{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T15:32:39Z","timestamp":1770823959393,"version":"3.50.1"},"reference-count":30,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Context.<\/jats:italic>\n                    \u2014In 2006, 9643 participants took the initial College of American Pathologists (CAP) Proficiency Test (PT). Failing participants may appeal results on specific test slides. Appeals are granted if 3 referee pathologists do not unanimously agree on the initial reference diagnosis in a masked review process.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objectives.<\/jats:italic>\n                    \u2014To investigate causes of PT failures, subsequent appeals, and appeal successes in 2006.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design.<\/jats:italic>\n                    \u2014 Appeals were examined, including patient demographic information, Centers for Medicare and Medicaid Services category (A, B, C, or D), exact reference diagnosis, examinees per appeal, examinee's Centers for Medicare and Medicaid Services category, referee's Centers for Medicare and Medicaid Services category, slide preparation type, and slide field validation rate.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results.<\/jats:italic>\n                    \u2014There was a 94% passing rate for 2006. One hundred fifty-five examinees (1.6%) appealed 86 slides of all preparation types. Forty-five appeals (29%) were granted on 21 slides; 110 appeals (72%) were denied on 65 slides. Reference category D and B slides were most often appealed. The highest percentage of granted appeals occurred in category D (35% slides; 42% of participants) and the lowest occurred in category B (9% slides; 8% of participants). The field validation rate of all appealed slides was greater than 90%.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    \u2014Despite rigorous field validation of slides, 6% of participants failed. Thirty percent of failing participants appealed; most appeals involved misinterpretation of category D as category B. Referees were never unanimous in their agreement with the participant. The participants and referees struggled with the reliability and reproducibility of finding rare cells, \u201coverdiagnosis\u201d of benign changes, and assigning the morphologically dynamic biologic changes of squamous intraepithelial lesions to static categories.\n                  <\/jats:p>","DOI":"10.5858\/133.1.44","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T07:42:23Z","timestamp":1613115743000},"page":"44-48","source":"Crossref","is-referenced-by-count":2,"title":["Appeals in Gynecologic Cytology Proficiency Testing: Review and Analysis of Data From the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program"],"prefix":"10.5858","volume":"133","author":[{"given":"Barbara A.","family":"Crothers","sequence":"first","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann T.","family":"Moriarty","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"Fatheree","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine N.","family":"Booth","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William D.","family":"Tench","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Wilbur","sequence":"additional","affiliation":[{"name":"From the Department of Pathology and Laboratory Services, Walter Reed Army Medical Center, Washington, DC (Dr Crothers); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); the Department of Cytology Surveys, College of American Pathologists, Northfield, Ill (Ms Fatheree); the Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Booth); Palomar Medical Center, Escondido, Calif (Dr Tench); and the Department of Pathology..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"key":"i1543-2165-133-1-44-b1","series-title":"Fed Regist","first-page":"62606","article-title":"Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists\u2013 HCFA. Final rule with comment period.","volume":"59","year":"1994","unstructured":"Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists\u2013 HCFA. Final rule with comment period.\n          Fed Regist\n          1994. 59:62606\u201362609."},{"key":"i1543-2165-133-1-44-b2","article-title":"2006 PAP Gynecologic Cytology PT Program (PAP PT) Year-End Summary Report.","unstructured":"2006 PAP Gynecologic Cytology PT Program (PAP PT) Year-End Summary Report.\n          Northfield, Ill: College of American Pathologists; 2006."},{"key":"i1543-2165-133-1-44-b3","article-title":"PAP PT Appeal Process and Submission page.","unstructured":"College of American Pathologists.\n          \n          PAP PT Appeal Process and Submission page.\n          Available at: http:\/\/www.cap.org\/apps\/cap.portal?_nfpb=true&_pageLabel=pappt_page. Accessed December 15, 2007."},{"key":"i1543-2165-133-1-44-b4","series-title":"Arch Pathol Lab Med","first-page":"788","article-title":"Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program.","volume":"132","author":"Bentz, J. S.","year":"2008","unstructured":"Bentz, J. S., J. H.Hughes, L. A.Fatheree, M. R.Schwartz, R. J.Soures, and D. C.Wilbur. for the Cytopathology Resource Committee, College of American Pathologists. Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program.Arch Pathol Lab Med2008. 132:788\u2013794."},{"key":"i1543-2165-133-1-44-b5","series-title":"JAMA","first-page":"2114","article-title":"Bethesda 2001: terminology for reporting the results of cervical cytology.","volume":"287","author":"Solomon, D.","year":"2002","unstructured":"Solomon, D., D.Davey, and A.Moriarty. et al. Bethesda 2001: terminology for reporting the results of cervical cytology.JAMA2002. 287:2114\u20132119."},{"key":"i1543-2165-133-1-44-b6","series-title":"Diagn Cytopathol","first-page":"83","article-title":"Candida-related changes and ASCUS: a potential trap!","volume":"16","author":"Miguel, N. L. Jr","year":"1997","unstructured":"Miguel, N. L. Jr, C. M.Lachowicz, and T. S.Kline. Candida-related changes and ASCUS: a potential trap!Diagn Cytopathol1997. 16:83\u201386."},{"key":"i1543-2165-133-1-44-b7","series-title":"J Low Genit Tract Dis","first-page":"210","article-title":"2006 consensus guidelines for the management of women with abnormal cervical screening tests.","volume":"11","year":"2007","unstructured":"Solomon D, for the 2006 ASCCP-sponsored Consensus Conference.\n          \n          2006 consensus guidelines for the management of women with abnormal cervical screening tests.\n          J Low Genit Tract Dis\n          2007. 11:210\u2013222."},{"key":"i1543-2165-133-1-44-b8","series-title":"Cancer Cytopathol","first-page":"272","article-title":"The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion.","volume":"99","author":"Nasser, S. M.","year":"2003","unstructured":"Nasser, S. M., E. S.Cibas, C. P.Crum, and W. C.Faquin. The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion.Cancer Cytopathol2003. 99:272\u2013276."},{"key":"i1543-2165-133-1-44-b9","series-title":"Cancer Cytopathol","first-page":"277","article-title":"The significance of \u201clow-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion\u201d as a distinct squamous abnormality category in Papanicolaou tests.","volume":"108","author":"Elsheikh, T. M.","year":"2006","unstructured":"Elsheikh, T. M., J. L.Kirkpatrick, and H. H.Wu. The significance of \u201clow-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion\u201d as a distinct squamous abnormality category in Papanicolaou tests.Cancer Cytopathol2006. 108:277\u2013280."},{"key":"i1543-2165-133-1-44-b10","series-title":"Arch Pathol Lab Med","first-page":"609","article-title":"Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?","volume":"129","year":"2005","unstructured":"Colgan TJ, for the Cytopathology Resource Committee, College of American Pathologists.\n          \n          Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?\n          Arch Pathol Lab Med\n          2005. 129:609\u2013613."},{"key":"i1543-2165-133-1-44-b11","series-title":"Arch Pathol Lab Med","first-page":"1119","article-title":"Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.","volume":"130","year":"2006","unstructured":"Colgan TJ, for the Cytopathology Resource Committee, College of American Pathologists.\n          \n          Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.\n          Arch Pathol Lab Med\n          2006. 130:1119\u20131122."},{"key":"i1543-2165-133-1-44-b12","series-title":"Arch Pathol Lab Med","first-page":"1413","article-title":"Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.","volume":"127","author":"Renshaw, A. A.","year":"2003","unstructured":"Renshaw, A. A., D. D.Davey, and G. G.Birdsong. et al. Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.Arch Pathol Lab Med2003. 127:1413\u20131420."},{"key":"i1543-2165-133-1-44-b13","series-title":"Cancer (Cancer Cytopathol)","first-page":"467","article-title":"The dysfunctional federally mandated proficiency test in cytopathology: a statistical analysis.","volume":"111","author":"Nagy, G. K.","year":"2007","unstructured":"Nagy, G. K. and S.Naryshkin. The dysfunctional federally mandated proficiency test in cytopathology: a statistical analysis.Cancer (Cancer Cytopathol)2007. 111:467\u2013476."},{"key":"i1543-2165-133-1-44-b14","series-title":"Cancer (Cancer Cytopathol)","first-page":"461","article-title":"Testing the test: remediation is needed.","volume":"111","author":"Birdsong, G. G.","year":"2007","unstructured":"Birdsong, G. G.\n          \n          Testing the test: remediation is needed.\n          Cancer (Cancer Cytopathol)\n          2007. 111:461\u2013464."},{"key":"i1543-2165-133-1-44-b15","article-title":"Cytopathology Checklist. Northfield, Ill: College of American Pathologists; 2007.","unstructured":"Commission on Laboratory Accreditation. Laboratory Accreditation Program.\n          \n          Cytopathology Checklist. Northfield, Ill: College of American Pathologists; 2007.\n          Available at: http:\/\/www.cap.org\/apps\/docs\/laboratory_accreditation\/checklists\/cytopathologysep07.pdf. Accessed December 20, 2007."},{"key":"i1543-2165-133-1-44-b1","series-title":"Fed Regist","first-page":"62606","article-title":"Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists\u2013 HCFA. Final rule with comment period.","volume":"59","year":"1994","unstructured":"Medicare, Medicaid and CLIA programs; extension of certain effective dates for clinical laboratory requirements and personnel requirements for cytologists\u2013 HCFA. Final rule with comment period.\n          Fed Regist\n          1994. 59:62606\u201362609."},{"key":"i1543-2165-133-1-44-b2","article-title":"2006 PAP Gynecologic Cytology PT Program (PAP PT) Year-End Summary Report.","unstructured":"2006 PAP Gynecologic Cytology PT Program (PAP PT) Year-End Summary Report.\n          Northfield, Ill: College of American Pathologists; 2006."},{"key":"i1543-2165-133-1-44-b3","article-title":"PAP PT Appeal Process and Submission page.","unstructured":"College of American Pathologists.\n          \n          PAP PT Appeal Process and Submission page.\n          Available at: http:\/\/www.cap.org\/apps\/cap.portal?_nfpb=true&_pageLabel=pappt_page. Accessed December 15, 2007."},{"key":"i1543-2165-133-1-44-b4","series-title":"Arch Pathol Lab Med","first-page":"788","article-title":"Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program.","volume":"132","author":"Bentz, J. S.","year":"2008","unstructured":"Bentz, J. S., J. H.Hughes, L. A.Fatheree, M. R.Schwartz, R. J.Soures, and D. C.Wilbur. for the Cytopathology Resource Committee, College of American Pathologists. Summary of the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program.Arch Pathol Lab Med2008. 132:788\u2013794."},{"key":"i1543-2165-133-1-44-b5","series-title":"JAMA","first-page":"2114","article-title":"Bethesda 2001: terminology for reporting the results of cervical cytology.","volume":"287","author":"Solomon, D.","year":"2002","unstructured":"Solomon, D., D.Davey, and A.Moriarty. et al. Bethesda 2001: terminology for reporting the results of cervical cytology.JAMA2002. 287:2114\u20132119."},{"key":"i1543-2165-133-1-44-b6","series-title":"Diagn Cytopathol","first-page":"83","article-title":"Candida-related changes and ASCUS: a potential trap!","volume":"16","author":"Miguel, N. L. Jr","year":"1997","unstructured":"Miguel, N. L. Jr, C. M.Lachowicz, and T. S.Kline. Candida-related changes and ASCUS: a potential trap!Diagn Cytopathol1997. 16:83\u201386."},{"key":"i1543-2165-133-1-44-b7","series-title":"J Low Genit Tract Dis","first-page":"210","article-title":"2006 consensus guidelines for the management of women with abnormal cervical screening tests.","volume":"11","year":"2007","unstructured":"Solomon D, for the 2006 ASCCP-sponsored Consensus Conference.\n          \n          2006 consensus guidelines for the management of women with abnormal cervical screening tests.\n          J Low Genit Tract Dis\n          2007. 11:210\u2013222."},{"key":"i1543-2165-133-1-44-b8","series-title":"Cancer Cytopathol","first-page":"272","article-title":"The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion.","volume":"99","author":"Nasser, S. M.","year":"2003","unstructured":"Nasser, S. M., E. S.Cibas, C. P.Crum, and W. C.Faquin. The significance of the Papanicolaou smear diagnosis of low-grade squamous intraepithelial lesion cannot exclude high-grade squamous intraepithelial lesion.Cancer Cytopathol2003. 99:272\u2013276."},{"key":"i1543-2165-133-1-44-b9","series-title":"Cancer Cytopathol","first-page":"277","article-title":"The significance of \u201clow-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion\u201d as a distinct squamous abnormality category in Papanicolaou tests.","volume":"108","author":"Elsheikh, T. M.","year":"2006","unstructured":"Elsheikh, T. M., J. L.Kirkpatrick, and H. H.Wu. The significance of \u201clow-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion\u201d as a distinct squamous abnormality category in Papanicolaou tests.Cancer Cytopathol2006. 108:277\u2013280."},{"key":"i1543-2165-133-1-44-b10","series-title":"Arch Pathol Lab Med","first-page":"609","article-title":"Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?","volume":"129","year":"2005","unstructured":"Colgan TJ, for the Cytopathology Resource Committee, College of American Pathologists.\n          \n          Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?\n          Arch Pathol Lab Med\n          2005. 129:609\u2013613."},{"key":"i1543-2165-133-1-44-b11","series-title":"Arch Pathol Lab Med","first-page":"1119","article-title":"Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.","volume":"130","year":"2006","unstructured":"Colgan TJ, for the Cytopathology Resource Committee, College of American Pathologists.\n          \n          Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.\n          Arch Pathol Lab Med\n          2006. 130:1119\u20131122."},{"key":"i1543-2165-133-1-44-b12","series-title":"Arch Pathol Lab Med","first-page":"1413","article-title":"Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.","volume":"127","author":"Renshaw, A. A.","year":"2003","unstructured":"Renshaw, A. A., D. D.Davey, and G. G.Birdsong. et al. Precision in gynecologic cytologic interpretation: a study from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.Arch Pathol Lab Med2003. 127:1413\u20131420."},{"key":"i1543-2165-133-1-44-b13","series-title":"Cancer (Cancer Cytopathol)","first-page":"467","article-title":"The dysfunctional federally mandated proficiency test in cytopathology: a statistical analysis.","volume":"111","author":"Nagy, G. K.","year":"2007","unstructured":"Nagy, G. K. and S.Naryshkin. The dysfunctional federally mandated proficiency test in cytopathology: a statistical analysis.Cancer (Cancer Cytopathol)2007. 111:467\u2013476."},{"key":"i1543-2165-133-1-44-b14","series-title":"Cancer (Cancer Cytopathol)","first-page":"461","article-title":"Testing the test: remediation is needed.","volume":"111","author":"Birdsong, G. G.","year":"2007","unstructured":"Birdsong, G. G.\n          \n          Testing the test: remediation is needed.\n          Cancer (Cancer Cytopathol)\n          2007. 111:461\u2013464."},{"key":"i1543-2165-133-1-44-b15","article-title":"Cytopathology Checklist. Northfield, Ill: College of American Pathologists; 2007.","unstructured":"Commission on Laboratory Accreditation. Laboratory Accreditation Program.\n          \n          Cytopathology Checklist. Northfield, Ill: College of American Pathologists; 2007.\n          Available at: http:\/\/www.cap.org\/apps\/docs\/laboratory_accreditation\/checklists\/cytopathologysep07.pdf. 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