Controle interno da qualidade em citopatologia ginecológica: um estudo de 48.355 casos

Abstract

Todos os sistemas de avaliação de desempenho em laboratórios de citopatologia exigem um programa de controle interno da qualidade estabelecido e executado. O presente estudo tem por objetivo identificar os resultados do programa e o desempenho dos citotécnicos. Para tanto foram revistos os laudos, emitidos pelos citotécnicos e pelos citopatologistas, de 48.355 exames citopatológicos ginecológicos realizados durante 21 meses. Foram identificados 2.299 casos anômalos encaminhados ao citopatologista, e confirmados 1.132; 2.973 casos de alto risco foram detectados e 998 anômalos identificados. A revisão de 10% dos negativos representou 3.180 casos, com identificação de 77 anômalos. Os anômalos totais detectados foram: 1.176 ASCUS, 60 AGUS, 819 NIC I/HPV, 85 NIC II, 33 NIC III, 11 carcinomas escamosos, 17 adenocarcinomas, cinco VAIN I e um VAIN III. Os ASCUS/AGUS foram 56%, e as outras lesões representaram 44%. Os 4,56% de anômalos detectados concordam com os valores propostos por Cardin (3% a 5%), pelo sistema Bethesda (4% a 6%) e por Kurman et al. (5%) (4, 6, 7). O citopatologista revisou 17,48% dos casos (n = 8.452). Dos 77 (0,16% do total) anômalos identificados no reescrutínio, 59 (0,12%) foram ASCUS, seis (0,01%) AGUS e 12 (0,02%) NIC I. O presente estudo mostra resultados do controle interno da qualidade desenvolvido em laboratório particular e fornece dados relevantes para o planejamento de um programa de prevenção do câncer uterocervical.

Evaluation of 100% rapid rescreening of negative cervical smears as a quality assurance measure

“…There is a need for improvement in sample collection techniques and in the internal quality control of laboratories, including the participation of relevant staff members in continued education programmes, individual excellence and proficiency tests 4–7 . The purpose of internal quality control in gynaecological cytopathology is to identify false‐negative cases that failed identification during routine screening 8 …”

“…[4][5][6][7] The purpose of internal quality control in gynaecological cytopathology is to identify false-negative cases that failed identification during routine screening. 8 The most commonly adopted method for quality assurance of cytopathology examinations is the random rescreening of 10% of smears that have initially been classified as negative, but this method has proved inefficient at reducing false-negative rates. [9][10][11][12][13][14][15] Another alternative is to select smears for revision on the basis of clinical criteria, as these cases may be associated with a greater prevalence of abnormal results that would be more subject to error and, consequently, would lead to a greater number of false-negative results.…”

Morphoquantitative Analysis of the Intraepithelial Neoplasic Uterine Cells by Computer Image System

“…Meanwhile, a good technique usage in DNA proof needs knowledge, standardization from the beginning of the material acquisition and its fixation, to the histochemic marker and reading from computerized equipments, to get precise diagnostics (Zuna et al, 2002). When we compared our findings with Arcuri et al (2002) and Schoolland et al (2002), we found a huge percentage of unused material, for failure to reach a proof of basic conditions, or simply having mistaken diagnostics. We know, public hospitals have different financing cycles in a year, thus, usually allowing a usage of different fixing agents, difficulties in storage and handling so, standardizing the beginning of the process is essential independently from a technique to be used.…”

Cervical Cytology and Histopathologic Abnormalities in Women living with AIDS in São Paulo, Brazil

“…24,25 In addition, regardless of the fact that the Pap smear is a low-cost test and easily available for women with AIDS in Brazil, there is a need to identify innovative interventions that reduce social, cultural, and environmental influences on HPV infection and cervical cancer in this population.…”