Quality assurance in gynecologic cytology. What is practical?

The quality of gynecologic cytology has been questioned in the last two years. This author's hospital laboratory has a sizable outpatient gynecologic cytology and biopsy practice from which data have been obtained in several different quality assurance projects. In this article the author analyzes those data with respect to detection of false negative cytology screening errors, specimen sampling errors, precision in cytology and biopsy interpretation, and productivity of quality assurance methods. Sampling errors in obtaining cytology specimens are a major problem to be addressed by cytology quality assurance. The most sensitive and efficient method for detection of false negative cytologic results in this laboratory was rescreening of previous negative Papanicolaou's (Pap) smears in patients presenting for the first time with an abnormal Pap smear. Data indicate that the currently mandated requirement for rescreening 10% of a laboratory's negative Pap smears should be reconsidered and rescinded in certain circumstances.