No abstract

BACKGROUND: Documenting the performance of gynecologic screening in actual practice settings is difficult to achieve. In the current study, the screening performance of 11 individual cytotechnologists as well as that of the overall laboratory over 2 consecutive time periods was examined using the rapid prescreening (RPS) method. METHODS: RPS was performed by all cytotechnologists in a single laboratory over 2 separate 8-month periods. The sensitivity of screening for individual and groups of cytotechnologists was examined. For purposes of comparison, cytotechnologists were divided into 2 groups: screeners with an overall routine sensitivity !95% and screeners with an overall sensitivity <95%. RESULTS: Atypical squamous cells (ASC) were used as a threshold, and routine screening sensitivity was found to vary from 68.3% to 96.8%.The overall sensitivity of the laboratory for RPS and routine screening was 43.6% and 88.4%, respectively. Over time, the overall laboratory sensitivity of routine screening improved from 85.3% to 91.3% (P ¼ .01).During this same time frame, the sensitivity of the screeners with an overall sensitivity <95% improved from 79.3% to 91.2% (P < .001), whereas the sensitivity of screeners with an overall routine sensitivity !95% remained the same (96.1% to 96.4%; P ¼ .6). CONCLUSIONS: In addition to improved overall performance of the laboratory by detecting and correcting errors, the results of the current study indicate that using RPS consistently over time might play a role leading to improved performance of cytotechnologists with an overall routine sensitivity <95% but not of cytotechnologists with an overall routine sensitivity !95%. KEY WORDS: rapid prescreening, routine screening, performance, sensitivity, improvement, gynecologic cytology, quality control, diagnostic accuracy.Many quality control (QC) methods have been used to increase the sensitivity of cytopathology laboratories, with full rescreening of approximately 10% of randomly selected negative Papanicolaou (Pap) smears being the most commonly used method in North America. Original Article criticized for being inefficient and lacking statistical power to detect low-level achievements in primary screening within laboratories.5-8 Alternative strategies include either manual rescreening of all negative Pap smears, which is time-consuming and not practical in a high-volume laboratory, or automated rescreening of all negative Pap smears, which has generated promising results but is still expensive and not widely used. [9][10][11][12][13][14][15][16] Rapid prescreening (RPS) of all gynecologic specimens is an inexpensive technique that was introduced in the United Kingdom (UK) as an alternative and useful QC standard; however, it is far from becoming routine practice in North America. 17-19As a matter of fact, even in the UK, the most widely used QC method is rapid rescreening (RR) rather than RPS. 9,16 In that regard, Arbyn et al 5 have demonstrated that RPS and RR yield comparable gains in the detection of missed abnormalities, with...

Organs involved by Castleman disease (CD) may be investigated by fine-needle aspiration cytology. No specific cytomorphological criteria are currently described for a definitive diagnosis. The cytological features of three fine-needle aspirations from three different lymph nodes of a patient with histologically confirmed CD of the hyaline-vascular type are herein reported, with a review of the literature. The fine-needle aspirations showed branching capillaries associated with fragments of germinal center. Review of the literature yielded 12 other case reports with over half describing similar findings. Because branching hyalinized small blood vessels penetrating follicular germinal center are characteristic of CD of the hyaline-vascular type on histology, this finding in fine-needle aspirates should raise that diagnostic possibility.

The atypical squamous cell/squamous intraepithelial lesion (ASC/SIL) ratio has been used as a surrogate quality control tool for specificity and uncertainty for cytopathologists. Whether this ratio is useful for cytotechnologists is not known. During an 8-month period, the sensitivity of screening for 11 cytotechnologists was determined using rapid prescreening. The ASC/SIL ratio for each cytotechnologist was correlated with the screening accuracy for each. Screening sensitivity varied from 50.5% to 97.7%, and the ASC/SIL ratio varied from 0.87 to 4.49. The mean screening sensitivity for cytotechnologists with ASC/SIL ratios less than 1.5 was significantly less than that of cytotechnologists whose ASC/SIL ratio was more than 3.0 (67% vs 95%; P = .021). In the absence of more accurate quality control data, an ASC/SIL ratio less than 1.5 for a cytotechnologist may be a surrogate marker for inadequate screening sensitivity.