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.
- Solomon D, Davey D, Kurman R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-2119.
- 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.