Rapid cervicovaginal smear screening: method of quality control and assessing individual cytotechnologist performance

Aim: To validate the method of rapid screening (RS) in the detection of cervical lesions and false‐negative results as well as in quality control of cytotechnologist performance. Material and methods: The RS method was validated on Papanicolaou‐stained and initially conventionally analysed vaginal...

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Published in:	Cytopathology (Oxford) Vol. 17; no. 3; pp. 121 - 126
Main Authors:	Pajtler, M., Audy-Jurković, S., Škopljanac-Mačina, L., Antulov, J., Barišić, A., Miličić-Juhas, V.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-06-2006
Subjects:	cervical cytology Cervical Intraepithelial Neoplasia - diagnosis Cervical Intraepithelial Neoplasia - epidemiology Cervical Intraepithelial Neoplasia - pathology Croatia - epidemiology Female Humans Mass Screening - methods Mass Screening - standards Medical Laboratory Personnel - standards Papanicolaou Test quality assurance Quality Control rapid screening Reproducibility of Results sensitivity Sensitivity and Specificity specificity Uterine Cervical Neoplasms - diagnosis Uterine Cervical Neoplasms - epidemiology Uterine Cervical Neoplasms - pathology Vaginal Smears - methods Vaginal Smears - standards Croatia
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Summary:	Aim: To validate the method of rapid screening (RS) in the detection of cervical lesions and false‐negative results as well as in quality control of cytotechnologist performance. Material and methods: The RS method was validated on Papanicolaou‐stained and initially conventionally analysed vaginal, cervical and endocervical (VCE) smears collected in an opportunistic programme for the detection of cervical carcinoma. The study included 3680 VCE smears from the Department of Gynaecologic Cytology, University Department of Gynaecology and Obstetrics, Zagreb University Hospital Center, Zagreb and from the Department of Clinical Cytology, Osijek University Hospital, Osijek. Histologically verified abnormal findings accounted for 10% of the study samples. Thirteen cytotechnologists, with no previous experience in RS, performed the test. Each slide was examined using the ‘step’ technique for 1.5 minutes, the findings were classified as negative or abnormal, and the abnormal ones were also classified according to differential cytological diagnosis. The results were compared with those obtained on initial screening. Abnormal findings from a group of initially negative findings were reanalysed using conventional methods to make definitive cytological diagnosis. Results: RS yielded a sensitivity of 83.7%, specificity of 93.7%, positive predictive value of 62.4%, negative predictive value of 97.9% and diagnostic accuracy of 92.6%. Relative to the initial abnormal differential cytological diagnosis, the diagnostic value of RS increased with lesion severity [54.8%, 68.0% and 91.3% for cervical intraepithelial neoplasia (CIN) I, CIN II and CIN III respectively]. RS detected 38 additional positive findings; 94.2% of these were atypical squamous cells of undetermined significance (ASCUS)/abnormal glandular cells undetermined significance (AGUS) and CIN I. The rate of additional positive findings was 1.14% (38/3135). The false‐negative rate of initial screening was 9.4% (38/406), and individual cytotechnologist sensitivity was 60.0–100.0%. Conclusion: RS could be introduced as an efficient method of quality control to improve the sensitivity of cytological screening as well as for quality control of cytotechnologist performance.
Bibliography:	ark:/67375/WNG-4JJH0Z12-1 istex:41282DE865DDCA3C7345405AEFFBAA704CA88559 ArticleID:CYT367 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0956-5507 1365-2303
DOI:	10.1111/j.1365-2303.2006.00367.x