A comprehensive internal quality control system for a large cytology laboratory

The British Columbia Cervical Cytology Program is operated through the Central Laboratory at the Cancer Control Agency in Vancouver and processes all of the gynecologic Papanicolaou smears collected by 3,200 physicians throughout the province of British Columbia. The laboratory receives approximately 2,400 smears per day, and the program currently processes in excess of 500,000 smears annually. This article describes the methods that have been developed for ensuring that adequate quality control is present in the screening and interpretation of half a million smears per year, both at the cytotechnologist and at the cytopathologist level. The results of the quality control program, which was considerably modified in 1985, are also presented. The modified program shows a significant improvement in the number of undercalled and overcalled cases detected in two comparable six-month periods.