Affordable Access

Garantia de qualidade do exame citopatologico no rastreamento do cancer do colo do utero

Authors
Publisher
Biblioteca Digital da Unicamp
Publication Date
Keywords
  • Controle De Qualidade
  • Garantia De Qualidade
  • Colo Uterino
Disciplines
  • Biology
  • Medicine

Abstract

Introduction: Cytopathologic examination has been frequently criticized because of its high rate of false-negative results. The most used method for obtaining quality assurance is the review of 10% of negative Pap smear tests. However, this practice does not seem to reduce the false-negative rates effectively. Objectives: To evaluate quality assurance of cytopathologic specimens on routine screening that had been negative for cervical cancer, comparing the results of a 100% rapid review of specimens with those of a 10% random review. Methods: In the Cytopathology Laboratory of the Center for Integral Attention to Women´s Health of the State University of Campinas, five thousand two hundred and fifteen negative Pap smears on routine screening were submitted to a 100% rapid review performed by one senior cytotechnologist, followed by a 10% review performed by another senior cytotechnologist. After these reviews, all Pap smears were analysed by two cytopathologists separately. When disagreement between diagnoses occurred, Pap smears were analysed by a third cytopathologist and the final diagnosis (gold standard) was defined by a consensus reached among the three cytopathologists. Results: The 100% rapid review of cytologic specimens identified 174 suspicious findings, 100 (57,5%) of which were confirmed by the gold standard. Of these, 72 were classified as atypical squamous cells of undetermined significance, 22 as low-grade squamous intraepithelial lesions and six as high-grade squamous intraepithelial lesions. The rapid review identified 321 Pap smears that were unsatisfactory for evaluation, 90.9% of which were confirmed by the gold standard. The sensitivity of the 100% rapid review was 73.5%. The 10% review identified 15 positive cases, nine of which were confirmed by the gold standard. Of these, six were classified as atypical squamous cells of undetermined significance, two as lowgrade squamous intraepithelial lesions and one as a high-grade squamous intraepithelial squamous lesion. The 10% review of Pap smears identified 28 smears that were unsatisfactory for evaluation, 87.5% of which were confirmed by the gold standard. The sensitivity of the 10% review was 40.9%. Of the 4694 Pap smears not included in the 10% review, the gold standard identified 86 cases of atypical squamous cells of undetermined significance, 20 cases of lowgrade squamous intraepithelial lesions and five cases of high-grade squamous intraepithelial lesions. Conclusion: The 100% rapid review of cytologic specimens is an effective alternative to reduce the false-negative rates of cytopathologic examinations. A limiting factor in the 10% review is that 90% of negative Pap smears are not submitted to review.

There are no comments yet on this publication. Be the first to share your thoughts.