Cytology of spontaneous nipple discharge-Is it worth it? Performance of nipple discharge preparations in the college of american pathologists interlaboratory comparison program in nongynecologic cytopathology

Ann T. Moriarty, Mary R. Schwartz, Rodolfo Laucirica, Christine N. Booth, Manon Auger, Nicole E. Thomas, Rhona J. Souers

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Context.-The usefulness of spontaneous nipple discharge analysis is controversial. Nipple discharge preparations are rare in clinical practice and malignant cases are exceptional. The College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology has included nipple discharge preparations since its inception. Objective.-To evaluate participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology to assess the accuracy of cytologic interpretation of nipple discharge preparation. Design.-General diagnostic category (benign, suspicious, malignant), participant type (pathologist, cytotechnologist), stain (Papanicolaou, modified Giemsa), and program year (2005-2009) were analyzed using χ2 and a nonlinear mixed model for slide factor correlation structure. Results.-Of 2506 responses, 1280 (51%) were malignant, 171 (7%) were papillary, and 1055 (42%) were benign. There were 222 discordant general category responses with a false-positive/ suspicious rate of 12.8% and a false-negative rate of 3.4%. The most common falsenegative diagnosis was mastitis/abscess (125 of 1272 responses; 9.8%). The most common false-positive response was papillary lesion (26 of 457 responses; 5.7%). There were no differences between stains or years. Cytotechnologists performed better than pathologists; pathologists had a higher false-negative rate than cytotechnologists (15.3% versus 7.9%, P < .001). Conclusions.-There is poor accuracy in evaluating nipple discharge preparation in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. If the findings in the program parallel clinical practice, nipple discharge preparations may adversely impact patient care. A benign nipple discharge cytologic diagnosis does not exclude malignancy, and the false-positive/suspicious rate requires confirmation of a malignant nipple discharge prior to definitive patient management.

Original languageEnglish (US)
Pages (from-to)1039-1042
Number of pages4
JournalArchives of Pathology and Laboratory Medicine
Volume137
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

Fingerprint

Cell Biology
Coloring Agents
Nonlinear Dynamics
Pathologists
Nipple Discharge
Mastitis
Abscess
Patient Care
Neoplasms

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

Cytology of spontaneous nipple discharge-Is it worth it? Performance of nipple discharge preparations in the college of american pathologists interlaboratory comparison program in nongynecologic cytopathology. / Moriarty, Ann T.; Schwartz, Mary R.; Laucirica, Rodolfo; Booth, Christine N.; Auger, Manon; Thomas, Nicole E.; Souers, Rhona J.

In: Archives of Pathology and Laboratory Medicine, Vol. 137, No. 8, 01.08.2013, p. 1039-1042.

Research output: Contribution to journalArticle

@article{7367ba91eeb54de08098c7fc5856e506,
title = "Cytology of spontaneous nipple discharge-Is it worth it? Performance of nipple discharge preparations in the college of american pathologists interlaboratory comparison program in nongynecologic cytopathology",
abstract = "Context.-The usefulness of spontaneous nipple discharge analysis is controversial. Nipple discharge preparations are rare in clinical practice and malignant cases are exceptional. The College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology has included nipple discharge preparations since its inception. Objective.-To evaluate participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology to assess the accuracy of cytologic interpretation of nipple discharge preparation. Design.-General diagnostic category (benign, suspicious, malignant), participant type (pathologist, cytotechnologist), stain (Papanicolaou, modified Giemsa), and program year (2005-2009) were analyzed using χ2 and a nonlinear mixed model for slide factor correlation structure. Results.-Of 2506 responses, 1280 (51{\%}) were malignant, 171 (7{\%}) were papillary, and 1055 (42{\%}) were benign. There were 222 discordant general category responses with a false-positive/ suspicious rate of 12.8{\%} and a false-negative rate of 3.4{\%}. The most common falsenegative diagnosis was mastitis/abscess (125 of 1272 responses; 9.8{\%}). The most common false-positive response was papillary lesion (26 of 457 responses; 5.7{\%}). There were no differences between stains or years. Cytotechnologists performed better than pathologists; pathologists had a higher false-negative rate than cytotechnologists (15.3{\%} versus 7.9{\%}, P < .001). Conclusions.-There is poor accuracy in evaluating nipple discharge preparation in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. If the findings in the program parallel clinical practice, nipple discharge preparations may adversely impact patient care. A benign nipple discharge cytologic diagnosis does not exclude malignancy, and the false-positive/suspicious rate requires confirmation of a malignant nipple discharge prior to definitive patient management.",
author = "Moriarty, {Ann T.} and Schwartz, {Mary R.} and Rodolfo Laucirica and Booth, {Christine N.} and Manon Auger and Thomas, {Nicole E.} and Souers, {Rhona J.}",
year = "2013",
month = "8",
day = "1",
doi = "10.5858/arpa.2012-0231-CP",
language = "English (US)",
volume = "137",
pages = "1039--1042",
journal = "Archives of Pathology and Laboratory Medicine",
issn = "0003-9985",
publisher = "College of American Pathologists",
number = "8",

}

TY - JOUR

T1 - Cytology of spontaneous nipple discharge-Is it worth it? Performance of nipple discharge preparations in the college of american pathologists interlaboratory comparison program in nongynecologic cytopathology

AU - Moriarty, Ann T.

AU - Schwartz, Mary R.

AU - Laucirica, Rodolfo

AU - Booth, Christine N.

AU - Auger, Manon

AU - Thomas, Nicole E.

AU - Souers, Rhona J.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Context.-The usefulness of spontaneous nipple discharge analysis is controversial. Nipple discharge preparations are rare in clinical practice and malignant cases are exceptional. The College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology has included nipple discharge preparations since its inception. Objective.-To evaluate participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology to assess the accuracy of cytologic interpretation of nipple discharge preparation. Design.-General diagnostic category (benign, suspicious, malignant), participant type (pathologist, cytotechnologist), stain (Papanicolaou, modified Giemsa), and program year (2005-2009) were analyzed using χ2 and a nonlinear mixed model for slide factor correlation structure. Results.-Of 2506 responses, 1280 (51%) were malignant, 171 (7%) were papillary, and 1055 (42%) were benign. There were 222 discordant general category responses with a false-positive/ suspicious rate of 12.8% and a false-negative rate of 3.4%. The most common falsenegative diagnosis was mastitis/abscess (125 of 1272 responses; 9.8%). The most common false-positive response was papillary lesion (26 of 457 responses; 5.7%). There were no differences between stains or years. Cytotechnologists performed better than pathologists; pathologists had a higher false-negative rate than cytotechnologists (15.3% versus 7.9%, P < .001). Conclusions.-There is poor accuracy in evaluating nipple discharge preparation in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. If the findings in the program parallel clinical practice, nipple discharge preparations may adversely impact patient care. A benign nipple discharge cytologic diagnosis does not exclude malignancy, and the false-positive/suspicious rate requires confirmation of a malignant nipple discharge prior to definitive patient management.

AB - Context.-The usefulness of spontaneous nipple discharge analysis is controversial. Nipple discharge preparations are rare in clinical practice and malignant cases are exceptional. The College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology has included nipple discharge preparations since its inception. Objective.-To evaluate participant responses in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology to assess the accuracy of cytologic interpretation of nipple discharge preparation. Design.-General diagnostic category (benign, suspicious, malignant), participant type (pathologist, cytotechnologist), stain (Papanicolaou, modified Giemsa), and program year (2005-2009) were analyzed using χ2 and a nonlinear mixed model for slide factor correlation structure. Results.-Of 2506 responses, 1280 (51%) were malignant, 171 (7%) were papillary, and 1055 (42%) were benign. There were 222 discordant general category responses with a false-positive/ suspicious rate of 12.8% and a false-negative rate of 3.4%. The most common falsenegative diagnosis was mastitis/abscess (125 of 1272 responses; 9.8%). The most common false-positive response was papillary lesion (26 of 457 responses; 5.7%). There were no differences between stains or years. Cytotechnologists performed better than pathologists; pathologists had a higher false-negative rate than cytotechnologists (15.3% versus 7.9%, P < .001). Conclusions.-There is poor accuracy in evaluating nipple discharge preparation in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology. If the findings in the program parallel clinical practice, nipple discharge preparations may adversely impact patient care. A benign nipple discharge cytologic diagnosis does not exclude malignancy, and the false-positive/suspicious rate requires confirmation of a malignant nipple discharge prior to definitive patient management.

UR - http://www.scopus.com/inward/record.url?scp=84881032996&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881032996&partnerID=8YFLogxK

U2 - 10.5858/arpa.2012-0231-CP

DO - 10.5858/arpa.2012-0231-CP

M3 - Article

C2 - 23899058

AN - SCOPUS:84881032996

VL - 137

SP - 1039

EP - 1042

JO - Archives of Pathology and Laboratory Medicine

JF - Archives of Pathology and Laboratory Medicine

SN - 0003-9985

IS - 8

ER -