The Differential Diagnosis of Reparative Changes and Malignancy: Performance in the College of American Pathologists Pap Education and Proficiency Testing Programs
| Autor: | Daniel F.I. Kurtycz, Zaibo Li, Kelly Goodrich, Rhona J. Souers, Paul N. Staats, Amberly Lindau Nunez, Christine N. Booth, Diane Davis Davey, Benjamin L. Witt |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Laboratory Proficiency Testing
medicine.medical_specialty Uterine Cervical Neoplasms Cervix Uteri Malignancy Pathology and Forensic Medicine Diagnosis Differential Predictive Value of Tests Proficiency testing Humans Regeneration Medicine False Positive Reactions False Negative Reactions Observer Variation Vaginal Smears business.industry General surgery Liquid Biopsy Reproducibility of Results Cervical cytology General Medicine medicine.disease United States Medical Laboratory Technology Female Squamous Intraepithelial Lesions of the Cervix Differential diagnosis business Papanicolaou Test Program Evaluation |
| Zdroj: | Archives of Pathology & Laboratory Medicine. 144:846-852 |
| ISSN: | 1543-2165 0003-9985 |
| DOI: | 10.5858/arpa.2019-0298-cp |
| Popis: | Context.— Repair is a challenging diagnosis and a significant source of false-positive (FP) interpretations in cervical cytology. No large-scale study of performance of repair in the liquid-based era has been performed. Objective.— To evaluate the performance of repair in the College of American Pathologists Pap Education and Proficiency Testing (PT) programs. Design.— The FP rate for slides classified as repair was evaluated by preparation type, participant type (cytotechnologist, pathologist, or laboratory), and program. The specific misdiagnosis category and individual slide performance were also evaluated. The rate of misclassification of slides as repair by participants for other diagnostic categories in the Pap Education program was assessed. Results.— The overall FP rate was 1700 of 12 715 (13.4%). There was no significant difference by program or preparation type. Within the Education program there was no difference by participant type, but pathologists' FP rate in the PT program (47 of 514, 9.1%) was significantly better than cytotechnologists in the PT program (51 of 380, 13.4%) and pathologists in the Education program (690 of 4900, 14.1%). High-grade squamous intraepithelial lesions/cancers (HSIL+) accounted for 1380 of 1602 FP interpretations (86%) in Education, but 43 of 98 (43.9%) in PT. Most slides had a low rate of misclassification, but a small number were poor performers. False-negative diagnosis of HSIL+ as repair was less common, ranging from 0.7% to 1.8%. Conclusions.— Despite initial indications that liquid-based cytology might reduce the rate of misclassification of repair, FP interpretations remain common and are no different by preparation type. Misclassification is most commonly as HSIL or carcinoma, potentially resulting in significant patient harm. |
| Databáze: | OpenAIRE |
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