T oday, diagnostic cytopathology laboratories are challenged more than ever to produce accurate results rapidly and inexpensivelyan incompatible combination. These challenges put ''Pap labs'' on a collision course with the real world (Fig. 1). This article addresses the contributions of specimen collection and preparation, microscopic screening techniques, and cytotechnologists' vigilance with regard to the diagnostic accuracy of cervicovaginal cytology (i.e., Pap smears). It also identifies critical control points and calls for changes in reimbursement rates and daily screening workloads that will reflect the labor-intensive realities of Pap smear screening.
Cytologic preparations represent patients. Diagnostic reports based on such preparations are the basis for patient management decisions that can profoundly affect the health and well-being of the patient. False-negative reports pose potentially the greatest health risk to the patient and ultimately to the financial health of the clinical laboratory as well. Quite simply, therefore, the goal of screening Pap smears is to get the right answer to the right patient the first time and at a competitive price.
''Quality'' is derived from the Latin word qualitas, meaning ''of what sort,'' and has many meanings; my dictionary lists 13. A quality outcome for Pap smears means simply that the cytologic findings match the sampled biologic process. A match signifies that the Pap smear possessed the attributes needed to satisfy its intended purpose. Those attributes, in turn, are functionality imparted to the Pap smear by all the processes that precede the signing of the report. When the processes are not uniformly well designed or executed, false-negative results can occur. Therefore, understanding the strengths and weaknesses of the processes and establishing policies and procedures that will promote their consistent implementation are fundamental to controlling the reliability of Pap smear outcomes.
As seen in Table 1 (based on an editorial by Miller 1 ), successfully identifying and treating cervicovaginal lesions is everyone's responsibility (i.e., that of the patient, physician, cytotechnologist, and cytopathologist). Within the laboratory, obtaining, transferring, retaining, finding, and interpreting abnormal cells is a function of the interdependent processes of 1) specimen collection and preparation, 2) mi-