The effect of continuous monitoring of cytologic-histologic correlation data on cervical cancer screening performance.
BACKGROUND
The use of Papanicolaou (Pap) test cytologic-histologic correlation in quality improvement activities is not well studied.


OBJECTIVE
To determine if continuous monitoring of correlation data improves performance.


METHODS
Participants in the College of American Pathologists Q-Tracks program (213 laboratories) self-reported the number of Pap test-histologic biopsy correlation discrepancies every quarter for up to 8 years. A mixed linear model determined if the length of participation in the Q-Tracks program was associated with improved performance. Main outcome measures were predictive value of a positive Pap test, Pap test sensitivity, sampling sensitivity, and proportion of positive histologic diagnoses following a Pap test diagnosis of atypical squamous cells or atypical glandular cells.


RESULTS
Institutions evaluated 287,570 paired Pap test-histologic correlation specimens and found 98,424 (34.2%) true-positive Pap test correlations, 19,006 (6.6%) false-positive Pap test correlations, and 6575 (2.3%) false-negative Pap test correlations. The mean predictive value of a positive Pap test, sensitivity, screening and interpretive sensitivity, sampling sensitivity, and proportion of positive histologic diagnoses following a Pap test diagnosis of atypical squamous or glandular cells were 83.6%, 93.7%, 99.2%, 94.2%, 60.3%, and 38.8%, respectively. Longer participation was significantly associated with a higher predictive value of a positive Pap test (P = .01), higher Pap test sensitivity (P = .002), higher Pap test sampling sensitivity (P = .03), and higher proportion of positive histologic diagnoses for a Pap test diagnosis of atypical squamous cells (P < .001).


CONCLUSIONS
Long-term monitoring of cytologic-histologic correlation is associated with improvement in cytologic-histologic correlation performance.
Raab
Stephen S
SS
University of Pittsburgh School of Medicine, UPMC Shadyside Hospital, Department of Pathology, 5150 Centre Ave, Pittsburgh, PA 15232, USA. raabss@upmc.edu
Jones
Bruce A
BA
Souers
Rhona
R
Tworek
Joseph A
JA
D001706:Biopsy; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006652:Histological Techniques / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D008403:Mass Screening; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D011785:Quality Assurance, Health Care / Q000379:methods*; D011786:Quality Control; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000517:prevention & control; D014626:Vaginal Smears / Q000592:standards* / Q000706:statistics & numerical data