An analysis of factors that influence the ASCUS/SIL ratio of pathologists

In pursuit of physician-specific performance data in cytology, we have been calculating the ASCUS/SIL (atypical squamous cells of undetermined signifi cance/squamous intraepithelial lesion) ratio of cytopathologists (CPs) and providing confidential feedback every, 6 months. At the same time, thin-lay er technology was introduced as an alternative to conventional smears. Thus we analyzed factors that may influence the ASCUS/SIL ratio, particularly t he effect of periodic feedback on outliers (defined by a professional bench mark). For 3 years, the mean ASCUS/SIL ratio for all CPs decreased signific antly from 2.92 to 1.87. There was great variability in the mean ASCUS/SIL ratio among 12 Cps (range, 1.11-5.89). Of the 6 CPs who worked continuously during this time, 2 showed a statistically significant decrease in their A SCUS/SIL ratio, including the CP with the highest ratio; 1 showed a signifi cant increase. The mean ASCUS/SIL ratio did not correlate well with years o f CP experience or with individual annual case volume. The ASCUS/SIL ratio of some Cps can decrease significantly over time. Whether it was due to fee dback or the introduction of thin-layer preparations could not be determine d.