Objectives

Implementation of quality control measures ensures acceptable performance by a laboratory. This study aims to assess the quality of cervical cytopathology reporting using quality metrics like ASCUS/SIL ratio, cytohistological correlation (CHC) and positive predictive value (PPV) of Pap smears for squamous lesions of cervix.

Methods

Retrospective study of Pap smears from 2015 to 2020 was done. Quality metrics analyzed include: a) ASCUS/SIL ratio, b) CHC and c) PPV. Cases with cervical biopsies/hysterectomy were included for CHC, and discrepancy defined as two category variations in CHC.

Results

A total of 22,695 cervical cytology smears were reported. Unsatisfactory smears(n=290) were excluded. Squamous lesions reported in 233 smears and Bethesda nomenclature was followed. Definitive diagnosis (SILs and SCC) was given in 74% cases. ASCUS and ASC-H were reported in 47 and 14 cases. Most common lesion on Pap smear was HSIL(n=92), followed by LSIL(n=64), and 2 were ungradable SIL. SCC was reported in 14 smears. The ASCUS/SIL ratio was 0.38. CHC(n=139) was 100% for ASC-H ,LSIL, SCC and 84.7% for HSIL. A review of discrepant cases suggested sampling and interpretational discrepancy in 5 and 1 cases respectively. The PPV of Pap smear for squamous lesions was 96.4%.

Conclusion

It is essential to have good quality cytopathology reports for early identification permitting accurate management.Most commonly used quality indicator for cytopathology is ASCUS/SIL ratio. This study suggests inclusion of CHC and PPV of pap smear as quality metrics, since these are easily measurable and serve as a good indicator of quality in cervical cytopathology reporting.