Making a Case for Rapid Prescreening of Pap Tests in Quality Assurance/Quality Control and Systems Based Approach to Reducing Errors.
Vijayalakshmi Padmanabhan, Samuel Q Armstrong, Diane M Green, Francis M Quinlisk, Susan L Augustinowicz, Vickie E Johncox. Dartmouth Hitchcock Medical Center, Lebanon, NH
Background: To increase the sensitivity of Pap tests, 10% of randomly selected negative Papanicolaou (Pap) smears are rescreened as a quality control (QC) measure. This has been mandated to reduce the false negative rate. Recently, there has been an interest in alternatives to the 10% QC, either rapid prescreening (RPS) or rapid rescreening (RRS). In the United Kingdon, RPS is the most widely used QC method though this is not the practice in the U.S. In this study, we use RPS as a tool for QC and as a system absed approach to reduce errors.
Design: Four hundred and forty seven ThinPrep Pap test smears were reviewed. These cases were initially processed on the ThinPrep Image system. RPS was performed by the cytopatholgy supervisor at a rate of 1 slide a minute. Additional time was taken to enter the interpretation in a standardized work sheet. No marks were made on these slides. These cases were then given to the cytotechnologists for review on the ThinPrep Image system review microscopes. RPS diagnosis and final diagnosis by the cytotechnologists and/ or the cytopathologists were noted (Table 1). Cases where the RPS diagnosis and the final diagnosis were negative were not reviewed; but cases with a difference of diagnosis between the 2 were reviewed. After a full manual rescreen, those cases that needed review by the pathologist were submitted to the pathologist. Cases with 10% QC diagnosis were also noted (Table 2).
|LSIL, cannot exclude HSIL||1||2|
|RPS||10% QC review|