title: Appeals in gynecologic cytology proficiency testing: review and analysis of data from the 2006 College of American Pathologists gynecologic cytology proficiency testing program.
abstract: BACKGROUND
  In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals are granted if 3 referee pathologists do not unanimously agree on the initial reference diagnosis in a masked review process.
  
  
  OBJECTIVE
  To investigate causes of PT failures, subsequent appeals, and appeal successes in 2006.
  
  
  METHODS
  Appeals were examined, including patient demographic information, Centers for Medicare and Medicaid Services category (A, B, C, or D), exact reference diagnosis, examinees per appeal, examinee's Centers for Medicare and Medicaid Services category, referee's Centers for Medicare and Medicaid Services category, slide preparation type, and slide field validation rate.
  
  
  RESULTS
  There was a 94% passing rate for 2006. One hundred fifty-five examinees (1.6%) appealed 86 slides of all preparation types. Forty-five appeals (29%) were granted on 21 slides; 110 appeals (72%) were denied on 65 slides. Reference category D and B slides were most often appealed. The highest percentage of granted appeals occurred in category D (35% slides; 42% of participants) and the lowest occurred in category B (9% slides; 8% of participants). The field validation rate of all appealed slides was greater than 90%.
  
  
  CONCLUSIONS
  Despite rigorous field validation of slides, 6% of participants failed. Thirty percent of failing participants appealed; most appeals involved misinterpretation of category D as category B. Referees were never unanimous in their agreement with the participant. The participants and referees struggled with the reliability and reproducibility of finding rare cells, "overdiagnosis" of benign changes, and assigning the morphologically dynamic biologic changes of squamous intraepithelial lesions to static categories.
authors.affiliation: Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. barbara.crothers@na.amedd.army.mil
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Crothers
authors.forename: Ann T
authors.initials: AT
authors.lastname: Moriarty
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Fatheree
authors.forename: Christine N
authors.initials: CN
authors.lastname: Booth
authors.forename: William D
authors.initials: WD
authors.lastname: Tench
authors.forename: David C
authors.initials: DC
authors.lastname: Wilbur
mesh_terms: D002983:Clinical Competence; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006176:Gynecology / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D009656:North America; D010338:Pathology, Clinical / Q000379:methods / Q000592:standards*; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012955:Societies, Medical; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000145:classification / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis