Automatic failure in gynecologic cytology proficiency testing. Results from the College of American Pathologists proficiency testing program.
BACKGROUND
Automatic failure in gynecologic cytology proficiency testing occurs when a high-grade lesion or carcinoma (HSIL+, Category D) is misinterpreted as negative for intraepithelial lesion or malignancy (Category B).


OBJECTIVE
To document the automatic failure rate in 2006 and 2007 from the College of American Pathologists proficiency testing program (PAP PT) and compare them to projected values from 2004.


METHODS
Identify automatic failures from PAP PT in 2006 and 2007 and compare the rates of failure regarding participant and preparation type to validated slides in the College of American Pathologists Interlaboratory Comparison Program in 2004.


RESULTS
There were 65 264 participant responses for HSIL+ slides included in this analysis from 2006 and 2007. Overall, 1% (666 of 65 264) of the HSIL+ responses were classified as negative, resulting in automatic failure for the participant. There were significantly fewer automatic failures in 2007 as compared with either 2006 or projected from 2004 data (P < .001). Conventional preparations had a lower automatic failure rate than liquid-based preparations but only for 2006. Both pathologists and cytotechnologists interpreting liquid-based preparations faired better than projected from 2004 data.


CONCLUSIONS
The automatic failure rate in PAP PT is lower than expected based on 2004 data from the College of American Pathologists Interlaboratory Comparison Program. Automatic failures are a relatively small component (1% or less) of proficiency testing failures. The rate of automatic failure decreased from 2006 to 2007 and may be due to loss of poor performers in the testing pool, the test-taking environment, or removal of less robust slides from the program.
Moriarty
Ann T
AT
Department of Pathology, AmeriPath Indiana, Indianapolis, Indiana 46219-1739, USA. amoriarty@ameripath.com
Crothers
Barbara A
BA
Bentz
Joel S
JS
Souers
Rhona J
RJ
Fatheree
Lisa A
LA
Wilbur
David C
DC
D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D010338:Pathology, Clinical / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012955:Societies, Medical; D002583:Uterine Cervical Neoplasms / Q000145:classification / Q000175:diagnosis*; D014626:Vaginal Smears / Q000145:classification / Q000379:methods / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000175:diagnosis*