Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade
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Data
2010-03-03
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Universidade Federal de Goiás
Resumo
Introduction: The External Quality Monitoring (MEQ) was developed from recommendations of the National Cancer Institute, in order to evaluate the performance of cytopathology diagnostic of the cervix and provide subsidies for continuing education to professionals in laboratories that provide services to public health. Objectives: To evaluate the results of Pap cervical smear between the laboratories accredited by the Single Health System (SUS) according to the diagnostic of the Unit of External Quality Monitoring (UMEQ), checking the frequency of the results of Pap cervical smear, the discordant cases, false positives (FP), false negative (FN) and diagnostic agreement. Methods: A total of 14 laboratories accredited by the SUS indicated by the Municipal Secretary of Health in Goiânia-GO participated in this
study. It was reviewed the period from January 2007 to December 2008, Pap cervical smear tests selected by the Information System of Cancer of the cervix including all positive cases, all unsatisfactory ones and at least 5% of negative test results which should achieve at least 10% of the monthly routine of each laboratory, totaling 10,053 tests. These were reviewed by professionals from UMEQ / Faculty of Pharmacy from Federal University of Goiás. It was considered discordant cases in which there was a change in clinical management in accordance with the criteria established by the Ministry of Health. To place the cytological cervical results the Bethesda System was used. The magnitude of agreement was evaluated between the diagnoses using the kappa coefficient. The level of agreement considering its
respective confidence intervals of 95% depending on the need to assign different weights to the disagreements were classified as follows: less than 0 - very bad agreement, 0 to 0.2, bad agreement; from 0.2 to 0.4 - reasonable agreement, from 0.4 to 0.6 - good agreement, from 0.6 to 0.8 - very good agreement and from 0.8 to 1.0 excellent. Results: There was disagreement between the UMEQ and laboratories of origin in 763 (7,59%) cases, of these 110 (1,1%) were FN distributed in: 37 (0,37%) atypical squamous cells of undetermined significance (ASC-US), 22 (0,22%) intraepithelial low-grade squamous lesions (LSIL), 30 (0,30%) atypical squamous cells cannot exclude a high-grade lesion (ASC-H), 12 (0,13%) squamous intraepithelial lesions of high grade (HSIL), an (0,01%) intraepithelial lesion of high-grade with suspicious features for invasion, six (0,07%) atypical glandular cells and two (0,02%) adenocarcinomas in situ. There was a delay in clinical management in 245 (2,44%)
cases, of these 85 (0,84%) were initially classified as ASC-US and 160 (1,50%) as LSIL.The cases of ASC-US were distributed in: 53 (0,53%) ASC-H, 31 (0,31%) HSIL and an (0,01%) atypical glandular. The cases of LSIL were distributed in: 19 (0,19%) ASC-H, 139 (1,38%) HSIL and two (0,02%) atypical glandular cells. It was considered 283 (2,82%) FP cases and 125 (1,24%) initially negative cases that were reclassified as unsatisfactory. The agreement
between the laboratories of origin and the UMEQ was excellent (Kappa = 0.81). It was found that for the evaluation of agreement of each laboratory, the majority showed very good agreement. The agreement of the sample adequacy was considered reasonable (Kappa = 0.30). Conclusion: Most laboratories showed very good agreement, however, it is worth mentioning that MEQ is an exercise of improvement needed to establish the standardization of diagnostic criteria and improve the accuracy of cervical smear.
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ÁZARA, Cinara Zago Silveira. Evaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Quality. 2010. 109 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2010.