Unsatisfactory Pap Test Results: A Critical Patient Management Problem Pre-Analytically Addressed by the Cytopathology Laboratory

IF 1 4区医学 Q4 MEDICAL LABORATORY TECHNOLOGY Diagnostic Cytopathology Pub Date : 2024-08-15 DOI:10.1002/dc.25398

Mohamad M. Gafeer, Susan Alperstein, Robert Appleby, Jose-Scarpa Carniello, Jonas J. Heymann, Abha Goyal, Momin T. Siddiqui

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Abstract

Background

The unsatisfactory rate of Pap tests (PT) is an important quality assurance (QA) metric for a cytopathology laboratory. At our institution, an unsatisfactory PT slide is followed by a second ThinPrep (TP) slide. The aim of this study is to evaluate this QA practice.

Methods

Our laboratory processes an unsatisfactory TP PT with a follow-up second TP slide with or without glacial acetic acid. The correlation between the unsatisfactory rate and the second slide rate test was examined.

Results

A total of 2739 cases with a second TP slide were prepared for an unsatisfactory initial TP PT. After second slide preparation, 780 cases (28%) remained unsatisfactory. Using Spearman's rank correlation test, there was a notable negative correlation between the unsatisfactory rate and the second slide rate (rho = −0.42). Of those PTs recategorized as satisfactory TP, 1742 were negative for intraepithelial lesion or malignancy (NILM) (89%), 135 as atypical squamous cells of undetermined significance (ASC-US) (7%), 37 as low-grade squamous intraepithelial lesion (LSIL) (1.9%), 11 as atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) (0.6%), 8 as high-grade squamous intraepithelial lesion (HSIL) (0.4%), and 20 as atypical glandular cells (AGC) (1%). The final Bethesda categorization for all cases and the human papilloma virus (HPV) data was tabulated.

Conclusions

A second slide preparation significantly reduced the unsatisfactory rate of the PT. This also had a significant impact by detecting clinically significant lesions. HPV testing can also be performed on slides reclassified from unsatisfactory to ASC-US or higher.

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子宫颈抹片检查结果不满意：细胞病理学实验室分析前处理的一个重要患者管理问题。

背景：巴氏试验（PT）的不满意率是细胞病理学实验室的一项重要质量保证（QA）指标。在我院，不满意的 PT 切片会进行第二次薄层切片（TP）。本研究旨在评估这一质量保证做法：我们实验室在处理不合格的 TP 切片时，会使用或不使用冰醋酸进行第二次 TP 切片的后续处理。研究了不满意率与第二次玻片率检测之间的相关性：共有 2739 个病例因初次 TP PT 不满意而进行了第二次 TP 切片制备。第二次制片后，仍有 780 个病例（28%）不合格。通过斯皮尔曼等级相关性检验，不满意率与第二次切片率之间存在明显的负相关（rho = -0.42）。在重新归类为满意 TP 的 PT 中，1742 例为上皮内病变或恶性肿瘤（NILM）阴性（89%），135 例为意义未定的非典型鳞状细胞（ASC-US）（7%），37 例为低级别鳞状上皮内病变（LSIL）（1.9%），11 个为不能排除高级别鳞状上皮内病变的非典型鳞状细胞（ASC-H）（0.6%），8 个为高级别鳞状上皮内病变（HSIL）（0.4%），20 个为非典型腺细胞（AGC）（1%）。所有病例的最终贝塞斯达分类和人类乳头状瘤病毒（HPV）数据已制成表格：结论：第二次制片大大降低了 PT 的不满意率。结论：第二次切片制备大大降低了 PT 的不满意率，同时还能发现有临床意义的病变。HPV检测也可以在从不满意率重新分类为ASC-US或更高的玻片上进行。

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来源期刊

Diagnostic Cytopathology 医学-病理学

CiteScore

2.60

自引率

7.70%

发文量

163

审稿时长

3-6 weeks

期刊介绍： Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.