Quality Assurance in Cervical Smears

Amaral, Rita Goreti; Zeferino, Luíz Carlos; Hardy, Ellen; Westin, Maria Cristina do Amaral; Martinez, Edson Zangiacomi; Montemor, Eliana Borin Lopes

doi:10.1159/000326144

Cited by 22 publications

(6 citation statements)

References 19 publications

(24 reference statements)

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“…Since then, various studies have confirmed the better performance of this technique in detecting false-negatives, in comparison to R-10% and clinical risk criteria [3,7,12,13,14,15]. …”

Section: Introductionmentioning

confidence: 99%

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Internal Quality Control for Cervical Cytopathology: Comparison of Potential False-Negatives Detected at Rapid Prescreening and at 100% Rapid Review

Tavares¹,

Souza²,

Manrique³

et al. 2014

Acta Cytologica

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Objective: To evaluate the performance of rapid prescreening (RPS) and 100% rapid review (RR-100%) as internal quality control (IQC) methods assessed by outcome at colposcopy, histopathology and repeat cytopathology for cases with false-negative results on cervical cytopathology at routine screening (RS). Study Design: Out of 12,208 cytology smears analyzed, 900 were abnormal. Of these, 656 were identified at RS, and 244 were false-negative, with 90.2% identified at RPS and 57.4% at RR-100%. Of the 900 abnormal cases, 436 were submitted for additional testing. Results: Of the 244 women with cytopathological abnormalities identified only by the IQC methods, 114 had supplementary examinations: 35 were submitted for colposcopy, 22 for biopsy and 99 for repeat cytopathology. The sensitivity of RPS for the detection of abnormalities identified on colposcopy, histopathology and repeat cytopathology was 87.5% (95% CI 67.6-97.3), 82.4% (95% CI 56.6-96.2) and 95.7% (95% CI 85.2-99.5), respectively. The sensitivity of RR-100% was 54.2% (95% CI 32.8-74.4), 52.9% (95% CI 27.8-77.0) and 47.8% (95% CI 32.9-63.1), respectively. RPS was more sensitive than RR-100% when compared to the findings on colposcopy (p = 0.011) and repeat cytopathology (p = 0.000). When compared to colposcopy, histopathology and repeat cytopathology, the sensitivity of RS was 83.2% (95% CI 76.1-88.9), 85.7% (95% CI 78.1-91.5) and 73.3% (95% CI 66.0-79.7), respectively. Conclusion: RPS performed better than RR-100% when compared to the results of colposcopy and repeat cytopathology.

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“…Since then, various studies have confirmed the better performance of this technique in detecting false-negatives, in comparison to R-10% and clinical risk criteria [3,7,12,13,14,15]. …”

Section: Introductionmentioning

confidence: 99%

“…The most used techniques are the review of 10% (R-10%) of negative smears at routine screening (RS) and cases with clinical risk criteria (CRC). These methods have been recommended in both the USA and Brazil [5,6] but they have proved ineffective for evaluating the performance of RS [3,7,8,9,10]. …”

Section: Introductionmentioning

confidence: 99%

Internal Quality Control for Cervical Cytopathology: Comparison of Potential False-Negatives Detected at Rapid Prescreening and at 100% Rapid Review

Tavares¹,

Souza²,

Manrique³

et al. 2014

Acta Cytologica

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“…In a study by Amaral et al comparing 100% RR and 10% rescreening for 5215 Pap smears (previously reported as N), it was found that although 100% RR was able to pick up the majority of the squamous lesions, 4 samples (0.08% of total smears) diagnosed as AGC by cytopathologists were not detected . In another study of RR of 2568 N smears, 5 Pap smears (0.19% of the total) with an AGC interpretation were among 194 slides (7.6%) detected as abnormal by RR .…”

Section: Discussionmentioning

confidence: 96%

Pap smears with glandular cell abnormalities: Are they detected by rapid prescreening?

Kanber

Charbonneau

Auger

2015

Cancer Cytopathology

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BACKGROUND: Rapid prescreening (RPS) is one of the quality assurance (QA) methods used in gynecologic cytology.The efficacy of RPS has been previously studied but mostly with respect to squamous lesions; in fact, there has been no study so far specifically looking at the sensitivity of RPS for detecting glandular cell abnormalities. METHODS: A total of 80,565 Papanicolaou (Pap) smears underwent RPS during a 25-month period. A sample was designated as "review for abnormality" (R) if any abnormal cells (at the threshold of atypical squamous cells of undetermined significance/atypical glandular cells [AGC]) were thought to be present or was designated as negative (N) if none were detected. Each sample then underwent full screening (FS) and was designated as either R or N and also given a cytologic interpretation. RESULTS:The final cytologic interpretation was a glandular cell abnormality ( AGC) in 107 samples (0.13%); 39 of these (36.4%) were flagged as R on RPS. Twenty-four patients (33.8%) out of 71 who had histologic follow-up were found to harbor a high-grade squamous intraepithelial lesion or carcinoma; 13 of those 24 Pap smears (54.2%) had been flagged as R on RPS. Notably, 11 AGC cases were picked up by RPS only and not by FS and represented false-negative cases; 2 of these showed endometrial adenocarcinoma on histologic follow-up. CONCLUSIONS: Pap smears with glandular cell abnormalities are often flagged as abnormal by RPS, and this results in a sensitivity of 36.4% (at the AGC threshold).Most importantly, some cases of AGC are detected on Pap smears by RPS only, and this demonstrates that RPS is a valuable QA method. Cancer (Cancer Cytopathol) 2015;123:739-44.

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“…As a measure to minimize the FN results and ensure their improvement, studies have shown that the rapid review of 100% of results previously classified as negative is an efficient and cost-effective method [19,20]. …”

Section: Discussionmentioning

confidence: 99%

External Quality Control of Cervical Cytopathology: Interlaboratory Variability

Ázara¹,

Manrique²,

Souza³

et al. 2013

Acta Cytologica

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Objective: To compare the variability of screening tests held at laboratories with the Unit for External Quality Control (UEQC), checking the frequency of cases that were discordant, false-positive, false-negative, unsatisfactory or that had a delay in clinical management and diagnostic agreement. Materials and Methods: The study analyzed 10,053 screening tests from January 2007 to December 2008, including all positive cases, all those that fall under unsatisfactory and at least 10% of negative screening tests. The magnitude of the agreement was analyzed using the kappa coefficient. Results: Out of the 10,053 cases analyzed, 7.59% were considered disagreeing, and it was estimated that 1.1% were false-negative. There was a delay in the clinical procedure regarding 2.44% cases. There were 2.82% of cases identified as false-positive and 1.24% as unsatisfactory. The diagnostic agreement was excellent (kappa = 0.81). The agreement of most laboratories concerning screening tests was classified as very good. The agreement of the sample adequacy was reasonable (kappa = 0.30) and the agreement regarding the representation of epithelia was considered excellent. Conclusion: Most laboratories showed very good agreement; however, it is worthy of note that to establish the standardization of diagnostic criteria, and enhance the accuracy of screening and improve the quality of cytopathology test results, it is necessary to perform external quality control.

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Quality Assurance in Cervical Smears

Cited by 22 publications

References 19 publications

Internal Quality Control for Cervical Cytopathology: Comparison of Potential False-Negatives Detected at Rapid Prescreening and at 100% Rapid Review

Internal Quality Control for Cervical Cytopathology: Comparison of Potential False-Negatives Detected at Rapid Prescreening and at 100% Rapid Review

Pap smears with glandular cell abnormalities: Are they detected by rapid prescreening?

External Quality Control of Cervical Cytopathology: Interlaboratory Variability

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