{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T05:37:42Z","timestamp":1770788262574,"version":"3.50.0"},"reference-count":12,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Context.<\/jats:italic>\n                    \u2014\n                    <jats:italic>Candida<\/jats:italic>\n                    may elicit cellular changes on otherwise negative screening Papanicolaou tests that may be misinterpreted as atypical squamous cells of undetermined significance. Although these changes have been correctly interpreted in the educational program of the College of American Pathologists, the Interlaboratory Comparison Program in Gynecologic Cytology, the performance of negative slides with\n                    <jats:italic>Candida<\/jats:italic>\n                    faltered when the same field validated slides were included in proficiency testing (PT).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Objective.<\/jats:italic>\n                    \u2014To identify the performance differences of negative for intraepithelial lesion (NILM)\n                    <jats:italic>Candida<\/jats:italic>\n                    challenges before and after PT.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Design.<\/jats:italic>\n                    \u2014We compare the performance of NILM College of American Pathologists slides with\n                    <jats:italic>Candida<\/jats:italic>\n                    as a single reference diagnosis, prior to PT (1991\u20132006) and after PT (2006\u20132007).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Results.<\/jats:italic>\n                    \u2014There were 147\u200a186 responses for slides with NILM\n                    <jats:italic>Candida<\/jats:italic>\n                    from the College of American Pathologists programs from 1991 through 2007. After PT, 79.7% of incorrect participant responses identified\n                    <jats:italic>Candida<\/jats:italic>\n                    as Category C (low-grade squamous intraepithelial lesion), whereas prior to PT only 59.5% of the incorrect diagnoses were low-grade squamous intraepithelial lesion (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001) in the field-validated component of the program. Validated\n                    <jats:italic>Candida<\/jats:italic>\n                    slides performed significantly more poorly in PT (97.2%) than prior to PT (98.3%) (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001).\n                    <jats:italic>Candida<\/jats:italic>\n                    challenges performed better in the educational component post-PT (98.3% versus 97.2%;\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). Cytotechnologists (97.9%) identified\n                    <jats:italic>Candida<\/jats:italic>\n                    more frequently than pathologists (97.3%) (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001) and ThinPrep preparations performed the best of all preparation types.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions.<\/jats:italic>\n                    \u2014Proficiency testing adversely affects the performance of participants in the identification of NILM\n                    <jats:italic>Candida<\/jats:italic>\n                    . Slides with\n                    <jats:italic>Candida<\/jats:italic>\n                    are more likely to be identified as low-grade squamous intraepithelial lesion in a PT exercise. Misidentification is not due to lack of recognition but most likely an attempt of test takers to optimize their likelihood of passing the examination.\n                  <\/jats:p>","DOI":"10.5858\/133.8.1272","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T10:43:41Z","timestamp":1613126621000},"page":"1272-1275","source":"Crossref","is-referenced-by-count":4,"title":["Performance of Candida\u2014Fungal-Induced Atypia and Proficiency Testing: Observations From the College of American Pathologists Proficiency Testing Program"],"prefix":"10.5858","volume":"133","author":[{"given":"Ann T.","family":"Moriarty","sequence":"first","affiliation":[{"name":"From the Department of Pathology, AmeriPath, Indiana; Indianapolis (Dr Moriarty); the Department of Pathology and Cytology, University of California-San Francisco Mount Zion Medical Center Clinic, San Francisco (Dr Darragh); Cytology Surveys (Ms Fatheree) and Statistics (Ms Souers), College of American Pathologists, Northfield, Illinois; and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Wilbur)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa M.","family":"Darragh","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, AmeriPath, Indiana; Indianapolis (Dr Moriarty); the Department of Pathology and Cytology, University of California-San Francisco Mount Zion Medical Center Clinic, San Francisco (Dr Darragh); Cytology Surveys (Ms Fatheree) and Statistics (Ms Souers), College of American Pathologists, Northfield, Illinois; and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Wilbur)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa A.","family":"Fatheree","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, AmeriPath, Indiana; Indianapolis (Dr Moriarty); the Department of Pathology and Cytology, University of California-San Francisco Mount Zion Medical Center Clinic, San Francisco (Dr Darragh); Cytology Surveys (Ms Fatheree) and Statistics (Ms Souers), College of American Pathologists, Northfield, Illinois; and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Wilbur)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rhona","family":"Souers","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, AmeriPath, Indiana; Indianapolis (Dr Moriarty); the Department of Pathology and Cytology, University of California-San Francisco Mount Zion Medical Center Clinic, San Francisco (Dr Darragh); Cytology Surveys (Ms Fatheree) and Statistics (Ms Souers), College of American Pathologists, Northfield, Illinois; and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Wilbur)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Wilbur","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, AmeriPath, Indiana; Indianapolis (Dr Moriarty); the Department of Pathology and Cytology, University of California-San Francisco Mount Zion Medical Center Clinic, San Francisco (Dr Darragh); Cytology Surveys (Ms Fatheree) and Statistics (Ms Souers), College of American Pathologists, Northfield, Illinois; and Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Wilbur)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3906","reference":[{"key":"i1543-2165-133-8-1272-b1","series-title":"Diagn Cytopathol","first-page":"83","article-title":"Candida-related changes and ASCUS: a potential trap!","volume":"16","author":"Miguel, N. L.","year":"1997","unstructured":"Miguel, N. L., C. M.Lachowicz, and T. S.Kline. Candida-related changes and ASCUS: a potential trap!Diagn Cytopathol1997. 16:83\u201386."},{"key":"i1543-2165-133-8-1272-b2","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":"i1543-2165-133-8-1272-b3","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","author":"Renshaw, A. A.","year":"2006","unstructured":"Renshaw, A. A., M. K.Walsh, B.Blond, A. T.Moriarty, D. R.Mody, and T. J.Colgan. for the Cytopathology Resource Committee, College of American Pathologists.Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.Arch Pathol Lab Med2006. 130:1119\u20131112."},{"key":"i1543-2165-133-8-1272-b4","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","author":"Renshaw, A. A.","year":"2005","unstructured":"Renshaw, A. A., E.Wang, D.Mody, D. C.Wilbur, D. D.Davey, and T. J.Colgan. Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?Arch Pathol Lab Med2005. 129:609\u2013613."},{"key":"i1543-2165-133-8-1272-b5","series-title":"Arch Pathol Lab Med","first-page":"279","article-title":"Changes in participant performance in the \u201ctest-taking\u201d environment: observations from the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAP PT).","volume":"133(2)","author":"Hughes, J. H.","year":"2009","unstructured":"Hughes, J. H., J. S.Bentz, L.Fatheree, R.Souers, and D. C.Wilbur. Changes in participant performance in the \u201ctest-taking\u201d environment: observations from the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAP PT).Arch Pathol Lab Med2009. 133(2):279\u2013282."},{"key":"i1543-2165-133-8-1272-b6","unstructured":"College of American Pathologists 2004 PAP Year End Summary Report. PAPC, PAPK and PAPM; 2004.\n          \n          College of American Pathologists: Northfield, IL. 2009."},{"key":"i1543-2165-133-8-1272-b1","series-title":"Diagn Cytopathol","first-page":"83","article-title":"Candida-related changes and ASCUS: a potential trap!","volume":"16","author":"Miguel, N. L.","year":"1997","unstructured":"Miguel, N. L., C. M.Lachowicz, and T. S.Kline. Candida-related changes and ASCUS: a potential trap!Diagn Cytopathol1997. 16:83\u201386."},{"key":"i1543-2165-133-8-1272-b2","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":"i1543-2165-133-8-1272-b3","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","author":"Renshaw, A. A.","year":"2006","unstructured":"Renshaw, A. A., M. K.Walsh, B.Blond, A. T.Moriarty, D. R.Mody, and T. J.Colgan. for the Cytopathology Resource Committee, College of American Pathologists.Robustness of validation criteria in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology.Arch Pathol Lab Med2006. 130:1119\u20131112."},{"key":"i1543-2165-133-8-1272-b4","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","author":"Renshaw, A. A.","year":"2005","unstructured":"Renshaw, A. A., E.Wang, D.Mody, D. C.Wilbur, D. D.Davey, and T. J.Colgan. Measuring the significance of field validation in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology: how good are the experts?Arch Pathol Lab Med2005. 129:609\u2013613."},{"key":"i1543-2165-133-8-1272-b5","series-title":"Arch Pathol Lab Med","first-page":"279","article-title":"Changes in participant performance in the \u201ctest-taking\u201d environment: observations from the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAP PT).","volume":"133(2)","author":"Hughes, J. H.","year":"2009","unstructured":"Hughes, J. H., J. S.Bentz, L.Fatheree, R.Souers, and D. C.Wilbur. Changes in participant performance in the \u201ctest-taking\u201d environment: observations from the 2006 College of American Pathologists Gynecologic Cytology Proficiency Testing Program (PAP PT).Arch Pathol Lab Med2009. 133(2):279\u2013282."},{"key":"i1543-2165-133-8-1272-b6","unstructured":"College of American Pathologists 2004 PAP Year End Summary Report. PAPC, PAPK and PAPM; 2004.\n          \n          College of American Pathologists: Northfield, IL. 2009."}],"container-title":["Archives of Pathology &amp; Laboratory Medicine"],"original-title":[],"link":[{"URL":"https:\/\/aplm.kglmeridian.com\/view\/journals\/arpa\/133\/8\/article-p1272.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/aplm\/article-pdf\/133\/8\/1272\/2768014\/1543-2165-133_8_1272.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aplm.kglmeridian.com\/downloadpdf\/journals\/arpa\/133\/8\/article-p1272.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aplm.kglmeridian.com\/downloadpdf\/journals\/arpa\/133\/8\/article-p1272.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T01:06:11Z","timestamp":1770771971000},"score":1,"resource":{"primary":{"URL":"https:\/\/aplm.kglmeridian.com\/view\/journals\/arpa\/133\/8\/article-p1272.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,8]]},"references-count":12,"journal-issue":{"issue":"8"},"URL":"https:\/\/doi.org\/10.5858\/133.8.1272","relation":{},"ISSN":["1543-2165","0003-9985"],"issn-type":[{"value":"1543-2165","type":"electronic"},{"value":"0003-9985","type":"print"}],"subject":[],"published":{"date-parts":[[2009,8]]}}}