Improvement in the routine screening performance of cytotechnologists over time

Abstract

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...

Improvement in the routine screening of cervical smears

“…As shown in various studies, it is possible to use abnormal cases identified both by rapid prescreening and by routine screening to monitor the performance of professionals in the daily routine of cytology laboratories. 6,9,20,[22][23][24][25] Nonetheless, it is only in Canada and the United Kingdom that this method is being routinely used. 4,25,26 Finally, the high rates of false-negatives constitute one of the principal problems faced by cytology laboratories.…”

“…6,9,20,[22][23][24][25] Nonetheless, it is only in Canada and the United Kingdom that this method is being routinely used. 4,25,26 Finally, the high rates of false-negatives constitute one of the principal problems faced by cytology laboratories. Of the internal quality control methods currently available, 10% random review is the least effective for detecting false-negative results at routine screening.…”

Rapid Pre-Screening Is More Sensitive in Liquid-Based Cytology than in Conventional Smears

“…In addition, it has recently been shown that long-term use of RPS significantly improves the estimated sensitivity of a subset of individual CTs in routine screening, presumably by providing constant, accurate, real-time feedback, improving both the accuracy and precision of the laboratory [12]. Previous studies have shown that the effectiveness of RPS is dependent on the time spent screening (the longer one is allowed to examine a case, the higher the estimated sensitivity [1]), and the technique used (the step technique being more sensitive than other techniques, at least in conventional smears [1]).…”

Quality Improvement in Cytology: Where Do We Go From Here?

“…[5][6][7] Using these surrogates, the maximum workload for cytotechnologists can be estimated so they have the best chance of achieving near-100% sensitivity. That workload is 30 slides/d for manual screening of conventional [8][9] and SurePath (BD Biosciences, Franklin Lakes, New Jersey) cases, 10 and an ECA-adjusted workload of 7 cases/d (or 70 cases/d for a laboratory with an ECA rate of 10% where 1 slide is counted as 1 slide) for screening with the ThinPrep Imaging System (Cytyc Corporation, Boxborough, Massachusetts). 5,11 Unfortunately, those workloads are less than the workloads currently being employed in some, if not many, cytology laboratories.…”