title: Limiting the use of atypical/inconclusive as a category in nongynecologic cytology specimens.
abstract: BACKGROUND
  'Atypical' has served as a descriptive term in cytology since the birth of the specialty by Dr Papanicolaou. This indeterminate diagnosis often results in repeat biopsies or additional tissue sampling and a needless delay in patient care if used inappropriately. Because of the definitional ambiguity of this term and the associated physician frustration, we have made a concerted effort at Methodist Hospital since 1995 to minimize the use of 'atypical' as a diagnostic category.
  
  
  OBJECTIVE
  To evaluate whether the dissolution of the 'atypical' category has increased our cytologic-histologic discordance rate to more than the published reference range.
  
  
  METHODS
  From March 3, 2006, through December 31, 2008, all nongynecologic cases with 'atypical/indeterminate' listed as the general diagnostic category were identified and retrieved from our laboratory data files. We then assessed the cytologic-histologic correlation rate during the corresponding time frame.
  
  
  RESULTS
  A total of 48 'atypical' cases (0.2%) from 19 347 nongynecologic specimens were identified. Of the 'atypical' cases, 52% (25 of 48) had intradepartmental consultation, 58% (28 of 48) had additional preparations examined, and 29% (14 of 48) documented limitations because of poor preservation. Our cytologic-histologic discrepancy rate for the period was 5.5% (214 of 3912 cases), with 89.3% (191 of 214 cases) resulting from sampling issues. On review of the small percentage of cytologic interpretative discrepancies, only one case was unhampered by less than 10% tumor cellularity or poor preservation.
  
  
  CONCLUSIONS
  Not using 'atypical' as a diagnostic category, unless defined by Bethesda guidelines, has not affected our cytologic-histologic correlation rate.
authors.affiliation: Department of Pathology and Laboratory Medicine, The Methodist Hospital, 6565 Fannin Street, Houston,TX 77030, USA. tjolley@tmhs.org
authors.forename: Tracie M
authors.initials: TM
authors.lastname: Koen
authors.forename: Dina R
authors.initials: DR
authors.lastname: Mody
authors.forename: Miriam
authors.initials: M
authors.lastname: Scheiber-Pacht
authors.forename: Todd
authors.initials: T
authors.lastname: Fairley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thrall
mesh_terms: D006801:Humans; D008499:Medical Records / Q000592:standards*; D010336:Pathology; D017410:Practice Guidelines as Topic; D009626:Terminology as Topic