QUALITY ASSURANCE IN CERVICAL-CANCER SCREENING - RESULTS OF A PROFICIENCY TESTING SCHEME FOR CYTOLOGY LABORATORIES IN THE NORTH-WEST THAMESREGION

Objectives. To examine the effectiveness of introducing External Quali ty Assessment (EQA) into all laboratories which undertake gynaecologic al cytopathology. To assess pathologists and cytotechnologists regular ly for their competence to screen cervical smears, regardless of their standing in the laboratory hierarchy or their experience of gynaecolo gical cytopathology. Methods. Each participant was asked to screen and report on 10 slides during a 2 h period. The assessment was carried o ut by a facilitator under the direction of a specially appointed EQA C ommittee. A maximum score of 20 points was awarded for a completely co rrect set of answers. A minus score was awarded for a missed abnormal smear. Seventeen pathology laboratories in North West Thames Regional Health Authority participated; 146 cytologists were assessed. Results. A pilot and four rounds of EQA have been completed and a total 5350 s mears examined. Out of 2568 dyskaryotic (abnormal) smears screened, 0. 7% were not identified correctly. Of the 146 cytologists taking part i n the assessment, 95% achieved a score of 17 or more. Three participan ts were identified who did not reach an acceptable level of competence and appropriate remedial action was taken. Conclusion. The EQA scheme detected unacceptable levels of performance which can be quickly rect ified. Participation of 100% has been maintained on a voluntary basis, and 4 years experience of the scheme confirms that a very high standa rd of screening prevails in the Region. The study illustrates that vol untary self-regulation is acceptable in the NHS, and the introduction of similar EQA schemes on a national scale will go a long way to estab lishing confidence in the cervical cancer screening programme.