title: Factors affecting the cytology outcome of Pap smears--a brief approach to internal quality control in private cytopathology laboratory practice.
abstract: We evaluated the effect of intrauterine device (IUD), patient age and hormone replacement therapy (HRT) on cytology outcome in Pap smears together with the important IQC procedures: 1) manual double-screening by cytotechnologists, and 2) retrospective senior pathologist review during 1996-1999. The results from primary double-screening (119 of 87,409 Pap smears) showed an excellent inter-observer correlation. The estimation of hormonal effects showed higher incidence of disagreements (p=0.013) in patients <47 yr. Some individual trends were found in the assessments of both cellular atypia (p=0.012) and Papanicolaou classification (p=0.018). The IUD had no influence on the accuracy when the degree of inflammatory reaction was evaluated (p>0.050), but showed an adverse effect on the estimation of cellular atypia (p=0.001). HRT distinctly equalized the entire sample material, since fewer disagreements were found in the age groups <47 yr and >47 yr when estimating the hormonal effects (p=0.013), inflammatory reaction (p=0.044) or cellular atypia (p=0.006) compared to those without HRT. The continuous cytopathologist supervision had a positive impact on the accuracy of hormonal effect estimation during the 4 years. The senior cytopathologists' reviews (354 of 87,409 Pap smears) showed mutually good interobserver correlation, and diagnostic conclusions of the same specimens differed only slightly between the cytopathologists. We found these state-of-the-art cytopathological IQC procedures to be effective and fit-for-purpose when evaluating hormonal effects, inflammatory reaction and cellular atypia.
authors.affiliation: Medix Laboratories Ltd, Department of Pathology, Espoo, Finland. solveig.linko@medix.fi
authors.forename: S
authors.initials: S
authors.lastname: Linko
authors.forename: E
authors.initials: E
authors.lastname: Taskinen
authors.forename: S
authors.initials: S
authors.lastname: Sarna
authors.forename: P
authors.initials: P
authors.lastname: Kärkkäinen
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D011786:Quality Control; D012015:Reference Standards; D014626:Vaginal Smears / Q000592:standards