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

Abstract

N Context.-Cytology is a success because of the many quality controls used to ensure the accuracy of its results. Nevertheless, additional information is becoming available to the cytologist, often from untraditional sources, and the best way to use that information to improve the quality of cytology is not yet known.Objective.-To review ways to use new information to improve the quality of cytology.Data Sources.-Review of relevant literature.Results.-Information contained in many sources can be used in new ways to improve the quality of cytology. These include the timing of cytologic and histologic correlation, electronic medical records, workload information, prior aspirations, and molecular tests.Conclusions.-To maintain their high standard of excellence, cytologists should seek to define the most appropriate way to incorporate this new information into their interpretation of individual cases. (Arch Pathol Lab Med. 2011;135:1387-1390 doi: 10.5858/arpa.2010-0606-RA) C ytology is an undeniable success in screening patients and obtaining accurate diagnoses with the least intervention. A significant part of this success is due to the high level of quality found in how the test is performed. Cytology is conducted successfully in every type of practice setting, from the solo pathologist in the community hospital doing it all to the fully specialized practitioner in a tertiary care setting. Even though cytology is composed of complex tests that can be extremely challenging to interpret, success is seen with all types of personnel, including cytotechnologists, private practice pathologists, and academic experts. A cornerstone of this success is the highly effective qualityassessment programs that are used in all these different settings and by all these different personnel.Given this success, one may ask, how can cytology improve on its current level of quality, or where should we go from here? An area in which cytology can improve is in how it uses and integrates prior information into the diagnostic process. Today, there is more information, more types of information, and more different sources of information available to the cytologist than ever before. This information can be specific to the patient (eg, a history of breast cancer that can only be found in the electronic medical record), may be results from large clinical trials, or may be results from new types of testing technologies. Indeed, a recent addition to the College of American Pathologists checklist is the requirement to ensure that the results of all other studies (not just anatomic tests) are correlated with the final diagnosis. 1This review focuses on selected areas of cytology in which there is new information available to the cytologists that may be important in either ensuring or improving the quality of cytology. This review is not meant to be all inclusive. Topics reviewed here include cytologic and histologic correlation, the electronic medical record, workload reporting and monitoring in gynecologic cytology, the importance of prior asp...

Recommendations on Quality Control and Quality Assurance in Cervical Cytology

“…Continuous overseeing of the accuracy and reproducibility of cytological examination (error of the primary screening, from incomplete examination or misinterpretation and error of supervision) is guaranteed by QC programmes which take into account all the possible causes of error [46,48]. It should be noted that the smaller the volume of activity (number of Pap tests per year), the more detailed and defined must be the QC programmes that are put in place [47,49,50]. …”

High neutrophil incorporation rate of ascitic fluid cytology as an indicator of cancerous ascites

“…Numerous studies describing emperipolesis and cell cannibalism are either about experiments that utilized cytological specimens or case reports (5,8,(17)(18)(19)(20). However, in light of recent advancements in other techniques, including immunocytochemistry, in-situ hybridization and reverse transcription-quantitative PCR (21), cytological evaluations should consider other characteristics, focusing on less frequently observed findings such as CiCP, in addition to routinely observed characteristics, including cellular atypia (22).…”

Improving the diagnostic accuracy of biliary cytology

“…Over the years, the accuracy of cytology has been studied by a number of authors using a variety of techniques . Certainly, there are many different approaches that are all valid, though some techniques may be more appropriate than others in any particular situation.…”

“…Over the years, the accuracy of cytology has been studied by a number of authors using a variety of techniques. [13][14][15][16][17][18] Certainly, there are many different approaches that are all valid, though some techniques may be more appropriate than others in any particular situation. Our interpretation of the literature in biliary cytology is that there are a core set of cytologic features that are important in making a diagnosis of malignancy in biliary specimens, the similarities between different studies are much greater than the differences, and specimen adequacy is an overriding factor in the overall performance of the test.…”