College of American Pathologists
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September 2006
PAP/NGC Programs Review

Jonathan H. Hughes, MD, PhD

If you encounter a slide in the Pap or nongyn program that you believe is technically suboptimal or doesn’t clearly represent the reference diagnosis, please let the CAP Cytopathology Committee know what your specific criticism is.

Particular care is given to selecting technically satisfactory slides that are clear representations of the reference diagnoses. Nonetheless, in spite of our best efforts, slides occasionally circulate that are suboptimal for evaluation. Often, these are slides that were originally of good quality at the time they were accepted into the Pap or nongyn program but that deteriorated or faded during months or years of their circulating among participants.

We appreciate, and rely upon, input from program participants to help us identify slides that are no longer suitable, but often the letters and e-mails we receive from program participants are too vague to be helpful. Comments such as “that slide is terrible” or “this slide should be thrown out” do not provide enough specific information for us to evaluate the complaint’s validity.

Examples of specific criticisms might include the following: “The stain is too faded for interpretation,” “The majority of the dysplastic cells are low grade, therefore calling into question the reference diagnosis of HSIL,” or “There are too few atypical cells present for a definitive diagnosis of malignancy.”

All participant criticism and complaints are taken seriously. At each quarterly meeting of the CAP Cytopathology Committee, all of the letters and e-mails we receive are read and studied, and multiple members of the committee review all slides that have been called into question. Moreover, everyone who sends a complaint receives a formal letter from the committee that describes the results of the slide review process and summarizes any resulting change in the status of the slide in question. In most cases, the committee members agree with the complainant, and the slide is removed from circulation. If the slide was from a graded slide set, the participant’s score is adjusted accordingly.

The letters we receive from program participants are a vital part of the collegial, mutually educational interaction the CAP strives to foster in the Pap and nongyn programs. We appreciate the letters that inform us of suboptimal slides, so keep your constructive criticisms and suggestions coming.

Dr. Hughes, a member of the CAP Cytopathology Committee, is with Laboratory Medicine Consultants Ltd., Las Vegas.