Learning From Our Mistakes: A Variety of Diagnostic Pitfalls in Gynecologic Cytopathology
Cindy M. McGrath, MD, FASCP
Cytopathology Gyn QA In Charge, University of Pennsylvania Medical Center, Philadelphia, PA
Assistant Professor of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, PA
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Upon completion of this program, you will be able to:
- Recognize that diagnostic errors provide an important learning opportunity
- Explain the importance of quality assurance and cytohistologic correlation
- Recognize pitfalls when evaluating and diagnosing high-grade squamous intraepithelial lesion
(HSIL), atypical glandular cells (AGC), endocervical adenocarcinoma in situ (AIS), and atypical squamous cells, cannot exclude HSIL (ASC-H) in liquid-based preparations
- Diagnose densely cellular fragments applying systematic morphologic criteria
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Mistakes happen. Diagnostic errors are anxiety-provoking, humbling, and can be difficult to admit, particularly in the current unforgiving litigious environment. Traditionally classified as major or minor and whether leading to major, minor, or no medical consequences for the patient, diagnostic errors provide a learning opportunity. The knowledge gained through re-review of pathology material can be invaluable. Quality assurance and cytohistologic correlation are important tools to identify potential errors in pathologic interpretation and improve diagnostic accuracy.
A variety of gynecologic cytopathology cases with histopathologic follow-up in which different diagnostic errors occurred will be illustrated. These include high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC), endocervical adenocarcinoma in situ (AIS), and atypical squamous cells, cannot exclude HSIL (ASC-H). Both false-negative and false-positive cases will be demonstrated, with a concentration on liquid-based (SurePath) pap specimens. The diagnostic pitfalls of densely cellular fragments and confounding factors, such as menses, atrophy, lower uterine segment, intrauterine device, inflammation, and reparative changes, will be emphasized. The importance of clinical history and communication with the clinician will be discussed as will the communication of diagnostic errors and reporting.
Intended Audience: Pathologists, Residents, Cytotechnologists, Students
The ASCP designates this educational activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation n the activities.
ASCP designates this activity for a maximum of 1 CMLE credits. This activity meets CMP and state licensure requirements for laboratory personnel.