PAP/NGC Programs Review
Ann T. Moriarty, MD
Proficiency testing in gynecological cytology has taken a front seat in the
practice of cytology. Many enhancements have been made this year to the CAP
Interlaboratory Comparison Program in Gynecological Cytology. In addition to
the traditional gyn challenges, the CAP offered a mock proficiency test as part
of the educational slide challenge program. This program allows labs to practice
for government-approved proficiency testing, offering a 10-slide challenge that
will be graded as if used in proficiency testing. The mock PT portion of the
program is not an official PT test; it’s a tool to help labs prepare for
their actual proficiency tests. As a result of the change this year in the Pap
program configuration, participants will receive three mailings consisting of
two educational five-case slide sets and one educational 10-case mock PT slide
The CAP has developed a PT program while at the same time calling for federal
review of the regulations leading to PT, and the Centers for Medicare and Medicaid
Services recently approved the CAP program for 2006. Since 1989, the CAP Cytopathology
Committee has been providing the Interlaboratory Comparison Program in Gynecologic
Cytology based on the PT requirements of CLIA ’88. For two years, the
CAP staff and members of the CAP Cytopathology Committee have worked tirelessly
to have the PT program in place when the CAP received CMS approval. For a single
annual fee, participants will receive two educational challenges of five slides
each as well as a single 10-slide PT. The CAP PT not only conforms to CMS standards
for PT, but also will meet the CAP’s more stringent criteria for field
validation. For participants in the CAP program, the benefits are a more rigorously
validated PT program and an opportunity to receive 12 continuing medical education
credits for the educational component. In addition, the educational program
fulfills accreditation requirements for an interlaboratory peer-comparison program.
Only CAP offers both PT and CME in the same program.
In addition to the CAP’s new PT program, progress has been made in new
College programs using the Internet, glass slides, and more traditional efforts.
In 2006 a new Web-based gyn and nongyn program will be offered. Using a virtual
slide scanning technique, participants will be able to view a slide using their
own computers, pick the correct answer, and answer several other challenge questions
based on the virtual slide exercise. The Web-based program will make it possible
to disseminate more unusual cases to a wider audience. In the classic interlaboratory
comparison programs, slides of unusual diseases are difficult to obtain in sufficient
volume to distribute them widely to participants. The Web-based design allows
more participants the opportunity to see odd or unusual cases incorporating
ancillary studies, such as flow cytometry, genetics, and immunological or molecular
studies. The new gyn program includes four yearly Web-based challenges as part
of the glass slide educational program. Two cases will accompany the first educational
glass slide challenge, and two cases will accompany the second glass slide challenge.
The new nongyn program will also offer four challenges; two thyroid and two
respiratory cases are being offered as an enhancement to the current glass-based
program. These new exercises will bring the experts into your office.
More improvements are underway in the glass slide interlaboratory comparison
program. Fine-needle aspirates of bone will be catalogued with their radiographs
during the course of next year. Participants will be able to obtain computer-based
images of the radiographs or other pertinent studies as they evaluate the bone
fine-needle aspirates. Similar programs are being evaluated for immunocytochemistries
and ancillary flow cytometry studies for various tumors and lymphomas.
Many cytologists still enjoy the feel and visual images in a standard text.
Members of the CAP Cytopathology Committee are composing a publication of gynecologic
cytology based on the committee’s findings and experiences over the last
16 years. Included in the brief text and atlas are topics of basic morphology,
classic differential diagnostic problems in gynecologic cytology, HPV biology—“what
you need to know,” management topics, practical discussions of new technology,
summary of TBS/ASCCP management guidelines, and quality improvement procedures
and policies. This small volume, which you can expect to see within the next
year, will be packed with important information arranged in a user-friendly
Of course, the CAP will continue to offer the classic glass slide interlaboratory
comparison program in nongynecologic cytology as well as the educational challenges
for gynecologic cytology. These programs still deliver the best opportunity
for learning and growth in cytopathology.
Dr. Moriarty, a member of the CAP Cytopathology Committee, is with AmeriPath, Indianapolis.