Gynecologic cytology proficiency testing failures: what have we learned?: observations from the college of american pathologists gynecologic cytology proficiency testing program.
BACKGROUND
In 2006, the first gynecologic cytology proficiency tests were offered by the College of American Pathologists. Four years of data are now available using field-validated slides, including conventional and liquid-based Papanicolaou tests.


OBJECTIVE
To characterize the pattern of error types that resulted in initial proficiency-test failure for cytotechnologists, primary screening pathologists, and secondary pathologists (those whose slides are prescreened by cytotechnologists).


METHODS
The results of 37 029 initial College of American Pathologists Papanicolaou proficiency tests were reviewed from 4 slide-set modules: conventional, ThinPrep, SurePath, or a module containing all 3 slide types.


RESULTS
During this 4-year period, cytotechnologists were least likely to fail the initial test (3.4%; 614 of 18 264), followed by secondary pathologists (ie, those reviewing slides already screened by a cytotechnologist) with a failure rate of 4.2% (728 of 17 346), and primary pathologists (ie, those screening their own slides) having the highest level of failure (13.7%; 194 of 1419). Failure rates have fallen for all 3 groups over time. Pathologists are graded more stringently on proficiency tests, and more primary pathologists would have passed if they had been graded as cytotechnologists. There were no significant differences among performances using different types of slide sets. False-positive errors were common for both primary (63.9%; 124 of 194 errors) and secondary (55.6%; 405 of 728 errors) pathologists, whereas automatic failures were most common for cytotechnologists (75.7%; 465 of 614 errors).


CONCLUSIONS
The failure rate is decreasing for all participants. The failures for primary pathologist screeners are due to false-positive responses. Primary screening cytotechnologists and secondary pathologists have automatic failures more often than do primary screening pathologists.
Cytopathology Resource Committee, College of American Pathologists, Northfield, Illinois; the Department of Pathology, West Virginia University, Morgantown, WV, USA.
Barbara S
BS
Ducatman
Joel S
JS
Bentz
Lisa A
LA
Fatheree
Rhona
R
Souers
Saula
S
Ostrowski
Ann T
AT
Moriarty
Michael
M
Henry
Rodolfo
R
Laucirica
Christine N
CN
Booth
David C
DC
Wilbur
D003581:Cytodiagnosis / Q000592:standards*; D003951:Diagnostic Errors / Q000517:prevention & control; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D010338:Pathology, Clinical / Q000193:education* / Q000592:standards*; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000592:standards; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis