title: Liquid-based Papanicolaou tests in endometrial carcinoma diagnosis. Performance, error root cause analysis, and quality improvement.
abstract: Recent reports show that the sensitivity of endometrial carcinoma detection on liquid-based Papanicolaou (Pap) tests (88%) is considerably higher than that reported on conventional Pap smears (20%-30%), although few laboratories have corroborated these results. We performed a 5-year retrospective review of all liquid-based Pap tests (n = 69) in women who later were given a diagnosis of endometrial carcinoma, performed error root cause analysis, and developed quality improvement initiatives as a means of error reduction. The original and rescreened Pap test sensitivity rates for endometrial carcinoma were 31.9% and 59.3%, respectively. Root cause analysis showed that poor specimen quality and cognitive failures contributed to a false-negative error in 67% (18/27) and 59% (16/27), respectively, of all cases. System analysis showed that latent factors contributing to error included lack of redundant and educational systems. We conclude that system redesign of liquid-based Pap test screening processes has the potential to improve sensitivity in endometrial carcinoma diagnosis.
authors.affiliation: Dept. of Pathology, University of Colorado, 12605 E 16th Avenue, Aurora, CO 80045, USA. .
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Sams
authors.forename: Heather S
authors.initials: HS
authors.lastname: Currens
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Raab
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors / Q000517:prevention & control*; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012189:Retrospective Studies; D013048:Specimen Handling; D014626:Vaginal Smears / Q000379:methods* / Q000592:standards