Negligence in Interpretation of Pap Smears

What Can Go Wrong Sometimes Does
A True Story (continued)

The Pap smear specimen of December 1992 was interpreted as satisfactory and within normal limits. The specimen was not rescreened. Again the accompanying requisition contained inaccurate information. The previous Pap smear of October 1991 had in fact not been normal, but had shown ASCUS. In fact, the patient had historically been subject to cryosurgery and had other risk factors for cervical cancer. A simple review of the service laboratory records for this patient would have revealed that there was a previous abnormal smear and, given the policies of the service laboratory, the specimen would have automatically been rescreened. This did not occur.

Figures 3, 4, 5 and 6 represent photomicrographs of the slide which corresponds to the requisition shown in Figure 2. Figure 3 presents a panoramic view photographed at low power. Near center is a flat cluster of cells demonstrating HGSIL. Figure 4 is a higher magnification of the flat cluster of cells marked in Figure 3. Figure 5 demonstrates another cluster at high magnification of HGSIL cells with overlapped nuclei and indistinct borders (syncytium) surrounded by LGSIL cells. Figure 6 is an HGSIL cell with large dark irregular nucleus and high N/C compared with adjacent normals.

The photomicrographs shown and discussed here are but a few of those taken of the Pap smear specimen of December 1992. Each of these photomicrographs when shown during deposition to the cytotechnologist (now a defendant in the case) resulted in her substantial agreement with the interpretations described above. Though similar abnormal cells were numerous in the specimen, the defendant cytotechnologist asserted she obviously had not seen these cells.

There was some question arising out of the testimony in the case as to whether the cytotechnologist's problem had in fact been a failure to locate the cells or failure to properly interpret them. Approximately a year and a half after the interpretation of the slide in question, this cytotechnologist was discharged by her laboratory. This occurred because she interpreted as negative a slide of another patient that was rescreened as showing a HGSIL suggesting invasive cancer in a patient who was later demonstrated by biopsy to have invasive cancer. The cytotechnologist's discharge resulted from her failure, when confronted with the discrepancy, to accept that her reading of the slide as negative was inappropriate.

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