Transformation zone sampling rate used as a performance indicator for cervical liquid‐based cytology sample‐takers

Abstract

Identification of practitioners with low TZSRs compared with their peers allows these individuals to be selected for personalized observation and training by a specialist in cervical cytology which can lead to an improvement in TZSR. As previous studies show a significant correlation between the TZSR and the detection rate of cytological abnormality it is useful to investigate low TZSRs.

ABC3 and LBC – Adequate or not?

“…Although, the Icelandic ThinPrep preparations were reported using the current Bethesda system (and presumably using the minimum cellularity of 5000 recommended therein), the inadequate rates quoted by Sigurdsson (0.1–0.4% for women aged 20–39 years and 0.1–0.6% for those aged 40–69 years) are very much smaller than those obtained by other users of ThinPrep publishing in this issue of 3.5–4.6% at Guy's and St Thomas’ and 2.7% in Scotland . The inadequate rates for conventional smears were also remarkably low (0.1–1.3%) compared with those seen in the UK before the introduction of LBC (greater than 8%). It may be that Icelandic smear‐takers are exceptionally well skilled and obtain specimens (both conventional and LBC) that are more cellular than those taken in the UK.…”

“…Be that as it may, lumping together the inadequate rates for laboratories using the different preparation methods does not make sense when trying to detect abnormally low inadequate rates in laboratories using ThinPrep and abnormally high rates in those using SurePath. Furthermore, as pointed out by Faraker and Greenfield in their paper on improving sampling practice, individual sample‐takers’ inadequate rates are audited (as part of the Quality Outcomes Framework in England) and are thus implicitly taken as an indicator of the quality of their performance. Although comparisons of inadequate rates for sample‐takers using the same LBC preparation methods are valid, comparisons of inadequate rates for those using different preparation methods are not.…”

“…Another aspect of the problem of adequacy is addressed in this issue by Faraker and Greenfield, who address the often neglected (by cytopathologists) aspect of ensuring adequacy, that of the sample‐takers’ technique. It is assumed that good technique, both in sampling the correct area of the cervix and in the use of the sampling broom, will maximize the chances of an adequate number of cells from the transformation zone of the cervix being present in the vial.…”

Lack of transformation zone in cervical Pap tests, should it be a concern? A quality assurance initiative

“…There may also be inadequate visualization of the cervix during the procedure. Monitoring these practitioners resulted in improvement of the ETZ rates …”