Controle interno da qualidade dos exames citológicos do colo do útero: pré-escrutínio rápido versus revisão rápida de 100%
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2011-09-29
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Universidade Federal de Goiás
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False-negative rates constitute a common problem in the daily routine of cytopathology laboratories. Among the various internal quality control methods, 10% random review is the least effective in detecting false-negative results in routine screening. On the other hand, good results have been found with 100% rapid review and with rapid prescreening. Nevertheless, no studies comparing these two methods have been reported. Objective: To compare the performance of rapid prescreening and 100% rapid review as internal quality control methods in cervical cytopathology. Methods: Over 27 months, 12,208 cervical cytology smears collected from Units of Primary Health Care of Goiânia were submitted to rapid prescreening and routine screening at Rômulo Rocha Center for Clinical Analyses at the School of Pharmacy, Federal University of Goiás, Goiânia, Goiás, Brazil. The 100% rapid review method was performed on all smears classified as negative at routine screening. Conflicting results obtained with either method were reviewed in detail to define final diagnosis, which was considered the gold-standard for evaluating the performance of rapid prescreening and 100% rapid review. In cases with abnormal cytology were evaluated the results of colposcopy, histopathology and of the new cytopathology. The sensitivity and specificity of internal quality control methods were estimated when compared to the final diagnosis, and to follow-up colposcopy, histopathology and at new cytopathology. Results: Compared to the final diagnosis, the sensitivity of routine screening and rapid prescreening was 72.9% (IC 95%: 70,0%-75,8%) and 75.6% (IC 95%: 72,8%-78,4%), respectively. Taking into account only those smears classified as negative at routine screening, the sensitivity of rapid prescreening and RR-100% was 90.2% (IC 95%: 86,4-93,9) and 57.0% (50,8%-63,2%), respectively. Rapid prescreening identified 220 (1.8%), while RR-100% identified 140 (1.15%) of the 244 (2.0%) cases with false-negative results at routine screening. The sensitivity of rapid prescreening in detect abnormal cases at follow-up colposcopy, histopathology and at new cytopathology was 87.5% (CI95%; 74.3%-100.7%) 82,4% (CI95%: 64.2%-100.,5%), 95.7% (CI95%:89.8%-101.5%), respectively, the sensitivity of 100% rapid review was 54.2% (CI95%: 34.2%-74.1%), 52.9% (CI95%: 29.2%-76.7%), 47.8% (CI95%: 33.4%-62.3%) respectively and the sensibility of routine screening was 83.2% (CI95%: 77.1%-89.3%), 85.7% (CI95%: 79.4%-92.0%), 73.3% (CI95%: 66.6%-79.9%), respectively. Conclusions: Rapid prescreening was more effective than 100% rapid review for the detection of false-negative results at routine screening, with a better performance when compared to final diagnosis, to follow-up colposcopy and at new cytopathology. The methods showed similar performance when compared at follow-up histopathology. Therefore, according to the results of this study, rapid prescreening provides subsidies to improve the performance of cervical cytopathology tests, whose the principal function of which is to detect cervical cancer precursor lesions.
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TAVARES, Suelene Brito do Nascimento. Internal quality control of the cervical cytologic exams:Rapid prescreenig versus 100% rapid review. 2011. 122 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2011.