Effectiveness of Rapid Prescreening and 10% Rescreening in Liquid-Based Papanicolaou Testing

Abstract

Although rapid prescreening (RPS) has been shown to be an effective quality control procedure for detecting false-negative conventional Papanicolaou (Pap) tests, RPS has not been widely implemented in the United States. In our laboratory, cytotechnologists performed RPS in 3,567 liquid-based Pap tests: 1,911 SurePath (BD Diagnostics-TriPath, Burlington, NC) preparations that were manually screened and 1,656 ThinPrep Pap tests (Hologic, Bedford, MA) that were imaged using the ThinPrep Imaging System (Hologic). We compared the sensitivity of RPS, 10% rescreening (R-10%), and routine screening (RS). In contrast with previously published findings, we found that RS + RPS did not improve screening sensitivity compared with RS + R-10%. These results support the following hypotheses: (1) Higher baseline RS sensitivity as a result of Pap test diagnoses standardization implemented for quality improvement purposes decreases the performance impact of RPS. (2) R-10% and RPS quality assurance methods detect diagnostic failures caused by different types of cognitive errors.

Impact of Implementing 100% Rapid Review as a Quality Control Tool in Cervical Cytology

“…Cervical cytology smear findings from female clients of the Brazilian National Health Service in the city of Goiânia, Goiás, screened as part of the country's primary health care policy, were evaluated. The sample consisted of all the cytology smears assessed in 2004 (4,943) and 2013 (6,278).…”

“…Some of the quality control methods used in cervical screening include: 100% rapid review (100% RR), rapid prescreening, 10% random review (10% R), and rescreening of negative smears based on clinical risk criteria [5][6][7]. Quality indicators are another means of assessing the performance of DOI: 10.1159/000487426 the cytology laboratory, permitting comparison between the ideal and the actual situation [8].…”

Assessment of 100% Rapid Review as an Effective Tool for Internal Quality Control in Cytopathological Services

“…This reinforces the importance of the 100%-RR as a method that decreases the percentage of FNR. Currens et al [22] analyzed 3,657 smears by liquid-based cytology and found that 272 (7.62%) of the smears were abnormal after 100%-RR. The results of studies that use different methodologies but still apply the 100%-RR as an IQC can be considered.…”

“…The major advantage of the 100%-RR method is in evaluating the performance of the examiner [8,21] . The 100%-RR may take up to 2 min, but it does not need any significant additional time during the process [21][22][23] . A disadvantage of the 100%-RR is the possible occurrence of errors because the reviewer lowers his/her concentration knowing that abnormal results have been removed, leaving some or all false-negative smears [8,21] .…”

Changing the cytology laboratory information system to improve cytology performance

“…7 Although it is true that some laboratories do a very good job reviewing negative cases, most often in settings with a very low workload, the only way they can document this performance is by performing an alternative quality assurance technique that does incorporate controls. 8 However, over 30 years ago, some investigators, most notably Hindman, 9-11 did the work of incorporating controls into gynecologic cytology by seeding unknown cases into the daily workload. Although this method worked, it was labor-intensive and required identifying abnormal cases, removing the dots, deidentifying them, renumbering them, and then incorporating them into the daily workload.…”