Qualität des konventionellen PAP-Abstrichs

Abstract

The success of cytology in screening programs for cervical cancer is highly dependent on the smear quality. Interdisciplinary projects which evaluate the smear quality and the results of collection devices could be helpful for an improvement and a successful example for quality improvement is presented here. An average of 83% technically adequate and representative smears was documented for 12 million conventional PAP smears; however only an average of 68% technically adequate and representative smears was found for the group of least successful smear takers of all laboratories. This indicates a potential for improvement. Following an interdisciplinary project on smear quality improvement the average rate of representative smears increased from 69 to 83% and in another project this rate remained stable at 86%. Based on 158,411 conventional smears, representative smears were achieved in 92% using Cervex-Brush®, 86% using Szalay Spatula and 82% Cytobrush methods. The combinations of Cytobrush with the Ayre wooden spatula, cotton wool swab or Szalay Spatula achieved 97%, 94% and 92% representative smears, respectively.

Quality of screening with conventional Pap smear in Austria – a longitudinal evaluation

“…Statutory health insurance providers should by any means ensure that their contractual partners (gynecologists and laboratories) sign a binding agreement concerning their active involvement in such quality assurance measures. The best option to start with would be rolling out a tried and tested model quality assurance project in all Austrian provinces [19,20]. Workshops on Pap smear quality and Pap smear taking practice performed in the past effectively lowered “satisfactory, but limited/SBL” rates over longer time periods [19].…”

“…This indicator is strongly dependent on the quality of smear taking and is therefore strongly dependent on the gynecologist taking the smear. On the other hand, the interpretation of the cytological features with the well-known intra- and interobserver variability is dependent on the cytologist, even though variability can be minimized by using detailed definitions of smear adequacy interpretation [20]. The quality standard for the indicator as set by the Austrian Society of Cytology provides for a maximum of 2% Pap 0 classifications (Bethesda 2001 equivalent: Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality) in relation to all smears taken [15].…”

“…These publications identified failures in Pap smear taking as well as in the interpretation of the smears [16-18]. The results have led the statutory health insurance providers of some provinces to implement a number of measures in order to improve Pap smear taking [19,20]. Furthermore, the Quality Assurance Committee of the Austrian Society of Cytology initiated a database for cytology results commencing in 1998.…”