Litigation cells: their incidence and classification in gynecologic smears

Area of Science:

• Cytopathology
• Cervical Cancer Screening

Background:

• Litigation cells are benign cells that can be mistaken for dysplasia or cancer.
• These cells may be used in legal cases to allege missed diagnoses by cytotechnologists or pathologists.

Purpose of the Study:

• To investigate the prevalence and characteristics of benign cells that mimic dysplasia or cancer in cervical smears from patients without uterine dysplasia or cancer.
• To assess the potential for misinterpretation of these cells in legal contexts.

Main Methods:

• Review of 180 cervical smears from 166 patients who underwent hysterectomy for benign leiomyomas.
• Histologic examination of uteri to confirm absence of dysplasia or cancer.
• Classification of atypical cells mimicking dysplasia or cancer.

Main Results:

• 90.6% of smears contained benign cells with atypia mimicking dysplasia or cancer.
• Identified "litigation cells" included parabasal, metaplastic, degenerated endocervical, reactive endocervical, endometrial cells, neutrophils, histiocytes, and air-dried cells.
• Mimicked conditions included squamous cell carcinoma, high-grade/low-grade squamous intraepithelial lesions, adenocarcinoma, and glandular dysplasia.

Conclusions:

• Experienced cytotechnologists and cytopathologists can correctly classify these benign "litigation cells".
• A panel of experienced cytopathologists should review smears in alleged malpractice cases, blinded to clinical outcomes.
• Simulating normal screening conditions during review is recommended.