College of American Pathologists
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  PAP/NGC Program Review





cap today

August 2003
Special Section

Calling a Pap program slide inadequate

Margaret H. Neal, MD, Theresa M. Voytek, MD

The answer form used in the CAPInterlaboratory Comparison Program in Cervicovaginal Cytopathology has been modified to reflect Bethesda 2001 terminology. A few of the changes on the form have been a source of confusion for participants, particularly regarding specimen adequacy.

Some participants have selected "unsatisfactory for evaluation" as their result based on insufficient endocervical/transformation zone component, even though the slides have adequate cellularity. In one case, the slide had adequate cellularity and Candida, but was reported as unsatisfactory due only to lack of a transformation component.

Participants are required to select an interpretation for each case from the interpretive menu, to report adequacy, and to select adequacy qualifiers, when applicable. An adequacy qualifier alone does not necessarily make a slide unsatisfactory. The Pap program uses the Bethesda 2001 guidelines for adequacy assessment. A specimen is still adequate for evaluation if it lacks an endocervical/transformation zone component. The presence of an obscuring factor does not make a slide unsatisfactory unless it obscures more than 75 percent of the cellular material. And, of course, no slide with a cellular abnormality is ever considered unsatisfactory.

Further explanation and examples are in the instructions provided with the slide kits. Participants can also refer to the Bethesda 2001 guidelines for further discussion of adequacy evaluation.

  1. Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-2119.
  2. Davey DD, Woodhouse S, Styer P, et al. Atypical cells and specimen adequacy. Current laboratory practices in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med. 2000;124:203-211.

Drs. Neal and Voytek are members of the CAP Cytopathology Committee. Dr. Neal is with KWB Pathology Associates, Tallahassee, Fla., and Dr. Voytek is in the Department of Pathology, Hartford (Conn.) Hospital.