Q. We are using direct smears for nongynecologic fine-needle aspirations and thinking about switching to liquid-based cytology (SurePath) preparation. There is nothing in the CAP accreditation checklist that pertains to a switch in slide preparation method.
Our lab plans to prepare concurrent direct smears and liquid-based cytology (LBC) preparation for a number of cases covering a range of diagnoses (benign to malignant) and FNA sites. A cytopathologist will review these slides to confirm that the quality of LBC preparation is comparable to direct smears.
Is there a recommended number of cases (for example, 10 per organ system) for this validation process? And does the CAP mandate, as part of a lab’s accreditation requirement, formal training for pathologists who are new to interpreting nongynecologic LBC?
A. You are correct that the CAP cytopathology checklist does not specify requirements for validating a change in slide preparation method for nongynecologic cytology, nor does it require formal retraining or certification for pathologists already credentialed in cytology when adopting nongynecologic LBC. In these situations, laboratories have the flexibility to design a validation protocol that ensures comparable diagnostic quality and patient safety. The approach you outlined reflects the most commonly adopted best-practice method.
Varsha Manucha, MD, MBBS
Professor, Department of Pathology
University of Mississippi Medical Center
Jackson, Miss.
Vice Chair, CAP Cytopathology Committee