Results of a control quality strategy in cervical cytology / Resultados de uma estratégia de controle de qualidade em colpocitologia
Einstein (Säo Paulo)
; 10(1): 86-91, jan.-mar. 2012. ilus, tab
Article
in English, Portuguese
| LILACS
| ID: lil-621516
Responsible library:
BR1.1
ABSTRACT
Objective:
To determine the efficacy of a quality control strategy in cervical cytology in the detection of high-grade squamous intraepithelial lesions.Methods:
Forty-two patients were selected who underwent a Pap smear and cervical uterine biopsy between April 2008 and December 2009, with evidence of a high-grade squamous intraepithelial lesion in one or both tests. The statistical parameters of the smear test were calculated before and after systematic meetings for review of the archived test results (6 years), in which the following was done interobserver diagnostic consensus; cytohistological correlation, with the latter as gold standard; and evaluation of the therapeutic status of each patient.Results:
Once these controls were applied, it was noted that sensitivity and positive likelihood ratio of the test for high-grade squamous intraepithelial lesion increased 9.5% (34.5 to 44%) and 0.45% (1.64 to 2.09%), respectively, while specificity remained at 79%. Reduction in interference of false-negative results associated with errors in the analytical phase of the cytological productive process gave an estimate of failures in collection of the specimens (pre-analytical phase).Conclusion:
In addition to improving the performance of the cytological diagnosis of the high-grade squamous intraepithelial lesion, the proposed quality control strategy allows a reflection on the causes of incorrect or conflicting scrutiny.RESUMO
Objetivo:
Determinar a eficácia de uma estratégia de controle de qualidade em colpocitologia na detecção da lesão intraepitelial escamosa de alto grau.Métodos:
Foram selecionadas 42 pacientes que realizaram Papanicolaou e biópsia cervicouterina entre abril de 2008 e dezembro de 2009, com evidência de lesão intraepitelial escamosa de alto grau em um ou em ambos os exames. Os parâmetros estatísticos do esfregaço foram calculados antes e após reuniões sistematizadas de revisão dos exames arquivados (6 anos), nas quais se procedeu a consensualização diagnóstica interobservadores; correlação cito-histológica, sendo a última padrão-ouro; e avaliação do status terapêutico de cada paciente.Resultados:
Aplicados tais controles, observou-se que a sensibilidade e a likelihood ratio positiva do teste para lesão intraepitelial escamosa de alto grau aumentaram 9,5% (34,5 para 44%) e 0,45% (1,64 para 2,09%), respectivamente, enquanto sua especificidade se manteve em 79%. A redução da interferência dos falso-negativos associados a erros na fase analítica do processo produtivo citológico traz estimativa das falhas de coleta do material (fase pré-analítica).Conclusão:
Além de melhorar o desempenho do diagnóstico colpocitológico de lesão intraepitelial escamosa de alto grau, a estratégia de controle de qualidade proposta permite refletir sobre as causas de escrutínio incorreto ou discordante.
Full text:
Available
Collection:
International databases
Health context:
Sustainable Health Agenda for the Americas
/
SDG3 - Health and Well-Being
Health problem:
Goal 9: Noncommunicable diseases and mental health
/
Target 3.4: Reduce premature mortality due to noncommunicable diseases
Database:
LILACS
Main subject:
Quality Assurance, Health Care
/
Vaginal Smears
/
Biopsy
/
Carcinoma, Squamous Cell
/
Uterine Cervical Dysplasia
/
Uterine Cervical Neoplasms
/
Cervix Uteri
Type of study:
Diagnostic study
/
Observational study
/
Prevalence study
/
Prognostic study
/
Risk factors
Limits:
Female
/
Humans
Language:
English
/
Portuguese
Journal:
Einstein (Säo Paulo)
Journal subject:
Medicine
Year:
2012
Document type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Faculdade de Medicina de São José do Rio Preto/BR