Comparison of False Negative Rates Between 100% Rapid Review and 10% Random Full Rescreening as Internal Quality Control Methods in Cervical Cytology Screening

Lee, Benjamin Chi Kui; Lam, Stephen T.S.; Walker, Todd

doi:10.1159/000325307

Cited by 12 publications

(10 citation statements)

References 21 publications

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“…The sensitivity of rapid prescreening was approximately 60% higher than that of 100% rapid review in detecting abnormalities as severe as ASC-US or worse, and although no other studies have yet been carried out to compare these methods, these findings are in agreement with other studies that have evaluated rapid prescreening and 100% rapid review separately. 3,4,9,19,20,[28][29][30][31][32] Significant improvement in sensitivity was found in routine screening following implementation of rapid prescreening and 100% rapid review as methods of internal quality control. Sensitivity increased 24% and 15% for rapid prescreening and 100% rapid review, respectively, in detecting abnormalities as severe as ASC-US or worse.…”

Section: Discussionmentioning

confidence: 99%

Improvement in the routine screening of cervical smears

Tavares

Sousa

Manrique

et al. 2011

Cancer Cytopathology

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Section: Discussionmentioning

confidence: 99%

Improvement in the routine screening of cervical smears

Tavares

Sousa

Manrique

et al. 2011

Cancer Cytopathology

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“…In recent years, several articles have focused on measures other than traditional 10% rescreening of negative slides to increase quality. Some of these have included 100% rapid rescreening of negative slides and rapid prescreening of slides 5–7. Many laboratories including ours now also rely upon automation to help with increasing Pap test accuracy and timeliness 8…”

mentioning

confidence: 99%

Focused rescreening of NILM Pap slides from women ≥30 years of age with positive high risk HPV DNA: An enhanced quality control measure

Sturgis¹,

Schaaf²,

Tickman³

2012

Diagnostic Cytopathology

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CLIA 88 regulations specify that at least 10% of negative for intraepithelial lesion or malignancy (NILM) Paps be rescreened as a means of quality control (QC). With the incorporation of HPV DNA testing into American Society for Colposcopy and Cervical Pathology guidelines for women ≥ 30 years of age, a population of NILM patients with positive HPV results exists. Slides from this cohort were rescreened to judge the value of focused QC. Three hundred and eighty-six consecutive, NILM, HCII+, Paps (SurePath and ThinPrep, September 2009 to December 2009) from women aged ≥ 30 were retrieved from the CellNetix files. These slides were rescreened by cytotechnologists. Slides rescreened as atypical squamous cells (ASC) or higher by cytotechnologists were viewed by cytopathologists (CDS/RJT) who assigned a final interpretation. Of the 386 rescreened cases, 50 (12.9%) were placed in categories of ASC or higher, and 11 (2.9%) were interpreted as LSIL or above. By comparison, routine QC (including random, FocalPoint enriched, and historically high risk cases) was performed on a total of 20,580 Paps (21% of 99,501 annual cases). Concomitant routine QC revealed that 2.1% (427/20,580) were upgraded to ASC or higher and 0.3% (52/20,580) were upgraded to LSIL or higher. Focused rescreening of NILM cases with positive HPV DNA resulted in the detection of approximately ten times more SIL cases than did routine QC Pap slide review at CellNetix. Focused rescreening of this patient set may enhance QC in cytopathology laboratories performing liquid-based Paps. An inherent potential bias in study design is recognized, as results of DNA testing were by definition known at the time of rescreen.

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“…Since the publication of the 1991 article by Baker and Melcher, at least an additional 37 articles have been published on some aspect of rapid rescreening of negative smears, reporting large or small studies, testing the best methods and times for rapid rescreening or editorializing 1, 3–41. Although the data have been variable, nearly all reports have concluded that additional abnormal cases have been detected at all levels beyond those found by 10% full rescreening of negatives, including high‐risk cases determined by a variety of clinical factors, most specifically a history of abnormal cervical cytology.…”

Section: Discussionmentioning

confidence: 99%

Rapid prescreen of cervical liquid‐based cytology preparations: Results of a study in an academic medical center

Frable¹,

Pedigo²,

Powers³

et al. 2010

Diagnostic Cytopathology

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A rapid prescreening or rapid rescreening method for quality assurance in cervical cytology has been used in Europe and in Canada but has not been accepted in the United States. The rapid prescreen method was tested in a cytology laboratory that serves an academic medical center with a high-risk population for cervical cancer. For a period of 3 months, a tray of 20 sequentially numbered Surepath™ liquid-based preparations, randomly selected from the cervical cytology daily workload, were each prescreened in a random fashion for 1 minute. Experienced cytotechnologists performed the rapid prescreen. Results were recorded as negative, further review needed, or epithelial cell abnormality, category specified. The 20 cervical cytology preparations were then replaced in their same position in the daily workload for routine screening performed by another cytotechnologist. Final interpretation was by a cytopathologist as requested or required by Clinical Laboratory Improvement Amendments of 1988. The rapid prescreen data was tabulated and compared with data for a similar time period using the laboratory's normal quality assurance program. Seven hundred and twelve cases underwent rapid prescreen. Six hundred and forty-two were interpreted as negative. Twenty-six cases were interpreted as low-grade squamous intraepithelial lesion (LGSIL) or higher. Forty-four cases were classified as needing further review. For the 642 negative cases by rapid prescreening, routine screening reported 537 as negative and 105 as either abnormal or needed cytopathologist review. The error rate for the rapid prescreen is 50 of 712 (7.0%); for LGSIL and above 19 of 712 (2.6%). Of the 105 abnormal cases or those submitted for cytopathologist review, 31 were interpreted as atypical squamous cells of undermined significance (ASCUS), 41 cases as reactive/repair, 17 as LGSIL, 4 as unsatisfactory, 1 as atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion (ASC-H), 8 as the presence of endometrial cells in a women aged >40, 1 as malignant melanoma, and 2 as within normal limits with the presence of Actinomyces. The laboratory's routine quality assurance program selects cases, 10% of initially interpreted negative cases plus any gynecologic cytology on patients with a prior abnormal cervical cytology, or history of cervical epithelial cell abnormality. This quality assurance program averages 29% of cases, 4,045 of a total of 13,767, in 2008. Thirty-seven (0.9%) cases were detected in this rescreen (ASCUS, 16 cases; LGSIL, 13 cases; 1 high-grade squamous intraepithelial lesion; 4 ASC-H; and 3 atypical glandular cells of undetermined significance). Eliminating ASCUS cases, eight significant cases were detected, with an error rate of 0.2%. In this cytology laboratory, the rapid prescreen did not prove as reliable as routine quality assurance program for cervical cytology cases.

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Comparison of False Negative Rates Between 100% Rapid Review and 10% Random Full Rescreening as Internal Quality Control Methods in Cervical Cytology Screening

Cited by 12 publications

References 21 publications

Improvement in the routine screening of cervical smears

Improvement in the routine screening of cervical smears

Focused rescreening of NILM Pap slides from women ≥30 years of age with positive high risk HPV DNA: An enhanced quality control measure

Rapid prescreen of cervical liquid‐based cytology preparations: Results of a study in an academic medical center

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