A Liquid Concept-Do Classic Preparations of Body Cavity Fluid Perform Differently Than ThinPrep Cases? Observations From the College of American Pathologists Interlaboratory Comparison Program in Non by ProQuest

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									                                           CAP Laboratory Improvement Programs




    A Liquid Concept—Do Classic Preparations of Body
   Cavity Fluid Perform Differently Than ThinPrep Cases?
        Observations From the College of American Pathologists Interlaboratory
                  Comparison Program in Nongynecologic Cytology
  Ann T. Moriarty, MD; Mary R. Schwartz, MD; Barbara S. Ducatman, MD; Christine N. Booth, MD; Jennifer Haja, CT(ASCP);
                                  Subhendu Chakraborty, MS; Beth Williamson, CT(ASCP)

● Context.—Newer liquid-based preparations differ mor-                   16 750 of the fluid challenges; 88% were classic prepara-
phologically from classic preparations (smears, filters, and              tions, and 12% were ThinPrep challenges. The exact match
cytocentrifuged preparations). Is adenocarcinoma more                    to the reference diagnosis of adenocarcinoma was seen in
readily detected in liquid-based preparations? We reviewed               77% of conventional preparations and 81% of ThinPrep
responses from 16 750 fluid challenges of adenocarcinoma                  challenges when a general category of ‘‘positive for malig-
distributed in 2005 in the College of American Pathologists              nancy’’ was assigned. When ‘‘suspicious for malignancy,’’
Interlaboratory Comparison Program in Nongynecologic                     an exact match diagnosis of adenocarcinoma was made in
Cytology (CAP NGC).                                                      5% and 4% of classic and ThinPrep challenges, respec-
  Objective.—To compare the performance of body cavity                   tively.
fluid liquid-based preparations with adenocarcinoma to
                                                                            Conclusions.—ThinPrep challenges performed slightly
that in classic preparations in the CAP NGC.
  Design.—Responses for ThinPrep challenges were com-                    better overall, but only pelvic washings and peritoneal flu-
pared with classic preparations for exact match diagnoses                ids demonstrated statistically significant improved perfor-
of adenocarcinoma from pelvic washes, pleural fluid, peri-                mance with ThinPrep challenges. Use of liquid-based prep-
cardial fluid, and peritoneal fluids in the 2005 CAP NGC.                  aration is widespread for nongynecologic preparations and
  Results.—A total of 13 690 pathologists, 8345 cytotech-                performs as well, and sometimes better than, classic prep-
nologists, and 5958 laboratories submitted responses to                  arations in an interlaboratory comparison program.
fluid challenges in 2005. Adenocarcinoma comprised                           (Arch Pathol Lab Med. 2008;132:1716–1718)


B   ody cavity fluid specimens are commonly encountered
     in daily practice; differentiating adenocarcinoma
from reactive mesothelial cells is a daily dilemma. Since
                                                                         laboratories converted from their classic method of fluid
                                                                         preparation (smears, filters, and/or cytocentrifuge, with
                                                                         or without a cell block) to newer liquid-based processing
1991, the ThinPrep (TP) processor has been approved by                   in addition to or as a replacement for their usual methods.
the US Food and Drug Administration for processing non-                     The College of American Pathologists Interlaboratory
gynecologic specimens and became commercially avail-                     Comparison Program in Nongynecologic Cytology (CAP
able in 2005. In 1999, the SurePath liquid-based technique               NGC) program began in 1997. During the following 8
was approved by the US Food and Drug Administration                      years, the program grew to include 1750 laboratories and
and used to prepare nongynecologic specimens. Many                       7776 participants. This purely educational program con-
                                                                         sists of a quarterly glass slide mailing with 5 slides and a
   Accepted for publication March 19, 2008.                              brief clinical history. Individuals and laboratories partici-
   From AmeriPath Indiana, Indianapolis (Dr Moriarty); the Cytopathol-   pate in the CAP NGC program for continuing education
ogy Resource Committee, College of American Pathologists, Northfield,     or to provide a measurement of their performance com-
Ill (Drs Moriarty, Schwartz, Ducatman, and Booth); the Department of     pared with other laboratories.
Pathology, The Methodist Hospital, Houston, Tex (Dr Schwartz and Mr         Th
								
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