Increasing cytotechnologist workload above 100 slides per day using the ThinPrep imaging system leads to significant reductions in screening accuracy.
BACKGROUND
With the current and projected shortage of a cytotechnologist (CT) workforce and the desire to reduce laboratory costs, increased productivity with automated assisted primary screening has become an attractive option for many laboratories. To the best of the authors' knowledge, longitudinal studies examining the effect of increasing workload on the performance of individual CTs have not been performed previously.


METHODS
Using the ThinPrep imaging system (TIS), the performance of 3 CTs with variable levels of experience were evaluated. Their productivity was noted to increase from an average of 87 to 118 slides per day. The analysis included comparisons of error rates, screening rates, and screening times, including a review of 22 fields of view (FOV). Poststudy interviews of the CTs were also performed.


RESULTS
Increased workload was found to be proportional to the decreased percentage of cases that underwent full manual review (25.2% to 20.1%; P < .001), and decreased actual screening times (7.3 hours/day to 6.7 hours/day, and 5.0 minutes/slide to 3.7 minutes/slide). This resulted in a lower detection of total abnormal findings (10.4% to 8.3%; P < .001), atypical squamous cells (6.7% to 4.9%; P < .001), and high-grade squamous intraepithelial lesion (0.9 %to 0.7%; P = .37), as well as an increased false-negative fraction rate (3.8% to 7.0%; P = .08).


CONCLUSIONS
The results of the current study indicate that an increased average CT workload >100 slides per day with the TIS appears to have been accomplished mostly through a reduction in the amount of time spent reviewing the 22 FOV and the percentage of cases that underwent full manual review, which resulted in a significantly reduced screening performance.
Department of Pathology, Ball Memorial Hospital, PA Labs, 2401 University Avenue, Muncie, IN 43703, USA. elsheikht@ecipath.com
Tarik M
TM
Elsheikh
Joseph L
JL
Kirkpatrick
Mackenzie K
MK
Cooper
Mary L
ML
Johnson
Allison P
AP
Hawkins
Andrew A
AA
Renshaw
D019411:Clinical Laboratory Techniques; D003952:Diagnostic Imaging / Q000295:instrumentation*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D011786:Quality Control; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods*; D016526:Workload