[414] Utility of “Low-Grade Squamous Intraepithelial Lesion, Cannot Exclude High-Grade Squamous Intraepithelial Lesion” (LSIL-H) Usage as a Quality Assurance (QA) Measure.

Ha Nishino, David Wilbur, Rosemary Tambouret. Massachusetts General Hospital, Boston

Background: LSIL-H is an increasingly used, equivocal interpretive category in gynecologic cytology. Studies have found that for a given laboratory, the histologic follow-up of cervical intraepithelial neoplasia 2 or greater (CIN 2+) to be intermediate between that following a cytologic diagnosis of low-grade squamous intraepithelial lesion (LSIL) and high grade squamous intraepithelial lesion (HSIL). Monitoring individual cytopathologists' use of LSIL-H could be useful as a QA measure in determining if the category is under/over-utilized and if the individual cytopathologist's outcome falls within the laboratory average.
Design: Papanicolaou tests (SurePath) performed at our institution between 1/09 and 4/10 were retrieved. We reviewed the records of 10 cytopathologists (CP) to identify diagnoses of LSIL, LSIL-H, and HSIL for each individual as well as the rate of CIN 2+ in follow-up (F/U) histologic specimens for each category. For LSIL, a random subset of cases was reviewed. The rate of LSIL-H diagnoses relative to the overall usage of LSIL (LSIL + LSIL-H) was also examined for each cytopathologist.
Results: Our analysis revealed that utilization of LSIL-H relative to LSIL and HSIL as well as associated outcomes on follow-up histology vary among cytopathologists:

Utilization of LSIL-H relative to LSIL and HSIL with associated histologic outcomes for individual cytopathologists
CPLSIL-H with available histology% CIN2+ on F/U of LSIL-HLSILwith available histology% CIN2+ on F/U of LSILLSIL-H/(LSIL + LSIL-H)HSIL with available histology% CIN2+ on F/U of HSIL
11520.0549.311.41872.2
2650.03915.413.03100.0
3812.5372.78.71190.9
42334.89310.814.82281.8
51241.7517.86.51668.8
65733.3956.317.94273.8
71241.7468.77.51275.0
83318.2816.213.63467.7
9728.6293.516.7366.7
102025.0557.311.7771.4
Overall19330.65807.812.216876.8



Conclusions: Studying the pattern of LSIL-H utilization with corresponding histologic outcome for individual cytopathologists can provide a useful measure of quality assurance within a pathology practice. While the overall rate of associated CIN 2+ on follow up for LSIL-H is intermediate between that of LSIL and HSIL, the outcomes for individual cytopathologists vary considerably. Interestingly, conservative usage of LSIL-H was not associated with a better cytologic-histologic correlation.
Category: Cytopathology

Tuesday, March 1, 2011 9:30 AM

Poster Session III # 104, Tuesday Morning

 

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