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Goyal A, Booth CN, Souers RJ, Tabbara SO, Roberson J, Henry MR, Sundling KE, Goodrich K, Nguyen L. Navigating Practice Issues Related to the Unsatisfactory Cervicovaginal Papanicolaou Test: Survey Results of Laboratories Participating in the 2020 College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2024; 148:48-54. [PMID: 37074866 DOI: 10.5858/arpa.2022-0330-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. OBJECTIVE.— To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. DESIGN.— A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. RESULTS.— Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About three-quarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. CONCLUSIONS.— This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York (Goyal)
| | - Christine N Booth
- the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Rhona J Souers
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- the Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Janie Roberson
- the Department of Pathology, University of Alabama Birmingham Hospital, Birmingham (Roberson)
| | - Michael R Henry
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Henry)
| | - Kaitlin E Sundling
- the Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene and University of Wisconsin, Madison (Sundling)
| | - Kelly Goodrich
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Lananh Nguyen
- the Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
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Hashimoto S, Taguchi H, Higashi M, Hatanaka K, Fujita T, Iwaya H, Nakazawa J, Arima S, Iwashita Y, Sasaki F, Nasu Y, Kanmura S, Ido A. Diagnostic efficacy of liquid-based cytology for solid pancreatic lesion samples obtained with endoscopic ultrasound-guided fine-needle aspiration: Propensity score-matched analysis. Dig Endosc 2017; 29:608-616. [PMID: 28160342 DOI: 10.1111/den.12827] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Using propensity score matching, we retrospectively analyzed the additional diagnostic value of LBC compared to a conventional Papanicolaou smear (CPS) for samples of solid pancreatic lesions obtained by EUS-FNA. METHODS This cohort study included 126 matched patients who underwent initial EUS-FNA for solid pancreatic lesions between January 2009 and August 2014. CPS was used for cytology of EUS-FNA samples obtained until May 2012 (63 patients). Subsequently, LBC was used for cytological analysis (63 patients). Diagnostic yields of CPS and LBC for malignancy were compared. Risk factors for cytological misdiagnosis with LBC were investigated. RESULTS Overall rate of malignancy was 86% after matching. LBC had higher diagnostic sensitivity and accuracy than CPS (96.6% vs 84.0%, P = 0.03; and 96.8% vs 87.3%, P = 0.05). LBC was significantly more sensitive for diagnosing pancreatic head lesions (96.4% vs 78.1%, P = 0.04). The sensitivity for pancreatic ductal adenocarcinoma (PDAC) with LBC was higher (98.1% vs 83.0%, P = 0.009). Multivariate analysis revealed that malignant tumors other than PDAC (P = 0.004) and lesion size ≤20 mm (P = 0.046) were risk factors for LBC misdiagnosis in all participants. CONCLUSIONS For solid pancreatic lesions, LBC of EUS-FNA samples contributes to the diagnosis of malignancy. Malignant tumors other than PDAC and small tumors are difficult to diagnose using EUS-FNA and LBC.
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Affiliation(s)
- Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroki Taguchi
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Michiyo Higashi
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuhito Hatanaka
- Department of Pathology, Field of Oncology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshihiro Fujita
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiromichi Iwaya
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Junichi Nakazawa
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shiho Arima
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuji Iwashita
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuichiro Nasu
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shuji Kanmura
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017; 51:314-319. [PMID: 28415159 PMCID: PMC5445207 DOI: 10.4132/jptm.2017.03.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
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Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women’s Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
- Corresponding Author Sung-Chul Lim, MD, PhD Department of Pathology, Chosun University School of Medicine, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-230-6343 Fax: +82-62-226-5860 E-mail:
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Jeong H, Hong SR, Chae SW, Jin SY, Yoon HK, Lee J, Kim EK, Ha ST, Kim SN, Park EJ, Jung JJ, Sung SH, Lim SC. Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test. J Pathol Transl Med 2017. [PMID: 28415159 DOI: 10.4132/jptm.2017.03.17.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cervical cytology for uterine cervical cancer screening has transitioned from conventional smear (CS) to liquid-based cytology (LBC), which has many advantages. The aim of this study was to compare the proportion of unsatisfactory specimens from CS versus LBC at multiple institutions including general hospitals and commercial laboratories. METHODS Each participating institution provided a minimum of 500 Papanicolaou (Pap) test results for analysis. Pap tests were classified according to the participating institution (commercial laboratory or general hospital) and the processing method (CS, ThinPrep, SurePath, or CellPrep). The causes of unsatisfactory results were classified as technical problems, scant cellularity, or complete obscuring factors. RESULTS A total of 38,956 Pap test results from eight general hospitals and three commercial laboratories were analyzed. The mean unsatisfactory rate of LBC was significantly lower than that of CS (1.26% and 3.31%, p = .018). In the LBC method, samples from general hospitals had lower unsatisfactory rates than those from commercial laboratories (0.65% vs 2.89%, p = .006). The reasons for unsatisfactory results were heterogeneous in CS. On the other hand, 66.2% of unsatisfactory results in LBC were due to the scant cellularity. CONCLUSIONS Unsatisfactory rate of cervical cancer screening test results varies according to the institution and the processing method. LBC has a significantly lower unsatisfactory rate than CS.
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Affiliation(s)
- Hoiseon Jeong
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital and Women's Health Care Center, Dankook University College of Medicine, Seoul, Korea
| | - Seoung-Wan Chae
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hye Kyoung Yoon
- Department of Pathology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Juhie Lee
- Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Kyung Kim
- Department of Pathology, Eulji General Hospital, Seoul, Korea
| | - Sook Tai Ha
- T&C Diagnostic Pathology Clinic, Seoul, Korea
| | | | | | | | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Chul Lim
- Department of Pathology, Chosun University School of Medicine, Gwangju, Korea
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Owens CL, Buist DSM, Peterson D, Kamineni A, Weinmann S, Ross T, Williams AE, Stark A, Adams KF, Doubeni CA, Field TS. Follow-up and clinical significance of unsatisfactory liquid-based Papanicolaou tests. Cancer Cytopathol 2014; 123:59-65. [PMID: 25346238 DOI: 10.1002/cncy.21490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND To the authors' knowledge, few studies to date have examined adherence to recommended guidelines for follow-up and outcomes after an unsatisfactory Papanicolaou (Pap) test (UPT) with liquid-based technologies. METHODS Within 4 US health plans, the median time to follow-up and the percentage of patients with follow-up testing by 120 days was calculated after a UPT. Multivariable analyses evaluated the association between clinical factors and follow-up testing. The authors compared the risk of a diagnosis of cervical intraepithelial neoplasia of type 2 or worse (CIN2+) after a UPT with the risk after a satisfactory Pap test while controlling for study site, test year, and other covariates. RESULTS A total of 634,644 Pap tests performed between 2004 and 2010 were included in the current study. Of 1442 UPTs, 53.4% had follow-up testing within 120 days; follow-up differed across the health plans (P<.001) and was found to be higher among patients aged <50 years (57.2% vs 48.8%; P = .01) and those with positive human papillomavirus (HPV) results (84.6% vs 53.9; P <.01). The risk of CIN2+ was similar for patients with both unsatisfactory and satisfactory Pap tests. However, after a UPT, the variables of age <50 years, having no previous history of Pap testing, having a history of a previous abnormal Pap test, and positive HPV status were all found to be risk factors for CIN2+; a positive HPV test was found to be the strongest risk factor for developing CIN2+. A negative HPV test result was protective for a CIN2+ diagnosis. CONCLUSIONS Various clinical factors associated with the risk of CIN2+ appear to influence the receipt of follow-up after a UPT. HPV test results in patients with UPTs might be used in follow-up strategies; specifically, a negative test result might reduce the urgency for repeat Pap testing.
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Affiliation(s)
- Christopher L Owens
- Meyers Primary Care Institute, University of Massachusetts Medical School, Fallon Community Health Plan and Reliant Medical Group, Worcester, Massachusetts; Department of Pathology, University of Massachusetts Medical School, Worcester, Massachusetts
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Quiroga-Garza G, Satrum LS, Trujillo CJ, Mody DR, Ge Y. Common causes for unsatisfactory Pap tests in a high-risk population: insights into a yet unresolved problem in gynecologic cytology. J Am Soc Cytopathol 2014; 3:256-260. [PMID: 31051679 DOI: 10.1016/j.jasc.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although the rates are generally low (0.2%-10%), unsatisfactory Papanicolaou (Pap) tests are associated with an increased risk of epithelial lesions on subsequent follow-up. Therefore, some studies have recommended extra laboratory processing, resampling of patients, and more recently, human papillomavirus testing. MATERIALS AND METHODS Consecutive cases signed out as unsatisfactory for evaluation (UE) were identified from January 1, 2008 to December 31, 2010 in the cytology laboratory at Houston Methodist Hospital. Patient's demographics, relevant prior clinical history, type of Pap test, reasons for UE diagnosis, and cytology or histology follow-up were obtained from the pathology database. RESULTS Among 56,563 total Pap tests, 276 were signed out as UE (0.47%). Nearly half of these patients were older than 50 years (15 to 88 years). The majority (85%) of patients over 50 years old had a history of prior gynecologic cancer. Low squamous cellularity was the most common cause of UE in all age groups. Follow-up abnormalities were identified in 21 of 73 patients (29%). CONCLUSIONS Low squamous cellularity was the most common cause of UE and was often seen in women older than 50 years of age. The significant risk associated with UE emphasizes the importance of appropriate follow-up on these patients.
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Affiliation(s)
- Gabriela Quiroga-Garza
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15221
| | - Laura S Satrum
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Crystal J Trujillo
- Department of Pathology, Baylor College of Medicine, Houston, Texas, 77030
| | - Dina R Mody
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist, 6565 Fannin Street, Suite M227, Houston, Texas, 77030.
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