title: Measuring the significance of participant evaluation of acceptability of cases in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.
abstract: BACKGROUND
  The quality of gynecologic cytology slides within educational and proficiency testing programs may deteriorate during use. Participant evaluation of the acceptability of these slides subsequent to possible deterioration is not known.
  
  
  OBJECTIVE
  To assess participants' evaluation of the acceptability of slides circulating within an educational gynecologic cytology glass slide program.
  
  
  METHODS
  The College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology is a peer comparison and educational program that evaluates the ability of the participants to correctly classify gynecologic cytology preparations. The program uses both expert review and field validation to select slides for the graded portion of the program. Participants were asked to assess the acceptability of slides within the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology, and their responses were assessed with respect to type of slide preparation, validation status, and reference diagnosis. In addition, we compared the cytodiagnostic discordancy rates of slides that were deemed acceptable by participants with those that were deemed unacceptable.
  
  
  METHODS
  Participant assessments were derived from pathologists and cytotechnologists from cytology laboratories of all types.
  
  
  RESULTS
  A total of 17,210 slide interpretations were reviewed, and 2.91% of the cases were labeled unacceptable by participants. For all slides, the percentage of cases called unacceptable varied from 1.65% for cases with a reference interpretation of herpes to 45% for cases with a reference interpretation of unsatisfactory. The percentage of slides deemed unacceptable was higher for validated slides than for educational slides (3.27% vs 2.55%, P = .006). The discordancy rate (to reference diagnosis series) for cases deemed unacceptable was significantly higher than the discordancy rate for cases deemed acceptable for both validated (10.39% vs 1.76%) and educational slides (21.72% vs 3.53%, P < .001).
  
  
  CONCLUSIONS
  Greater than 97% of all slides in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology were judged acceptable by participants. Despite expert review and field validation, a small percentage of slides (almost 3%) in this program were deemed unacceptable by participants. These results support the use of participant evaluation of cases to continually improve the quality of cases in this program.
authors.affiliation: Department of Pathology, Baptist Hospital of Miami, Miami, FL, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: Dina R
authors.initials: DR
authors.lastname: Mody
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: David C
authors.initials: DC
authors.lastname: Wilbur
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Colgan
mesh_terms: D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control; D005104:Expert Testimony; D005260:Female; D006801:Humans; D009656:North America; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care; D011786:Quality Control; D015203:Reproducibility of Results; D012955:Societies, Medical; D014626:Vaginal Smears / Q000145:classification / Q000379:methods / Q000592:standards*