Accuracy and False-Positive Rate of the Cytologic Diagnosis of Follicular Cervicitis: Observations from the College of American Pathologists Pap Educational Program
Manon Auger, Walid Khalbuss, Ritu Nayar, Patricia Wasserman, Chengquan Zhao, Rhona Souers, Nicole Thomas, Ann T Moriarty. McGill University and McGill University Health Center, Montreal, QC, Canada; University of Pittsburg Medical Center and ShadySide Hospital, Pittsburgh, PA; Northwestern University and Northwestern Memorial Hospital, Chicago, IL; Long Island Jewish Medical Center, New Hyde Park, NY; University of Pittsburgh Medical Center and Magee Women's Hospital, Pittsburgh, PA; College of American Pathologists, Northfield, IL; AmeriPath Indiana, Indianapolis, IN
Background: Follicular cervicitis has been viewed traditionally as a relatively simple cytological diagnosis. There are, however, occasional cases of follicular cervicitis, reported in the literature, that have been misinterpreted, leading to false-positive diagnoses. The objective of this study was to determine the accuracy of the diagnosis and the false-positive rate of follicular cervicitis in gynecologic cytology by assessing the responses of participants in the context of the College of American Pathologists (CAP) PAP educational program.
Design: We performed a retrospective review of 4914 participant responses for gynecologic cytology challenges with the reference diagnosis of follicular cervicitis from 2000 to 2010 from the CAP PAP educational program. Reference diagnosis category, false-positive rates by participant type, and preparation type (conventional smears versus ThinPreps) were analyzed.
Results: Of the total 4914 general category responses, 4368 (88.9%) were benign while 546 (11.1%) responses were abnormal (>/= LSIL); the latter correspond to the false-positive diagnoses. Of the benign responses, only 2026 (46.4% of the benign responses) were an exact match to follicular cervicits. Adenocarcinoma and HSIL were the most common diagnoses chosen in the false-positive interpretations, accounted for 42.3% and 20.1% of the false-positive diagnoses respectively. Reader type was significantly associated with false positive diagnoses (laboratory: 19.2% versus cytotechnologist:11.1% versus pathologist: 7.9%; p<.001). Thin-Prep was also significantly associated with false-positive diagnoses as compared to conventional smears (12.2% versus 3.6%; p<.001).
Conclusions: In an education program, follicular cervicitis is difficult to diagnose accurately and represents an important cause of false-positive responses in gynecologic cytology. These results highlight the importance of follicular cervicitis as a mimic of adenocarcinoma and HSIL, in particular in ThinPreps.
Tuesday, March 20, 2012 1:00 PM
Platform Session: Section C, Tuesday Afternoon