BACKGROUND: Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method. METHODS: RPS was performed by all cytotechnologists in a single laboratory over 2 separate 8-month periods. The sensitivity of screening for individual and groups of cytotechnologists was examined. For purposes of comparison, cytotechnologists were divided into 2 groups: screeners with an overall routine sensitivity !95% and screeners with an overall sensitivity <95%. RESULTS: Atypical squamous cells (ASC) were used as a threshold, and routine screening sensitivity was found to vary from 68.3% to 96.8%.The overall sensitivity of the laboratory for RPS and routine screening was 43.6% and 88.4%, respectively. Over time, the overall laboratory sensitivity of routine screening improved from 85.3% to 91.3% (P ¼ .01).During this same time frame, the sensitivity of the screeners with an overall sensitivity <95% improved from 79.3% to 91.2% (P < .001), whereas the sensitivity of screeners with an overall routine sensitivity !95% remained the same (96.1% to 96.4%; P ¼ .6). CONCLUSIONS: In addition to improved overall performance of the laboratory by detecting and correcting errors, the results of the current study indicate that using RPS consistently over time might play a role leading to improved performance of cytotechnologists with an overall routine sensitivity <95% but not of cytotechnologists with an overall routine sensitivity !95%. KEY WORDS: rapid prescreening, routine screening, performance, sensitivity, improvement, gynecologic cytology, quality control, diagnostic accuracy.Many quality control (QC) methods have been used to increase the sensitivity of cytopathology laboratories, with full rescreening of approximately 10% of randomly selected negative Papanicolaou (Pap) smears being the most commonly used method in North America. Original Article criticized for being inefficient and lacking statistical power to detect low-level achievements in primary screening within laboratories.5-8 Alternative strategies include either manual rescreening of all negative Pap smears, which is time-consuming and not practical in a high-volume laboratory, or automated rescreening of all negative Pap smears, which has generated promising results but is still expensive and not widely used. [9][10][11][12][13][14][15][16] Rapid prescreening (RPS) of all gynecologic specimens is an inexpensive technique that was introduced in the United Kingdom (UK) as an alternative and useful QC standard; however, it is far from becoming routine practice in North America. 17-19As a matter of fact, even in the UK, the most widely used QC method is rapid rescreening (RR) rather than RPS. 9,16 In that regard, Arbyn et al 5 have demonstrated that RPS and RR yield comparable gains in the detection of missed abnormalities, with...
BACKGROUND:The terminology used in reporting urine cytology lacks uniformity and the significance of the "atypical"and "suspicious" categories is still not well established. This results in variable clinical follow-up and management of those cases. The authors sought to investigate the prognostic value of a diagnosis of "suspicious for high-grade urothelial carcinoma" (HGUCA). METHODS: All cases with a "suspicious" or "positive" cytological diagnosis spanning 4 years were included and correlated with the subsequent biopsies obtained within 6 months of urine collection. RESULTS: A total of 447 correlative events (57% positive and 43% suspicious) corresponding to 773 cytology specimens and 337 patients were included. The morphology of the "suspicious" cells was similar to what has recently been reported in the literature as "atypical urothelial cells, cannot exclude HGUCA." A "suspicious" diagnosis was more often rendered than a "positive" one in voided specimens (80% vs 65%, respectively). The mean interval between cytology and biopsy was 31 days. On follow-up, 92% of "suspicious" diagnoses (176 of 191 diagnoses) and 90% of "positive" diagnoses (230 of 256 diagnoses) were found to have a biopsy with a diagnosis of carcinoma (low grade or high grade). A diagnosis of HGUCA followed a "suspicious" and a "positive" diagnosis in 79% and 86% of cases, respectively. CONCLUSIONS: A "suspicious" diagnosis as defined in the current study warrants close investigations and repeat biopsy to rule out HGUCA. In addition, the findings of the current study raise the question of the need for quantitative criteria for diagnosing HGUCA on cytology. Cancer (Cancer Cytopathol) 2014;122:796-803.
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