title: Etiologic factors related to unsatisfactory ThinPrep(®) cervical cytology: Evaluation and potential solutions to improve.
abstract: BACKGROUND
  In cervical cytology, the unsatisfactory rates for ThinPrep (TP) are slightly higher compared to SurePath. We examined various causes and explored potential for resolution of this discrepancy.
  
  
  METHODS
  Totally, 19,422 cases were reviewed and 1000 unsatisfactory specimens were selected and analyzed. 531 specimens were available for wash protocol. Out of 114 unsatisfactory specimens associated with atrophic cellular changes (ACC), 48 were resubmitted by provider and reevaluated.
  
  
  RESULTS
  Lubricant and lubricant-like debris/contamination (LUBE) was the most common cause of unsatisfactory specimens (68%; 681/1000) followed by blood (7.5%); ACC only (without other interfering factors) (2.4%); inflammation (3.0%); and combinations thereof (1.9%). 11.5% showed scant cellularity without an identifiable cause. 3.3% were virtually acellular. Wash protocol improved cellularity in 48% (256/531) of cases. However, only 29% (73/256) of those were satisfactory (with more than 5000 cells). Quantitative reduction in LUBE after wash protocol varied with different morphological subtypes. Interpretation patterns on satisfactory specimens after wash protocol were comparable to the results on selected cohort of specimens during the same study period. Out of 114 ACC, wash protocol was performed on 68 ACC specimens leading to satisfactory TP in 24% (16/68). Totally, 48 cases reported as unsatisfactory with ACC, were resubmitted by the providers between 2 weeks and 2 years. 44 (92%) showed increased cellularity, out of which 52% (23/44) did not show ACC.
  
  
  CONCLUSIONS
  LUBE was the most common cause of unsatisfactory TP in addition to interference by blood and association with atrophic changes. Knowing the morphological spectrum of LUBE would help to identify it as the cause of unsatisfactory TP. Communicating the cause of unsatisfactory TP such as LUBE, ACC, and blood would hint the provider to take appropriate precaution during submission of the repeat specimen, leading to improved patient care.
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Tatyana
authors.initials: T
authors.lastname: Kalinicheva
authors.affiliation: Department of Pathology, University at Buffalo, Buffalo, New York, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Frisch
authors.affiliation: Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Tamar
authors.initials: T
authors.lastname: Giorgadze
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Shashi
authors.initials: S
authors.lastname: Madan
authors.affiliation: Student, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Anushree
authors.initials: A
authors.lastname: Shidham
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Amarpreet
authors.initials: A
authors.lastname: Bhalla
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Linette
authors.initials: L
authors.lastname: Mejias-Badillo
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Tranchida
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Bandyopadhyay
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Inderpreet
authors.initials: I
authors.lastname: Dhillon
authors.affiliation: Address: Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, 4707 St. Antoine Blvd, Detroit, MI 48201, USA.
authors.forename: Vinod B
authors.initials: VB
authors.lastname: Shidham
keywords: Cervical cancer; Papanicolaou smear; ThinPrep; cytology; liquid based cytology; lubricant; unsatisfactory; wash protocol