January 2009
PAP/NGC Programs Review

Galen M. Eversole, MD
Beth Anne Chmara, CT(ASCP)

Eleven years ago, in a nondigital world far, far away, the CAP offered a glass slide, ungraded educational subscription program, the Interlaboratory Comparison Program in Nongynecologic Cytology. In 1997 there were 794 laboratories with 3,371 participants (1,891 pathologists and 1,480 cytotechnologists). This program has expanded to 1,982 laboratories and 9,656 participants. Each quarter, the laboratory receives five glass slides from fine-needle aspirations and exfoliative smears with associated clinical information. After the participants choose a diagnosis, they receive a description of the diagnostic entity with pertinent references that may include immunohistochemical or flow cytometric findings. Benchmarking data are included to allow interlaboratory comparison, and statistics are generated for each diagnostic category.

The glass slide program is purely morphological and includes entities that are difficult (or impossible) to diagnose without access to ancillary information. Participants often commented that specific diagnoses were impossible without special studies. Changes and enhancements have been made to the program in the past few years as access to digital image technology has become more widely available. In 2007, the program included virtual microscopy cases that were characterized by a whole slide image and selected still images of rare and unusual cases, complete with radiographs, immunohistochemical studies, molecular studies, or other ancillary information. Participants received immediate feedback on their online interpretations and were challenged with educational questions. Virtual challenge participants were awarded additional CME credit.

This year, the glass slide program has been expanded to include access to additional information needed for specific diagnoses. The enhanced features are accessed through e-Lab Solutions. By opting in to this process, each laboratory and its enrolled participants will be able to view additional ancillary images in one or more of five categories of images. These categories are radiologic images, additional cytology, ancillary stains, flow cytometry, and molecular/genetic testing. The intent is to provide appropriate ancillary information that is often necessary for a definitive and specific subclassification of a cytology abnormality.

The process for accessing e-Lab Solutions is as follows:

• Establish a personal Web account at www.cap.org.
• Log in to the CAP Web site with your user ID and password.
• To take advantage of e-Lab Solutions, your lab’s site administrator must log on to www.cap.org and “Opt In.” Each laboratory enrolled received a one-time PIN to activate (opt in to) the lab’s online account. If your lab administrator does not have a PIN, call the CAP customer contact center at 800-323-4040, option 1.
• After logging in, request access to CAP programs for your laboratory through the following steps: on the Administration Options page, click the Request Access link; enter your laboratory’s seven-digit CAP number (found on your result form) in the designated field and click Submit; and confirm your request. An e-mail message will automatically be sent to your laboratory’s site administrator so that he or she can approve or deny your request for access. You will receive an e-mail message notifying you that the administrator has approved or denied your request.
• If you have access to more than one laboratory’s program data, you must first select the laboratory whose program data you want to access. Click on the Select or Change Laboratory link. A list is displayed of all laboratories to which you have been granted access. Select a laboratory using the appropriate radio button and click Select.

Here’s how to access the Web-enhanced images:

• Log in to www.cap.org.
• Go to e-Lab Solutions, proficiency testing.
• Under Anatomic Pathology, click on Result Forms.
• Choose a kit number from the list or enter your kit number.
• Click View Details for your kit number.
• Click the View Image(s) box.
• View appropriate image(s).

Help is available at 800-323-4040, option 1, or in the kit instructions for the current mailing.

We welcome your feedback. Call the CAP customer contact center at 800-323-4040, option 1, or click on Contact Us at www.cap.org to send comments by e-mail.