title: Room for improvement: initial experience with anal cytology: observations from the College of American Pathologists interlaboratory comparison program in nongynecologic cytology.
abstract: BACKGROUND
  Anal cytology is being used more frequently for anal cancer screening, yet many cytologists are unfamiliar with it.
  
  
  OBJECTIVE
  To describe the performance of anal cytology in the College of American Pathologists' Interlaboratory Comparison Program in Non-Gynecologic Cytology (CAP NGC) educational slide program during a 6-year time span, from 2006 to 2011, using participant responses (pathologist, cytotechnologist, and laboratory).
  
  
  METHODS
  Concordance rates for the target diagnosis and general category for each slide challenge were analyzed. Four main factors were included in the analysis: (1) general category or specific responses, (2) program year from 2006 to 2011, (3) participant type (pathologist, cytotechnologist, or overall laboratory), and (4) preparation type (liquid-based or conventional).
  
  
  RESULTS
  Participants most frequently correctly classified negative for intraepithelial lesion or malignancy, low-grade squamous intraepithelial lesion, and herpes simplex virus infection, with concordance rates of 78.8%, 85%, and 80.2%, respectively. Performance on challenges with target diagnoses of high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma, and ameba was poor, with concordance rates of 57.1%, 56.2%, and 41.5%, respectively. Significant improvement during the 6 years was seen in the concordance rates of participants' responses for low-grade squamous intraepithelial lesion challenges but not for HSIL. There was no significant difference in performance by slide preparation type.
  
  
  CONCLUSIONS
  The poor performance on anal cytology in the CAP NGC program, especially with regard to correct identification of HSIL and squamous cell carcinoma, indicates that there is a need for continued education about anal cytology.
authors.affiliation: From the Departments of Pathology, and Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco (Dr Darragh); the Department of Pathology, Mount Kisco Medical Group, Mount Kisco, New York (Dr Winkler); Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania (Dr Zhao); and the Department of Pathology, AmeriPath, Indianapolis, Indiana (Dr Moriarty).
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Darragh
authors.forename: Barbara
authors.initials: B
authors.lastname: Winkler
authors.forename: Rhona J
authors.initials: RJ
authors.lastname: Souers
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Laucirica
authors.forename: Chengquan
authors.initials: C
authors.lastname: Zhao
authors.forename: Ann T
authors.initials: AT
authors.lastname: Moriarty
mesh_terms: D001003:Anal Canal / Q000166:cytology*; D001004:Anus Diseases / Q000175:diagnosis; D001005:Anus Neoplasms / Q000175:diagnosis; D002278:Carcinoma in Situ / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D003581:Cytodiagnosis / Q000706:statistics & numerical data*; D004404:Dysentery, Amebic / Q000175:diagnosis; D005260:Female; D006561:Herpes Simplex / Q000175:diagnosis; D006801:Humans; D007753:Laboratories; D008297:Male; D015588:Observer Variation; D010338:Pathology, Clinical / Q000193:education; D012955:Societies, Medical; D014481:United States