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Unsatisfactory ThinPrep Pap Tests: An Educational Approach to Quality.

Kelly Olson1, Erek Kucher2, Ashley Rasmussen2

  • 1Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

Diagnostic Cytopathology
|March 20, 2026
PubMed
Summary
This summary is machine-generated.

Improving ThinPrep Pap Test (TPPT) quality involved analyzing data to identify root causes of unsatisfactory samples, such as low cellularity. Targeted interventions and education significantly reduced TPPT rejection rates.

Keywords:
educational approachlimiting pap test factorsquality monitorsunsatisfactory ThinPrep pap tests

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Area of Science:

  • Cytopathology
  • Laboratory Medicine
  • Quality Improvement in Healthcare

Background:

  • ThinPrep Pap Test (TPPT) unsatisfactory rates at our institution exceeded the College of American Pathologists (CAP) benchmark of 2.7%.
  • A quality improvement initiative was launched to identify contributing factors and implement corrective actions.

Purpose of the Study:

  • To identify factors leading to unsatisfactory TPPT results.
  • To target interventions at specific clinics with high rejection rates.
  • To establish a system for ongoing monitoring of TPPT quality.

Main Methods:

  • Laboratory Information System (LIS) data from April-June 2022 identified 232 unsatisfactory TPPT cases.
  • Cytopathologists and a cytotechnologist reviewed cases to determine limiting factors (e.g., low cellularity, blood, mucus).
  • Clinics were stratified by TPPT volume, and those exceeding the benchmark were targeted for intervention.

Main Results:

  • Low cellularity was the primary limiting factor in 100% of unsatisfactory cases.
  • Blood (51.7%) and lubricant (18.5%) were also significant contributors.
  • Two clinics exceeded the 3% unsatisfactory rate, prompting targeted educational interventions.

Conclusions:

  • Educational interventions, including best practice bulletins and approved lubricant lists, were provided to targeted clinics.
  • Ongoing monitoring of TPPT data via LIS reports is crucial for sustained quality improvement.
  • Effective LIS utilization is essential for efficient investigation and resolution of laboratory quality variances, especially during staffing shortages.