IMPROVING ACCURACY IN GYNECOLOGIC CYTOLOGY - RESULTS OF THE COLLEGE-OF-AMERICAN-PATHOLOGISTS INTERLABORATORY COMPARISON PROGRAM IN CERVICOVAGINAL CYTOLOGY

The College of American Pathologists Interlaboratory Comparison Progra m in Cervicovaginal Cytology (PAP) is a quarterly mailed glass-slide q uality improvement program. This growing program started as a pilot in 1989 with 207 laboratories. In 1991, 605 laboratories participated. T he diagnostic menu is modified from the Bethesda System and divides re ferenced slides into a negative series (normal, infectious, and reacti ve) and a positive series of epithelial lesions. A facsimile option fa cilitates immediate educational feedback. The 1989 through 1991 major discrepancy rate averaged 5%. The consensus laboratory response had hi gher concordance than either pathologist or cytotechnologist responses . Low-grade squamous intraepithelial lesion was the leading cause of f alse-negative participant response, while reactive/reparative change w as the leading cause of false-positive response. Pathologist false-neg ative and false-positive responses from group or large case-volume pra ctices were significantly lower than those from solo or small case-vol ume practices. Cytotechnologists in multiple-technologist or large-vol ume laboratories had significantly lower false-negative responses than solo technologists or those in low case-volume laboratories, but fals e-positive rates did not differ. Experienced participants had fewer ma jor discrepancies. The interlaboratory Comparison Program in Cervicova ginal Cytology illustrates the feasibility of a large, mailed glass-sl ide program, and offers laboratories a continuous method for monitorin g and improving performance in gynecologic cytology.