title: False-Negative Interpretation of Adenocarcinoma In Situ in the College of American Pathologists Gynecologic PAP Education Program.
abstract: BACKGROUND
  - Adenocarcinoma in situ (AIS) is difficult to correctly interpret on Papanicolaou (Pap) cytology slides and false-negative interpretations of AIS can cause significant problems in daily practice.
  
  
  OBJECTIVE
  - To investigate the false-negative interpretation rate of AIS and the factors related to false-negative interpretation through responses in an educational environment.
  
  
  METHODS
  - We retrospectively evaluated 11 337 responses in the PAP Education Program (PAP-Edu) from 173 AIS slides from 2011 to 2015. The false-negative interpretation rate, most common false-negative interpretations, and related other factors were evaluated.
  
  
  RESULTS
  - The overall false-negative rate was 6.9% (784 of 11 337). Respondents correctly interpreted AIS 50.0% (5667 of 11 337) of the time; high-grade intraepithelial lesion (HSIL) and malignancies (adenocarcinoma, squamous cell carcinoma, and other carcinomas) accounted for 42.7% (4842 of 11 337) and low-grade intraepithelial lesion accounted for 0.4% (44 of 11 337) of responses. Overall, 92.7% (10 509 of 11 337) of responses were HSIL and above. Among 784 false-negative responses, negative for intraepithelial lesion or malignancy was the most common (61.5% [482 of 784]), followed by reparative changes (24.1% [189 of 784]) and atrophic vaginitis (7.7% [60 of 784]). Overall, pathologists' responses showed a significantly higher false-negative rate than cytotechnologists' responses (8.3%, 403 of 4835 versus 5.7%, 275 of 4816; P < .001). The false-negative response rates were not statistically different among preparation types.
  
  
  CONCLUSIONS
  - The low correct interpretation rate and higher false-negative rate for AIS demonstrate the difficulty in interpreting AIS on Pap cytology, which may cause clinical consequences. The higher false-negative rate with pathologists than with cytotechnologists suggests cytotechnologists' higher screening sensitivity for AIS or cautious interpretation to avoid false-positive results by pathologists.
authors.forename: Chengquan
authors.initials: C
authors.lastname: Zhao
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Crothers
authors.forename: Z Laura
authors.initials: ZL
authors.lastname: Tabatabai
authors.forename: Zaibo
authors.initials: Z
authors.lastname: Li
authors.forename: Mohiedean
authors.initials: M
authors.lastname: Ghofrani
authors.forename: Rhona J
authors.initials: RJ
authors.lastname: Souers
authors.forename: Mujtaba
authors.initials: M
authors.lastname: Husain
authors.forename: Fang
authors.initials: F
authors.lastname: Fan
authors.forename: Rulong
authors.initials: R
authors.lastname: Shen
authors.forename: Idris Tolgay
authors.initials: IT
authors.lastname: Ocal
authors.forename: Christine N
authors.initials: CN
authors.lastname: Booth
authors.forename: Kelly
authors.initials: K
authors.lastname: Goodrich
authors.forename: Donna
authors.initials: D
authors.lastname: Russell
authors.affiliation: From the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Zhao); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Crothers); the Department of Pathology, University of California San Francisco and VA Medical Centers, San Francisco (Dr Tabatabai); the Department of Pathology, Ohio State University Medical Center, Columbus (Drs Li and Shen); the Department of Pathology PeaceHealth Laboratories, Vancouver, Washington (Dr Ghofrani); the Departments of Biostatistics (Ms Souers) and Survey (Ms Goodrich), College of American Pathologists, Northfield, Illinois; the Department of Clinical Sciences, University of Central Florida, Orlando (Drs Husain and Davey); the Department of Pathology, University of Kansas Medical Center, Kansas City (Dr Fan); the Department of Pathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Arizona (Dr Ocal); the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); and the Department of Pathology, University of Rochester Medical Center, Rochester, New York (Ms Russell).
authors.forename: Diane D
authors.initials: DD
authors.lastname: Davey
mesh_terms: D065311:Adenocarcinoma in Situ / Q000175:diagnosis / Q000473:pathology*; D000574:American Medical Association; D059268:Atrophic Vaginitis / Q000175:diagnosis / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology*; D003951:Diagnostic Errors; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D065006:Papanicolaou Test; D010338:Pathology, Clinical / Q000193:education*; D057089:Pathology, Molecular / Q000193:education*; D012189:Retrospective Studies; D014481:United States