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Unsatisfactory Pap Test Results: A Critical Patient Management Problem Pre-Analytically Addressed by the

Mohamad M Gafeer¹, Susan Alperstein¹, Robert Appleby¹

¹Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA.

Diagnostic Cytopathology

|August 15, 2024

Summary

A second Pap test (PT) slide significantly reduces unsatisfactory rates, improving the detection of clinically significant lesions. This quality assurance practice also enables HPV testing for cases initially deemed unsatisfactory.

Keywords:

glacial acetic acid human papilloma virus quality assurance second slide rate unsatisfactory rate

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Area of Science:

Cytopathology
Quality Assurance in Healthcare
Cervical Cancer Screening

Background:

Unsatisfactory Pap test (PT) rates are a key quality assurance (QA) metric in cytopathology.
Current practice involves preparing a second ThinPrep (TP) slide for initially unsatisfactory PTs.
This study evaluates the effectiveness of this QA protocol.

Purpose of the Study:

To assess the impact of a second ThinPrep (TP) slide on reducing unsatisfactory Pap test (PT) rates.
To determine the diagnostic yield of follow-up slides.
To evaluate the feasibility of HPV testing on reclassified slides.

Main Methods:

An analysis of 2739 cases requiring a second TP slide after an initial unsatisfactory PT.
Correlation analysis between initial unsatisfactory rates and second slide adequacy.
Tabulation of Bethesda classifications and HPV data for satisfactory follow-up slides.

Main Results:

The second slide preparation reduced the overall unsatisfactory rate.
28% of cases remained unsatisfactory after the second slide.
Significant detection of cervical lesions, including high-grade squamous intraepithelial lesions (HSIL) and atypical glandular cells (AGC), on follow-up slides.

Conclusions:

A second slide preparation is effective in lowering unsatisfactory Pap test (PT) rates.
This practice enhances the detection of clinically significant cervical lesions.
Slides reclassified as satisfactory (ASC-US or higher) are suitable for Human Papillomavirus (HPV) testing.