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    The Differential Diagnosis of Reparative Changes and Malignancy: Performance in the College of American Pathologists Pap Education and Proficiency Testing Programs

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    Author
    Staats, Paul N.
    Souers, Rhona J.
    Nunez, Amberly Lindau
    Li, Zaibo
    Kurtycz, Daniel F. I.
    Goodrich, Kelly
    Witt, Benjamin Lloyd
    Davey, Diane Davis
    Booth, Christine Noga
    Date
    2020-07
    Journal
    Archives of Pathology and Laboratory Medicine
    Publisher
    College of American Pathologists
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.5858/arpa.2019-0298-CP
    Abstract
    Context.-Repair is a challenging diagnosis and a significant source of false-positive (FP) interpretations in cervical cytology. No large-scale study of performance of repair in the liquid-based era has been performed. Objective.-To evaluate the performance of repair in the College of American Pathologists Pap Education and Proficiency Testing (PT) programs. Design.-The FP rate for slides classified as repair was evaluated by preparation type, participant type (cytotechnologist, pathologist, or laboratory), and program. The specific misdiagnosis category and individual slide performance were also evaluated. The rate of misclassification of slides as repair by participants for other diagnostic categories in the Pap Education program was assessed. Results.-The overall FP rate was 1700 of 12 715 (13.4%). There was no significant difference by program or preparation type. Within the Education program there was no difference by participant type, but pathologists' FP rate in the PT program (47 of 514, 9.1%) was significantly better than cytotechnologists in the PT program (51 of 380, 13.4%) and pathologists in the Education program (690 of 4900, 14.1%). High-grade squamous intraepithelial lesions/cancers (HSILþ) accounted for 1380 of 1602 FP interpretations (86%) in Education, but 43 of 98 (43.9%) in PT. Most slides had a low rate of misclassification, but a small number were poor performers. False-negative diagnosis of HSILþ as repair was less common, ranging from 0.7% to 1.8%. Conclusions.-Despite initial indications that liquid-based cytology might reduce the rate of misclassification of repair, FP interpretations remain common and are no different by preparation type. Misclassification is most commonly as HSIL or carcinoma, potentially resulting in significant patient harm.
    Keyword
    Cervix Uteri--cytology
    Cervix Uteri--pathology
    Diagnosis, Differential
    Pathology, Clinical--education
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/13425
    ae974a485f413a2113503eed53cd6c53
    10.5858/arpa.2019-0298-cp
    Scopus Count
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