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:
|CP||LSIL-H with available histology||% CIN2+ on F/U of LSIL-H||LSILwith available histology||% CIN2+ on F/U of LSIL||LSIL-H/(LSIL + LSIL-H)||HSIL with available histology||% CIN2+ on F/U of HSIL|