Digital Images in Gynecologic Cytology Reports: An Incentive To Downgrade.
Bryan L Janssen, Michael J Thrall. Weill-Cornell Medical College, The Methodist Hospital, Houston, TX
Background: The use of digital images in cytology and surgical pathology reports is a growing trend but by current guidelines is considered entirely optional. There has been little investigation of the effects, including potential unforseen consequences, of requiring the inclusion of such ancillary material in anatomic pathology reports, and, more specifically, gynecologic cytology reports.
Design: A recent management change in a large consulting supplier of ThinPrep liquid-based gynecologic cytology specimens for our institution resulted in a requirement for digital photographs in gynecologic cytology reports for the following interpretive categories: ASC-H, LSIL, LSIL-H, and HSIL. We reviewed 1425 liquid-based gynecologic cytology cases submitted for pathologist review at our institution, all from the same consulting group, occurring over a consecutive time period: 713 of these fell prior to the new requirement and 712 followed the start of the photograph requirement. We evaluated these cases based on the number of pathologist upgrades and downgrades and whether these changes resulted in a change in the picture status.
Results: Of the specimens reviewed by a pathologist following the photograph requirement, 32 cases were upgraded from NILM or ASC-US to a photograph-requiring interpretation of ASC-H, LSIL, LSIL-H, or HSIL (compared with 40 before the requirement), and 37 were downgraded from a photograph-requiring interpretation to NILM or ASC-US (compared with 20 before the requirement). The remaining specimen interpretations were either changed without changing the need for a photograph (129 cases after the requirement versus 96 cases before) or were left unchanged by the pathologist (514 cases after the requirement versus 557 cases before). A chi-square analysis of these results yielded a p-value of 0.0058. The ASC:SIL ratio increased from 1.07 to 1.45 after the start of the photography requirement.
Conclusions: Inserting a picture into the cytology report requires additional effort on the part of the pathologist. Therefore, there is an incentive to not add a picture either by downgrading or by not upgrading an interpretation. Our results show a corresponding shift in gynecologic cytology interpretations in our institution.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 98, Tuesday Morning