Hi- Since joining a small private practice group as the only cytopathologist, I've been battling to get the lab ASCUS rate down. After some improvement, we have lost some staff and now the ASCUS rate is out of control again (13-16%, 95th percentile nationally 12%). I will re-educate again, but am curious if anyone else has dealt with this issue and what you have done to remedy. Thanks!
ASCUS rate
- Thread starter Amylacea
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What is your HPV positivity rate for ASCUS cases? If your HPV positivity rate for ASCUS cases is below 40 percent, you might be overcalling.
The ASC:SIL ratio is also high. It is not a patient population issue since looking back from before I arrived and even since I've been here, the ASCUS rate has never been this high. My feeling is paps are put to the backburner and rushed through. I don't have recent HPV stats, but they are also low. I know it is overcalling, and I will re-educate (tough to do with every pathologist having way more experience than me and they are my bosses). What will happen is I will end up doing more paps, with no decrease in my other workload, and there is the frustration. Have any other small labs dealt with an overcalling issue?
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Deck chairs...titanic....It is only a matter of time till HPV testing is the screening test, just hang in there. Once that happens, every Pap will probably be diagnosed as ASCUS since morphology will be a biased reflex test.
You can always show them QA monitors like HPV positivity rate and look at cases together but it is a field with a lot of litigation so good luck getting them to change. I would love to see how many cytopath diagnoses contain "atypical cells". Every case we send out for second opinion, whether it be bile duct brush, urinary specimen or FNA, seems to come back with that diagnosis. It is why cytopath has such a bad rep and it poised to be replaced.
How big of a deal is overcalling nowadays ? This isn't 2 decades ago, when an ASCUS pap got you another pap in 6 months. Most docs don't put much stock into the diagnosis if the HPV is negative. I am not seeing any patients that get biopsied off an ASCUS diagnosis alone but I am seeing many patients getting biopsied off a positive HPV test.
How many Paps are you being forced to screen? We didn't do very many until the great OBGYN practice sell-off began. Not sure we need to be screening pap tests. It is not something you are prepared to do out of training.
You can always show them QA monitors like HPV positivity rate and look at cases together but it is a field with a lot of litigation so good luck getting them to change. I would love to see how many cytopath diagnoses contain "atypical cells". Every case we send out for second opinion, whether it be bile duct brush, urinary specimen or FNA, seems to come back with that diagnosis. It is why cytopath has such a bad rep and it poised to be replaced.
How big of a deal is overcalling nowadays ? This isn't 2 decades ago, when an ASCUS pap got you another pap in 6 months. Most docs don't put much stock into the diagnosis if the HPV is negative. I am not seeing any patients that get biopsied off an ASCUS diagnosis alone but I am seeing many patients getting biopsied off a positive HPV test.
How many Paps are you being forced to screen? We didn't do very many until the great OBGYN practice sell-off began. Not sure we need to be screening pap tests. It is not something you are prepared to do out of training.
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My main concern isn't the clinical impact, it's the inspection. Technically, if you are over the 95th percentile nationally, you have to explain this when inspection time comes. I will document the re-education etc, and maybe inspectors have more important things to look at and it won't be noticed. I was just curious what other people have done in this situation. Our pap volume is about 23K, with 3-5 pathologists, but I do most. I like paps, but I don't get the time to do them justice.
