Cervical Cancer Cases
The Negligent Interpretation of Pap Smears (continued)

Though there are a variety of diagnostic errors which occur due to negligence in the processing and interpretation of Pap smears some misinterpretations are unavoidable. Assume that a gynecologist properly obtains a Pap smear that is then properly applied to a slide and fixed. Though the patient, at the time is suffering from a pre-invasive lesion of the cervix, so few abnormal cells are present in the smear that they are unlikely to be located during a careful screening of the slide. The delay in diagnosis that results from this unrevealing smear is unavoidable and undoubtedly occurs. However, in the author's experience the patient presenting with advanced cervical cancer, following serial purportedly benign annual Pap smears has been the victim of professional carelessness. Review of slides, in such cases, reveals inadequate smears which were not reported, abnormal cells that were either identified but then ignored by the physician performing the Pap smear or were misinterpreted or not located by the cytopathologist or cytotechnologist examining the smear.

The devastation that results from a needlessly advanced case of cervical cancer, a disease, which most believe is largely preventable, is tragic. It is the obligation of the lawyer representing claimants in such cases to obtain through the legal system what compensation is there available. However, the legal process also can reveal the causes of a client's injuries and properly identify those persons responsible. Ideally, the process of litigation should inform those persons responsible of their errors and encourage them and others to act more responsibly in the future.

The cytopathologist can have a far-reaching role in reducing morbidity due to cervical cancer. This role is not limited to interpreting properly Pap smears submitted for review. The cytopathologist also has a responsibility to inform those submitting smears of the adequacy of the smears and to submit reports in a comprehensive and comprehensible form, together with recommendations for future management (diagnostic evaluation).

The following case, recently concluded, embraces virtually every breach of principles of practice for which a cytopathologist and laboratory can be held liable in the processing of Pap smears.

In October 1991, a 25-year-old patient completed her eighth office visit with a gynecologist since October of 1988. During this course she was attended by three different offices of gynecologists (each in a different office). Neither of her last two gynecologists requested records from the immediately preceding gynecologist. HGSIL was reported on a Pap smear in October of 1988 and colposcopy was recommended. The patient's second gynecologist, though aware that a prior Pap smear was abnormal and had resulted in a previous recommendation for colposcopy, instead performed cryotherapy. He did not perform a colposcopy until February 1990. In spite of an aceto-white lesion of the cervix being present at the time of that colposcopy, no biopsy was taken. Soon after, gynecologist "2" retired.

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