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What do screeners refer for checking?

What do screeners refer for checking?. Allan Wilson Lead Biomedical Scientist in Cellular Pathology Advanced Practitioner in Cervical Cytology. Plan for today. What do screeners refer for checking? Monklands audit of checkers National survey of checker role Interactive session.

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What do screeners refer for checking?

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  1. What do screeners refer for checking? Allan Wilson Lead Biomedical Scientist in Cellular Pathology Advanced Practitioner in Cervical Cytology BAC 24th October 2013

  2. Plan for today • What do screeners refer for checking? • Monklands audit of checkers • National survey of checker role • Interactive session BAC 24th October 2013

  3. Screeners referral decisions • What do screeners refer to checkers? • What influences screeners referral patterns? • How do we monitor referrals? • Can we influence over-referral and under-referral? BAC 24th October 2013

  4. Why do screeners refer slides for checking? • Marked inflammation ?dyskaryosis • Bland nuclear enlargement • Atrophy • ?Koilocytes / HPV / dyskeratosis • ?GA / ?Endometrium • ?Small cells • ?degenerate only • Local issues BAC 24th October 2013

  5. Some ground rules..... • Images are representative of slides • All slides changed from BNA to negative by checkers are double screened • All from Thinprep slides • All stained using imager stain • Limited biopsy confirmation • Our opinions on BNA Negative could be wrong...... BAC 24th October 2013

  6. Why do screeners refer slides for checking? • Marked inflammation BAC 24th October 2013

  7. BAC 24th October 2013

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  12. Why do screeners refer slides for checking? • Bland nuclear enlargement • ?perimenopausal or post menopausal changes. BAC 24th October 2013

  13. BAC 24th October 2013

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  18. Why do screeners refer slides for checking? • Atrophy BAC 24th October 2013

  19. BAC 24th October 2013

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  22. Why do screeners refer slides for checking? • ?HPV / ?Koilocytes BAC 24th October 2013

  23. BAC 24th October 2013

  24. 3a BAC 24th October 2013

  25. BAC 24th October 2013

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  28. Why do screeners refer slides for checking? • ?glandular abnormality / ?endometrium BAC 24th October 2013

  29. BAC 24th October 2013

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  33. Why do screeners refer slides for checking? • Immature squamous metaplasia BAC 24th October 2013

  34. BAC 24th October 2013

  35. BAC 24th October 2013

  36. Why do screeners refer slides for checking? • ?degenerate only BAC 24th October 2013

  37. BAC 24th October 2013

  38. BAC 24th October 2013 2a

  39. Why do screeners refer slides for checking? • Check small cells ?high grade BAC 24th October 2013

  40. BAC 24th October 2013

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  44. Why do screeners refer slides for checking? • Other oddities........ BAC 24th October 2013

  45. BAC 24th October 2013

  46. What influences screeners referral patterns? • Confidence levels • Personal issues • Fatigue • Previous performance • Ability • Training • Post –invasive audit or review BAC 24th October 2013

  47. Over referral v Under referral (false +ve v false –ve!) • We tend to notice over referral more quickly as it has a “nuisance” value! • Under referral is potentially more dangerous and more difficult to detect • Usual balance between sensitivity and specificity BAC 24th October 2013

  48. How do we monitor referrals? • Gut feeling? • Worksheets • Spreadsheets • LIMS • Do we have any idea of what a “normal” referral rate is? • What should we do if a referral rate is deemed to be too low? BAC 24th October 2013

  49. How can we influence screener referrals? • Feedback! • More feedback! • Training • Setting targets, self audit • Selected slide reviews • Don’t just live with over or under referral BAC 24th October 2013

  50. Monklands Checker audit BAC 24th October 2013

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