Eficiência do pré-escrutínio rápido, revisão aleatória de 10% e critérios clínicos de risco como métodos de controle interno da qualidade dos exames citopatológicos cervicais
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Data
2007-09-06
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Universidade Federal de Goiás
Resumo
Cytopathology is an effective method of screening for cervical cancer; however, this
method has high rates of false-negative results (FNR). To reduce FNR, routine
measures of internal and external quality control are required in laboratories. The
10% random review of negative smears (R-10%) is the most commonly used
method; however, it is not effective in reducing FNR. Nevertheless, there is evidence
that the review of smears selected according to clinical risk factors (RCRF) and rapid
prescreening (RPS) of all smears present good results. This study evaluated the
performance of RPS, R-10% and RCRF as methods of internal quality control of
cervical smear testing. The sample was composed of a total of 6,135 cervical
smears from women who had attended Basic Health Clinics in Goiânia Goiás
between March 2006 and March 2007. The cytopathological results were classified
according to the 2001 Bethesda System. Initially, 6,135 smears were submitted to
RPS followed by routine scrutiny (RS). Following RS, smears classified as negative
were selected on the basis of clinical risk criteria, while 10% of all the smears were
selected randomly, both sets then being submitted to the respective reviews. Four
cytologists were responsible for RPS, RS, R-10% and RCRF, and three for reviewing
the abnormal and discordant smears from any of the reviews. The smears classified
as negative in RPS, RS, R-10% and RCRF were considered to have a final diagnosis
(FD) of negative. Smears considered suspect or unsatisfactory at RPS were
analyzed separately by two other cytologists. Smears considered abnormal or
unsatisfactory at RS, R-10% and/or RCRF were likewise reviewed. When the two
reviewing cytologists reached concordant diagnoses, these were considered the FD.
Discordant results were analyzed by a third cytologist and a consensus meeting was
held to define the FD. All stages of the study were performed blinded except for the
consensus meeting. Smears classified as negative at RS, which were suspect at RPS and/or considered abnormal at R-10% and RCRF and confirmed abnormal in
the FD, were considered FN results. Of the 6,135 smears, 5,522 were classified as
negative, 84 as unsatisfactory and 529 as abnormal in the FD. Sensitivity of RPS
was 63.0% for all abnormalities and 96.7% for high-grade squamous intraepithelial
lesion (HSIL) compared to RS. The sensitivity of RPS was 74.9% for all
abnormalities and 95.0% for HSIL compared to FD. The sensitivity of R-10% was
53.8% for all abnormalities when compared to FD. R-10% failed to detect any cases
of HSIL. The sensitivity of RCRF was 64.0% for all abnormalities and 75.0% for HSIL
compared to the FD. RPS identified an additional 132 (2.15%) abnormal smears,
whereas R-10% and RCRF identified an additional 7 (0.11%) and 32 (0.52%),
respectively. In conclusion, RPS is an effective method of internal quality control and
has better sensitivity than R-10% and RCRF for the detection of FN results. It also
allows the FN rate of the laboratory to be monitored and permits continuous
evaluation of the prescreening cytologist and the routine screening cytologist.
Descrição
Palavras-chave
Câncer cervical , controle da qualidade , resultados falsonegativos , pré-escrutínio rápido , revisão com base em critérios clínicos de risco , revisão aleatória de 10% , Cervical cancer. Quality control. False-negative results. Rapid
prescreening. Review based on clinical risk criteria. 10% random review.
Citação
TAVARES, Suelene Brito do Nascimento. Efficiency of rapid prescreening, 10% random review and review based on clinical risk criteria as methods of internal quality control of cervical smear testing. 2007. 127 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2007.