Prospective and retrospective review of gynecologic cytopathology: findings from the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference working group 2.
BACKGROUND
Two quality metrics for gynecologic cytology are the subject of this review: "prospective rescreening" and "retrospective rescreening."


OBJECTIVE
To offer consensus best practice approaches based on the College of American Pathologists' laboratory-based survey funded by the Centers for Disease Control and Prevention.


METHODS
The College of American Pathologists submitted a paper-based survey to 1245 laboratories. After review of initial results, follow-up Web-based survey results, and a literature review, consensus best practice statements were presented at a national consensus conference. These statements were discussed and voted upon by conference participants. Results.-A total of 541 laboratories responded to survey questions about prospective and retrospective rescreening. Most laboratories (>85%) prospectively rescreen more than 10% of Pap tests interpreted as negative for intraepithelial lesion or malignancy. Most (72%) report inclusion of less than 20% high-risk cases. Most laboratories use multiple measures to define "high risk." Most laboratories (96.2%) retrospectively rescreen Pap tests from the preceding 5 years only. In most laboratories (71.4%) only Pap test results with high-grade squamous intraepithelial lesion or worse prompt retrospective review.


CONCLUSIONS
The number of Pap tests from high-risk patients should be maximized in prospective and retrospective rescreening. Unsatisfactory Pap tests should also be included. All readily identifiable high-risk human papillomavirus-positive cases with an interpretation of negative for intraepithelial lesion or malignancy should be prospectively rescreened. Cervical biopsy results with high-grade cervical intraepithelial neoplasia or worse (CIN 2+) should trigger retrospective rescreening. Regular feedback should be provided to cytotechnologists and cytopathologists. Upgraded diagnoses from negative for intraepithelial lesion or malignancy to atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion, should be monitored.
Department of Anatomic Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. brainaj@ccf.org
Jennifer A
JA
Brainard
George G
GG
Birdsong
Tarik M
TM
Elsheikh
David A
DA
Hartley
Kalyani
K
Naik
Margaret H
MH
Neal
Rhona J
RJ
Souers
Michael R
MR
Henry
D003585:Cell Biology / Q000592:standards*; D003625:Data Collection; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D030361:Papillomavirus Infections / Q000175:diagnosis; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012955:Societies, Medical; D014412:Tumor Virus Infections / Q000175:diagnosis; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000592:standards; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis