], and high-grade squamous intraepithelial lesion [HSIL]) rates for 4 cytotechnologists (CTs) among different days of the week and at different times during the day while they were performing primary screening with the ThinPrep Imaging System. RESULTS: Three of 4 CTs detected significantly less abnormal cases on 1 day of the week than another (1 Monday, 2 Friday). Two of those CTs detected significantly fewer total abnormal cases in the afternoon than in the morning; this was strongly correlated with increased speed in the afternoon and decreased detection of ASC cases. HPV þ rates for ASC cases dropped as the abnormal rate dropped. The third CT detected significantly fewer ASC cases in the morning; this was counterbalanced by an increase detection of LSIL cases, suggesting a shift in diagnostic threshold between the AM and PM. The difference in abnormal detection rates between morning and afternoon correlated with a false-negative fraction of 0.96. CONCLUSIONS: There are significant differences in detection rates of abnormal cases between days of the week and the morning and afternoon. Correlating abnormal rates and workload between the morning and afternoon may represent a sensitive way to detect excessive workload. Because individual CTs may have different responses to workload and no overall pattern emerged, data on their workload and performance need to be tracked individually. Cancer (Cancer Cytopathol) 2010;118:41-6.