Diagnostic performance of United States Air Force cytology laboratories. An eight-year experience in central monitoring.

Based on experience obtained through review of historical case material, the cytology program of the United States Air Force was regionalized into ten cytocenters, which annually process approximately 375,000 gynecologic cases. In order to assure uniformity and quality of diagnosis to multiple supplying clinics, standardized diagnoses were developed with required central reporting of all abnormal recovery rates. Initial results showed a sign-out abnormal rate (class II or worse) ranging from 1% in two cytocenters to nearly 6% in two others--over a fivefold variation on a demographically similar population. Variation by diagnostic class and follow-up tissue biopsies are reported to validate the higher abnormal rates. Through an applied program over the last seven years of formal education of pathologists and cytotechnologists, consultative visits and sharing of comparative referred statistics, the subsequent abnormal rates were substantialy altered to a range of 3.5% to 7.0%. More recently, required reporting of abnormal rates per technologist appears to be another monitor of laboratory quality, in that a given cytocenter may have a total abnormal rate of 4.5%, but a range among cytotechnolgists of 1.3% to 8.7%. These and other presented statistics may prove valuable for external monitoring (including assessment of quality performance) of individual cytology laboratories.