Russell, Donna K.

Context.— Though numerous quality assurance (QA) measures are in place for the practice of gynecologic cytopathology, many of them are not clearly defined and may be variably used by laboratories worldwide. Objective.— To assess current practice patterns regarding the implementation of selected gynecologic cytology QA metrics to help develop guidance for laboratories. Design.— A supplemental questionnaire was mailed to laboratories participating in the 2022 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program requesting data regarding their QA measures in gynecologic cytology. Results.— A total of 562 laboratories responded to the supplemental questionnaire; responses from 511 laboratories were analyzed further. Of 492 laboratories, most considered Papanicolaou (Pap) tests from patients with untreated abnormal cytology in the previous year (386; 78.5%) or with an abnormal gynecologic biopsy finding (concurrent or within the past year) (331; 67.3%) as high-risk for negative rescreening. Many laboratories (436 of 511; 85.3%) required pathologist review of Pap tests for indications other than reactive/abnormal cells (eg, endometrial cells in women 45 years of age and older). For assessing cytologists’ performance, 88.5% (399 of 451) of respondents recorded the discrepancy rate between cytologist’s and pathologist’s interpretations. For monitoring pathologists’ performance, most laboratories (243 of 389; 62.5%) evaluated cases with significant cytologic-histologic discrepancy. Conclusions.— The CAP survey provided a detailed assessment of current QA practices regarding gynecologic cytology, which can aid laboratories in making decisions related to enhancement of QA in their setting. As the guidelines and tools for cervical cancer screening evolve, QA metrics will need to be accordingly refined.

Context.— Ensuring equitable laboratory patient care within diverse populations is a priority. The cytopathology laboratory has an important role in providing gender-inclusive care, particularly with regard to screening and prevention of human papillomavirus–related carcinoma, for individuals who are transgender, gender nonbinary, intersex, and with same-gender sexual orientation. Providing equitable care necessitates an understanding of gender-inclusive processes within the cytopathology laboratory. Many barriers to implementation exist and include sociocultural, legal, ethical, and financial hurdles. Objective.— To review the current literature regarding gender-inclusive care within a multi-institutional setting and identify challenges and opportunities for future growth in cytopathology. Specific areas of focus include appropriate terminology in laboratory information systems and requisitions, and variables affecting Papanicolaou test interpretation, human papillomavirus testing, and anal Papanicolaou test screening. Data Sources.— Primary literature was searched within the areas highlighted throughout the article. Multi-institutional experiences from the authors, in addition to editorials and expert opinion, were used. Conclusions.— The cytopathology laboratory has an important role in providing care that is inclusive and accurate for all patients. Gaps in care exist and further work is needed to address these disparities. This review attempts to increase awareness, educate, and share our own multi-institutional experiences, and calls for improvements in cytopathology to optimize quality in gender-inclusive patient care.