[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

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
1	15	20.0	54	9.3	11.4	18	72.2
2	6	50.0	39	15.4	13.0	3	100.0
3	8	12.5	37	2.7	8.7	11	90.9
4	23	34.8	93	10.8	14.8	22	81.8
5	12	41.7	51	7.8	6.5	16	68.8
6	57	33.3	95	6.3	17.9	42	73.8
7	12	41.7	46	8.7	7.5	12	75.0
8	33	18.2	81	6.2	13.6	34	67.7
9	7	28.6	29	3.5	16.7	3	66.7
10	20	25.0	55	7.3	11.7	7	71.4
Overall	193	30.6	580	7.8	12.2	168	76.8

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