Tabbara S O, Sidawy M K
Department of Pathology, George Washington University Medical Center, Washington, D.C., USA.
Diagn Cytopathol. 1996 Jul;15(1):7-10; discussion 10-1. doi: 10.1002/(SICI)1097-0339(199607)15:1<7::AID-DC3>3.0.CO;2-H.
Federal regulations require laboratories to re-examine negative cervical smears from the 5 yr preceding a diagnosis of high-grade squamous intraepithelial lesion (HSIL) or carcinoma. To assess the value of this regulation as a quality assurance measure, we evaluated the previous cervical smears from 47 patients with a diagnosis of HSIL rendered during a 9-mo period. Fifteen patients had a total of 24 previous smears initially reported as squamous intraepithelial lesions (SIL). The remaining 32 patients had a total of 58 smears that carried a diagnosis lesser than SIL. Upon re-screening 22/58 (38%) smears, from 16 patients, were upgraded to SIL (8 low grade, 14 high grade). Underdiagnosed SIL was detected in seven (44%) patients with the 1-yr review, 12 (75%) with the 2-yr review, 15 (94%) with the 3-yr review, and 16 (100%) with the 5-yr review. The authors conclude that the negative smear review is a beneficial quality assurance and teaching method that may lead to quality improvement. A 3-yr retrospective review is effective and detects 94% of the undercalls.
联邦法规要求实验室重新检查在高级别鳞状上皮内病变（HSIL）或癌诊断前5年的阴性宫颈涂片。为了评估这项法规作为质量保证措施的价值，我们评估了在9个月期间确诊为HSIL的47例患者之前的宫颈涂片。15例患者共有24份之前的涂片最初报告为鳞状上皮内病变（SIL）。其余32例患者共有58份诊断低于SIL的涂片。重新筛查时，来自16例患者的22/58（38%）份涂片被升级为SIL（8份低级别，14份高级别）。在1年复查时，7例（44%）患者检测到漏诊的SIL，2年复查时为12例（75%），3年复查时为15例（94%），5年复查时为16例（100%）。作者得出结论，阴性涂片复查是一种有益的质量保证和教学方法，可能会带来质量改进。3年的回顾性复查是有效的，能检测出94%的漏诊情况。
