Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests

Xie, Fengxiang; Zhang, Liran; Zhang, Huina; Qi, Debo; Zhao, Dongman; Zhang, Xin; Wang, Xinguo; Zhao, Chengquan

doi:10.1016/j.jasc.2018.06.002

Cited by 5 publications

(8 citation statements)

References 14 publications

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“…Xie et al [29] emphasized the importance of formal training programs in cytology and quality control to ensure standardized and effective screening of cervical cancer in underdeveloped countries, which present the highest percent incidence of annual cervical cancer and which have a largely unscreened population.…”

Section: Discussionmentioning

confidence: 99%

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

et al. 2019

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Objective: To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM). Study Design: Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ 2 and the Fisher exact test (p < 0.05). Results: All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomor-phological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504). Conclusions: Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.

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Section: Discussionmentioning

confidence: 99%

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

et al. 2019

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“…LBC preparation was carried out strictly in accordance with the manufacturers' instructions [9,27,28]. All cytological examinations were reported using the terminology of the 2001 Bethesda System.…”

Section: Cytology Preparation and Interpretationmentioning

confidence: 99%

“…The cytological interpretations were divided as follows: unsatisfactory specimen, negative for intraepithelial lesion or malignancy (NILM), atypical cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), atypical glandular cells (AGC), and cervical cancer cells. We conducted a rigorous and systematic training and QC program for cytology processes, as we have previously reported [9,10].…”

Section: Cytology Preparation and Interpretationmentioning

confidence: 99%

“…Jinan KingMed Diagnostics (JKD), a local pathology laboratory of KD in Shandong Province, has conducted a similar cytopathologist training and QC program since 2013. After the implementation of these measures, the abnormal cervical cytology reporting rates significantly increased in large-scale test programs involving the CPS or LBC method, suggesting that cytopathologist training and QC programs significantly improve screening efficacy [9]. In this study, we further compared the screening efficiency of LBC testing alone, HR-HPV detection alone, and their combination in patients who subsequently received histological diagnoses of CIN1, CIN2/3, and ICC.…”

Section: Introductionmentioning

confidence: 99%

“…After the implementation of these training and QC provisions, the incidence and mortality of cervical cancer has drastically reduced in the last 60 years [ 6 – 8 ]. At the beginning of this century, the cytological efficiency of cervical cancer screening was further improved with the widespread application of liquid-based cytology (LBC) [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of prior cervical cytology and HR-HPV testing in women subsequently diagnosed with CIN1, CIN2/3, and invasive cervical cancer: a 4-year routine clinical experience after implementation of systematic training and quality control programs

et al. 2020

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Background: In 2013, Jinan KingMed Diagnostics (JKD) first established a systematic cervical cytology training and quality control (QC) program in Shandong Province, China. We compared the efficacy of high-risk human papillomavirus (HR-HPV) detection, cytology, and their combination in routine clinical practice after the implementation of the training and QC program to identify the optimal first-line screening method in this region. Methods: The data of patients histologically diagnosed with cervical intraepithelial neoplasia (CIN) 1, CIN2/3, and invasive cervical cancer (ICC) between January 2014 and December 2017 were retrieved from the JKD database. Cytology and/or HR-HPV testing results within 3 months preceding the CIN1 diagnoses and 6 months preceding the CIN2/3 and ICC diagnoses were analyzed. Results: Prior screening data were available for 1829 CIN1 patients, 2309 CIN2/3 patients, and 680 ICC patients. Cytology alone and HR-HPV testing alone had similar rates of positive results for CIN2/3 (97.2% [854/879] vs. 95.4% [864/906], P = 0.105) and ICC detection (89.1% [205/230] vs. 92.7% [204/220], P = 0.185). Compared with either method alone, co-testing slightly increased the screening sensitivity for CIN2/3 (99.8% [523/524], all P < 0.001) and ICC (99.6% [229/230], all P < 0.001) detection. In the CIN1 group, cervical cytology alone (92.9% [520/560]) was more sensitive than HR-HPV testing alone (79.9% [570/713], P < 0.001), and co-testing (95.3% [530/556]) did not significantly improve the screening sensitivity (P = 0.105).

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Bethesda system reporting rates, histological follow‐up and HPV genotypes distribution of abnormal cytology in Anhui province of China: Analysis of 93,168 cervical liquid‐based cytology test reports

Chen

Zhao

et al. 2023

Diagnostic Cytopathology

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Objective To analyze the Bethesda System reporting rates, histological follow‐up, and HPV genotypes distribution of abnormal cytology in Anhui province of China. Methods According to the Bethesda Reporting System of Cervical Cytology (2014), a retrospective analysis of the cervical liquid‐based cytology (LBC) results, abnormal cytology with concurrent HPV genotype testing, and immediate histological follow‐up. HPV genotype testing was performed for 15 High‐risk types and 6 Low‐risk types. Immediate histological correlation results within 6 months after the LBC and HPV results. Results 6.70% of women with abnormal LBC results, and ASC/SIL was 1.42. The severe histological results in abnormal cytology were ASC‐US (18.58%), ASC‐H (53.76%), LSIL (16.62%), HSIL (82.07%), SCC/ACa (100.00%), AGC (63.77%). The total HPV‐positive rate in abnormal cytology was 70.29%, of which ASC‐US, ASC‐H, LSIL, HSIL, SCC/ACa, and AGC were 60.78%, 80.83%, 83.05%, 84.93%, 84.51%, 33.33%. The top three detected genotypes were HR HPV 16, 52, and 58. The most commonly detected genotype in HSIL and SCC/ACa was HPV 16. Of the 91 AGC patients, 34.78% were cervical lesions, and 42.03% were endometrial lesions. The HPV‐positive rate in the group of AGC‐FN was highest and lowest in the group of AGC‐EM. Conclusion The Bethesda System reporting rates of cervical cytology were all within the benchmark range of the CAP laboratory. HPV 16, 52, and 58 were the most common genotypes in our population, and HPV 16 infection has a higher degree of malignancy of cervical lesions. Among patients with ASC‐US results, HPV positive patients had a higher rate of biopsy‐detected CIN2+ than HPV negative patients.

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Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests

Cited by 5 publications

References 14 publications

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

Outcomes of prior cervical cytology and HR-HPV testing in women subsequently diagnosed with CIN1, CIN2/3, and invasive cervical cancer: a 4-year routine clinical experience after implementation of systematic training and quality control programs

Bethesda system reporting rates, histological follow‐up and HPV genotypes distribution of abnormal cytology in Anhui province of China: Analysis of 93,168 cervical liquid‐based cytology test reports

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