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May 2003
Special Section
A sweep for missing slides
Marianne Prey, MD
The Cytopathology Committee is in search of missing survey
slides distributed to participants in the Interlaboratory Comparison Program in Gynecologic Cytopathology, or Pap program.
The loss of Pap program slides and slidesets now approaches 10 percent. This
loss of slides affects program participants by delaying survey shipments,
and it limits the CAP's ability to accept new laboratories
that want to participate.
The Pap program is unique in that it takes years to complete the
validation process for a single survey slide to fulfill proficiency
testing requirements. The slides for this program are truly one
of a kind. Unlike slides used in the CAP Surveys or PIP programs,
Pap program slides cannot be kept by participating labs.
CAP staff cytotechnologists
first examine donated slides to determine whether the slides are
of good technical quality and an excellent example of the reference
interpretation. Once that is established, at least three Board-certified
pathologists from the Cytopathology Committee review the slides.
The committee members must agree on the exact target interpretation,
and this must agree with the submitted biopsy interpretation (if
LSIL or higher) before the slide can be accepted into the program
as an educational slide.
To move from the educational to graded category, a slide must be field validated.
Validation criteria are as follows:
- At least 20 laboratory participants must submit a response on the slide.
- The percentage of participant responses in the correct selection series must be at least 90 percent.
- The standard error of this percentage cannot exceed 0.05.
- The interpretations submitted on slides in the 100 series must show at least 50 percent
concordance with the exact reference interpretation. Interpretations
submitted on SIL slides must show at least 70 percent concordance
with the exact reference interpretation.
Survey slidesets are mailed only four times a year; thus it takes years of constant
circulation to generate statistics for validation. If even a single
slide is not returned, years of committee and participating laboratory
efforts are lost. More important, these slides are loaned to the
CAP with the understanding that the CAP will track the slides and
be able to retrieve them for the donor laboratory if they are needed
for review for patient care or litigation. If a laboratory fails
to return slides, it is not only hindering the success of the program
but also may be detrimental to patient care.
Slidesets must
be returned using a traceable shipping method within seven working
days as stated in the kit instructions. Continuing medical education
certificates will not be released until CAP staff receives the slideset.
The laboratory will not receive its next slideset until the outstanding
slideset is returned. Failure to comply will make the laboratory
ineligible for participation in the Interlaboratory Comparison Program
in Cervicovaginal Cytopathology. It is important to remember that
laboratories must participate in a glass slide proficiency testing
program to meet CAP Laboratory Accreditation Program requirements
for cytopathology.
Please take the time now to respond to missing slide return requests. Search
every possible place where slides may be. Send everything you find
to the CAP as soon as possible. Call the CAP customer service department
at 800-323-4040, option 3, if you have questions or to request shipping
materials.
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