The clinical impact of including pictures in Papanicolaou test reports

Introduction: Although the inclusion of representative photomicrographic images in pathology reports remains uncommon, the frequency has increased in recent years. The impact of the inclusion of pictures has not previously been examined in peer-reviewed literature. Materials and methods: We compared the Papanicolaou (Pap) test interpretations produced by our laboratory before and after the introduction of a requirement to include pictures in reports with interpretations of low-grade squamous intraepithelial lesion (LSIL); atypical squamous cells, cannot rule out high-grade squamous intraepithelial lesion; high-grade squamous intraepithelial lesion; atypical glandular cells; or carcinoma. Atypical squamous cells of undetermined significance (ASC-US) did not require a picture, creating an incentive to interpret borderline cases as ASC-US instead of LSIL. We compared 1810 Pap tests from before the picture requirement to 1807 after. Results: The number of cases upgraded by the pathologists from a cytotechnologist interpretation of negative or ASC-US to one of the positive interpretations requiring a picture decreased from 99 in the prepicture era to 80 in the picture era (P = 0.19). Conversely, the number of cases downgraded by the pathologists increased from 65 to 98 (P = 0.015). The ASC-US to LSIL (ASC-SIL) ratio for the laboratory went from 0.92 to 1.45. Conclusions: The introduction of a picture requirement in Pap test reports significantly affected the practice of pathologists in our laboratory. The ASC-SIL ratio of the laboratory shifted toward the national mean in association with this change.