Blinded review of papanicolaou smears

Frable, William J.

doi:10.1002/cncr.20310

Cancer

2004

DOI: 10.1002/cncr.20310

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Blinded review of papanicolaou smears

William J. Frable

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“…I am writing to expand on Dr. Frable's excellent editorial1 on a report by Renshaw et al2 Pathologists became the target of malpractice litigation for misdiagnoses within the year after an article appeared in the Wall Street Journal in 1987 3. In 1988, The Doctors Company (TDC) recorded 11 Papanicolaou smear/cervical cytology claims, a significant increase considering that only 7 had been filed in the company's entire history of insuring pathologists.…”

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Blinded review of Papanicolaou smears

Gill

2005

Cancer

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The author reported that cytotechnologists and pathologists should not be held accountable for the local outcome consequences of global process shortcomings. Even if all identifiable process control factors were addressed and implemented, errors still would occur. False‐negative Papanicolaou smears arise from the nature of the process, not the negligence of the practitioner. Respected cancer advocacy organizations should educate the public regarding the limitations of Papanicolaou test performance.

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confidence: 99%

Blinded review of Papanicolaou smears

Gill

2005

Cancer

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Papanicolaou Test Litigation: Real Figures for the Judge and Jury

Leiman¹

2006

Advances in Anatomic Pathology

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Observations From Pap Litigation Consultations

Austin

Zhao

2011

Pathology Case Reviews

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Papanicolaou test litigation in the United States reflects widespread societal expectations that even occasional cervical screening should prevent nearly all cervical cancers in screened women. Scientific evidence clearly shows that these expectations are unfounded, especially for increasingly prevalent glandular cervical cancers and for more rapidly progressive cervical cancers in younger women. Reviews of Papanicolaou test slides involved in litigation repeatedly show 1 or more of 3 cytologic patterns: difficult-to-interpret abnormal glandular cell groups, difficult-tointerpret hyperchromatic crowded cell groups, and/or difficult-to-locate or -interpret abnormal immature metaplastic squamous cells. Multipleslide blinded reviews, supported by professional organization guidelines, should be used to identify and differentiate culpable medical errors from factors primarily associated with the inherent limitations of human screening and interpretation. In the authors' opinion, remaining US cases of cervical cancer are most likely to be prevented or minimized by more widespread utilization of cotesting with US Food and Drug AdministrationYapproved methods of liquid-based cytology and high-risk human papillomavirus DNA testing.T he Papanicolaou test is the most successful cancer screening test in medical history. 1 The twin goals of cervical screening are (1) to detect and ablate cervical precancer and (2) to detect and minimize the stage at diagnosis of cases of already invasive cervical cancer. 2 Papanicolaou test litigation consultations provide opportunities for valuable insights into both the natural history of cervical carcinogenesis and the limitations of current cervical screening methods and practices. 3 Although the demonstrated capability of cytology-based screening to detect and prevent or downstage invasive cervical cancer (CxCa) is significantly less for both glandular cervical cancers 4,5 and for more rapidly progressive cervical cancers in younger women, 6 there is, nevertheless, a strong public presumption that almost any cervical screening should essentially guarantee that almost all cervical cancers will be prevented. 3 This presumption that cervical screening should prevent almost all cervical cancers in screened women forms the basis for screened patients' consideration of legal recourse after a cervical cancer diagnosis. In our opinion, the same unfounded presumption that cervical screening should reliably prevent almost all cervical cancers strongly influences most consultants asked by plaintiffs to review durable slide evidence after a diagnosis of CxCa and to ascertain whether a culpable medical error occurred. The multiple-slide blinded rescreening (MSBR) method 3,7Y10 has been developed to improve the objectivity of retrospective reviews of litigated Papanicolaou cases and has had some success in helping to adjudicate and resolve disputed cases. Newer cervical screening technologies also have the potential to help achieve cervical screening performance and outcomes that more closely approach...

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Blinded review of papanicolaou smears

Cited by 4 publications

References 4 publications

Blinded review of Papanicolaou smears

Blinded review of Papanicolaou smears

Papanicolaou Test Litigation: Real Figures for the Judge and Jury

Observations From Pap Litigation Consultations

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