An Analysis of Factors That Influence the ASCUS/SIL Ratio of Pathologists

Juskevicius, Ridas; Zou, Kelly H.; Cibas, Edmund S.

doi:10.1309/0bl4-6h9v-dqvv-ugxr

Cited by 50 publications

(43 citation statements)

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“…Thus, while performance measures such as the required 10% rescreen of negative cases [13,14], the tracking of CT and cytopathologist diagnostic discrepancies [5,6] as well as the atypical squamous cells-to-squamous intraepithelial lesion (ASC/SIL) are all routine in the quanitification of CT quality [15,16,17], the extension of these tools to thyroid FNA is less straightforward [18,19]. This is because the parallels between indeterminate diagnoses in gynecological cytopathology and thyroid cytopathology are few and tenuous.…”

Section: Discussionmentioning

confidence: 99%

Cytotechnologist Performance for Detecting Nuclear Atypia in Indeterminate Thyroid Fine Needle Aspirates

VandenBussche

Adams

Ali³

et al. 2014

Acta Cytologica

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Introduction: The thyroid gland is arguably the fastest growing anatomic site for fine needle aspiration (FNA). With the increase of thyroid cases, a reevaluation of cytotechnologist screening quality metrics in terms of thyroid FNA is called for. We present our institutional cytotechnologist performance at screening for nuclear atypia by applying established quality metrics. Materials and Methods: Information on 8,814 consecutive thyroid cytopathology cases over a 10-year period was retrieved from computerized records. A subsample of cases categorized either as atypia of uncertain significance with nuclear atypia or suspicious for malignancy with features suspicious for papillary thyroid carcinoma. The cytotechnologist and cytopathologist diagnoses were compared using step discrepancies and Δ-ratios. Results: Overall discrepancy between the cytotechnologist and cytopathologist diagnoses existed in <10% of all thyroid cases. One-category discrepancies were the most common (7.8%), while two-category discrepancies were rare (0.5%). The one-category discrepancy rate correlated with cytotechnologist experience. One-category undercalls were twice as common as overcalls (5.3 vs. 2.5%, p < 0.0001). Conclusions: We identified a high level of quality in the screening for nuclear atypia in thyroid FNA. The one-category discrepancy rate is suited to tracking individual cytotechnologist performance, identifies outliers and appears to correlate with cytotechnologist experience.

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Section: Discussionmentioning

confidence: 99%

Cytotechnologist Performance for Detecting Nuclear Atypia in Indeterminate Thyroid Fine Needle Aspirates

VandenBussche

Adams

Ali³

et al. 2014

Acta Cytologica

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“…Currently, cytopathologists in our laboratory receive annual confidential feedback on certain metrics, including turnaround time, and, for gynecologic specimens, their ASCUS-to-SIL ratio and HPV positivity rate for ASCUS cases [18,19]. Over the 5-year period studied here, the AUS utilization rate was not routinely measured or reported to cytopathologists, and TBSRTC was formally published only at the conclusion of the study period.…”

Section: Discussionmentioning

confidence: 99%

The Frequency of ‘Atypia of Undetermined Significance’ Interpretations for Thyroid Fine-Needle Aspirations Is Negatively Correlated with Histologically Proven Malignant Outcomes

VanderLaan

Krane²,

Cibas³

2011

Acta Cytologica

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Objective: Cytopathologists’ usage patterns for ‘atypia of undetermined significance’ (AUS) in thyroid fine-needle aspiration (FNA) are not well understood. AUS rates over a 5-year period were analyzed to quantify variability and identify correlations with experience and histologic outcomes. Study Design: A retrospective review of thyroid FNAs from a tertiary-care hospital from 2005 to 2009 was performed. Results were compiled for individual cytopathologists, stratified by year, and correlated with histologic outcomes. Results: Thyroid FNAs (5,327) were evaluated by 7 cytopathologists, with an overall AUS rate of 11.2%. The annual AUS rate remained relatively constant over this time period, though notable inter- and intrapathologist variability was seen. The AUS rate was significantly lower for those with cytopathology boards (10.3%) compared to those without (14.0%). There was no correlation between the AUS rate and cytopathologist experience or thyroid FNA volume. The AUS rate and malignant outcome were inversely related: the higher an individual’s AUS rate was, the lower the rate of malignancy for that AUS cohort was. Conclusions: Individual cytopathologist AUS rates were variable and often exceeded the recommended target of 7%. The application of recently published defined diagnostic criteria, along with directed cytopathologist feedback, may reduce observer variability and appropriately lower AUS utilization.

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“…[4][5][6][8][9][10]19 Furthermore, because ASCUS and LSIL are the major contributors to ASC and SIL, respectively, the difficulty in differentiating between ASCUS and LSIL is a likely explanation for the wide variation of ASC to SIL ratios between laboratories 1,3 and between cytotechnologists and pathologists, even when they practice at the same institution. [20][21][22][23][24][25][26][27] Previous studies have suggested that the variability among pathologists in the classification of squamous abnormalities may be related to differences in both diagnostic thresholds as well as in diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%