Impact of Implementing 100% Rapid Review as a Quality Control Tool in Cervical Cytology

2018 ◽  
Vol 62 (2) ◽  
pp. 115-120
Author(s):  
Juliana Cristina Magalhães ◽  
Cinara Zago Silveira Ázara ◽  
Sulene Brito do Nascimento Tavares ◽  
Edna Joana Claudio Manrique ◽  
Rita Goreti Amaral
Keyword(s):  
Quality Indicators ◽  
False Negative ◽  
Rapid Review ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Negative Results ◽  
False Negative Results ◽  
Quality Control Tool ◽  
Intraepithelial Lesion ◽  
Control Tool

Objective: We aimed to evaluate the impact of implementing 100% rapid review (100% RR) as a quality control tool in cervical smear cytology. Design: A cross-sectional study was conducted in which cytology findings, false-negative results, and quality indicators were evaluated. The variables were analyzed in 2004, the year in which 100% RR was implemented, and again in 2013, i.e., 10 years on. Results: Detection of atypical squamous cells of undetermined significance (ASC-US) increased from 0.90% in 2004 to 2.47% in 2013 by routine screening. Detection of atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) increased from 13.33% in 2004 to 36.27% in 2013 by 100% RR. Detection of high-grade squamous intraepithelial lesion (HSIL) increased from 0.64% in 2004 to 4.29% in 2013 by routine screening, and increased from 0% in 2004 to 19.61% in 2013 by 100% RR. There was a significant increase (p = 0.00001) in the identification of false-negative results of ASC-US, low-grade squamous intraepithelial lesion, ASC-H, HSIL, and atypical glandular cells. All quality indicators had increased in 2013 when compared to 2004 results. Conclusions: Ten years after the implementation of the 100% RR method, improvements were found in the detection of atypia and precursor lesions and in quality indicators.

Does 100% Rapid Review Improve Cervical Cancer Screening?

2018 ◽  
Vol 62 (3) ◽  
pp. 209-214
Author(s):  
José Queiroz Filho ◽  
José Eleutério, Jr. ◽  
Ricardo Ney Cobucci ◽  
Janaina Cristiana de Oliveira Crispim ◽  
Paulo César Giraldo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Final Diagnosis ◽  
Rapid Review ◽  
Squamous Intraepithelial Lesion ◽  
Squamous Cells ◽  
Negative Results ◽  
Intraepithelial Lesion ◽  
Positive Results

Objective: The aim of this work was to evaluate 100% rapid review (100% RR) as a useful tool to detect false negative (FN) results. Study Design: A sample of 8,677 swabs was investigated; the unsatisfactory and negative results were referred to 100% RR, concordant results were taken as the final diagnosis, while the discordant results were debated in a consensus meeting to reach a conclusion. The positive results were examined by 2 cytologists. The data were entered into SAS statistical software, and the agreement of the 100% RR results with the final diagnosis was tested with the weighted kappa statistic. Results: There was a significant increase in unsatisfactory results from 348 to 1,927, and of positive results from 174 to 349. On the other hand, there was a substantial decrease in negative results from 8,155 to 6,401. Assessing the relative risk of FN results in smears that were not referred to quality control (100% RR) revealed the following results: atypical squamous cells of undetermined significance (ASC-US), 2.93; low-grade squamous intraepithelial lesion (LSIL), 2.72; high-grade squamous intraepithelial lesion/atypical squamous cells – cannot exclude HSIL (HSIL/ASC-H), 2.25. Evaluating by age group, a higher risk for LSIL (4.90) and ASC-US (3.85) was observed in patients aged under 25 years, whereas patients between 25 and 64 years and those over 64 years presented a higher risk for HSIL and ASC-H: 2.46 and 2.75, respectively. Conclusion: 100% RR is an effective screening tool for FN results in countries where molecular tests for DNA-HPV and prophylactic vaccines are not available in cervical cancer screening programs.

scholarly journals Management of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil

2018 ◽  
Vol 40 (03) ◽  
pp. 121-126 ◽  
Author(s):  
Geilson Oliveira ◽  
Judite Oliveira ◽  
Renata Eleutério ◽  
José Eleutério Júnior
Keyword(s):  
Northeastern Brazil ◽  
National Guideline ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
National Guidelines ◽  
Squamous Cells ◽  
Negative Results ◽  
Hpv Test ◽  
Intraepithelial Lesion

Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p < 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p < 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p < 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Performance of Laboratories after 10 Years of Participating in External Quality Monitoring in Cervical Cytology

2019 ◽  
Vol 64 (3) ◽  
pp. 224-231
Author(s):  
Leonarda Silvestre Faria de Morais ◽  
Juliana Cristina Magalhães ◽  
Iara da Silva Braga ◽  
Luiza Alessandra Marega ◽  
Suelene Brito do Nascimento Tavares ◽  
...  
Keyword(s):  
False Negative ◽  
National Health System ◽  
Quality Monitoring ◽  
Internal Quality ◽  
Fisher Exact Test ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
External Quality ◽  
Squamous Cells ◽  
Intraepithelial Lesion

Objective: To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM). Study Design: Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ2 and the Fisher exact test (p < 0.05). Results: All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomorphological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504). Conclusions: Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.

scholarly journals Diagnostic Three Slides Pap Test Compared to Punch Biopsy and Endocervical Curettage in Confirmed HSIL+ Diagnosis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 942
Author(s):  
Roberta Rubeša-Mihaljević ◽  
Danijela Vrdoljak-Mozetič ◽  
Morana Dinter ◽  
Damjana Verša Ostojić ◽  
Snježana Štemberger-Papić ◽  
...  
Keyword(s):  
False Negative ◽  
Pap Test ◽  
Punch Biopsy ◽  
Direct Access ◽  
Brush Cytology ◽  
Biopsy Material ◽  
Negative Results ◽  
False Negative Results ◽  
Intraepithelial Lesion ◽  
Endocervical Canal

Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher (p < 0.0001). Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.

Clinical Relevance of ASC-H Cytologies: Experience in a Single Tertiary Hospital

2016 ◽  
Vol 60 (3) ◽  
pp. 217-224 ◽  
Author(s):  
Cristina Díaz del Arco ◽  
Mª Carmen Sanabria Montoro ◽  
Dolores García López ◽  
Eva Rodríguez Escudero ◽  
Mª Jesús Fernández Aceñero
Keyword(s):  
Predictive Value ◽  
False Negative ◽  
Tertiary Hospital ◽  
Pap Smears ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Negative Results ◽  
Intraepithelial Lesion ◽  
Clinical Records

Objectives: To review the cases of atypical squamous cells (ASC), cannot exclude squamous intraepithelial lesion (ASC-H) diagnosed at a single institution and to discuss the interpretation challenges and clinical management of these cases. Study Design: The ASC-H cases diagnosed at our institution from 2006 to 2015 were studied retrospectively; of 159,000 Pap smears, there were 959 cases of ASC of undetermined significance (ASC-US) and 148 cases of ASC-H. We have reviewed the clinical records of the ASC-H cases, and data have been analyzed using SPSS 20.0. Results: Median age was 43.1 years; 49.6% of the patients had previous cervical cytologies, and 55.9% of them were negative. Following ASC-H diagnosis, another smear was obtained in 97.1% of the cases and in 67.6% a biopsy was performed. Biopsy revealed low-grade dysplasia in 18.8% of the cases, high-grade dysplasia in 27.8%, and infiltrating carcinoma in 2.3%. Patients with significant lesions in histology were younger than patients with negative results (p = 0.08). A diagnosis of ASC-H/squamous intraepithelial lesion in the repeated cytology had a sensitivity of 74.2%, specificity of 39.6%, positive predictive value of 44.8%, and negative predictive value of 70% for the diagnosis of dysplasia. Conclusions: ASC-H diagnosis is associated with a high incidence of histological high-grade lesions. A repeat cytology can aid in the selection of high-risk patients, but there may be false-negative results.

Critical Evaluation of Impedance Phlebography for the Diagnosis of Deep Vein Thrombosis

1974 ◽  
Vol 31 (02) ◽  
pp. 273-278
Author(s):  
Kenneth K Wu ◽  
John C Hoak ◽  
Robert W Barnes ◽  
Stuart L Frankel
Keyword(s):  
Deep Vein Thrombosis ◽  
False Positive ◽  
False Negative ◽  
Critical Evaluation ◽  
Original Method ◽  
Vein Thrombosis ◽  
Negative Results ◽  
False Negative Results ◽  
Deep Vein ◽  
Positive Results

SummaryIn order to evaluate its daily variability and reliability, impedance phlebography was performed daily or on alternate days on 61 patients with deep vein thrombosis, of whom 47 also had 125I-fibrinogen uptake tests and 22 had radiographic venography. The results showed that impedance phlebography was highly variable and poorly reliable. False positive results were noted in 8 limbs (18%) and false negative results in 3 limbs (7%). Despite its being simple, rapid and noninvasive, its clinical usefulness is doubtful when performed according to the original method.

Scoring System for the Diagnosis of COVID-19

2020 ◽  
Vol 13 (1) ◽  
pp. 413-414 ◽  
Author(s):  
Mohamed Farouk Allam
Keyword(s):  
Scoring System ◽  
Clinical Symptoms ◽  
False Negative ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Pcr Assay ◽  
Negative Results ◽  
False Negative Results ◽  
Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

Detection of Streptococcus pneumoniae in Sputum Samples by Real- Time PCR.

2020 ◽  
Vol 18 ◽  
Author(s):  
Pegah Shakib ◽  
Mohammad Reza Zolfaghari
Keyword(s):  
Streptococcus Pneumoniae ◽  
Real Time ◽  
Real Time Pcr ◽  
False Negative ◽  
Cross Sectional Study ◽  
Laboratory Culture ◽  
Cross Sectional ◽  
Negative Results ◽  
False Negative Results ◽  
Pcr Method

Background: Conventional laboratory culture-based methods for diagnosis of Streptococcus pneumoniae are time-consuming and yield false negative results. Molecular methods including real-time (RT)-PCR rapid methods and conventional PCR due to higher sensitivity and accuracy have been replaced instead traditional culture assay. The aim of the current study was to evaluate lytA gene for detection of Streptococcus pneumoniae in the cerebrospinal fluid of human patients with meningitis using real-time PCR assay. Material and Methods: In this cross-sectional study, a total of 30 clinical specimens were collected from patients in a period from September to December 2018. In order to evaluate the presence of lytA gene, conventional and real-time PCR methods were used without culture. Results: From 30 sputum samples five (16.66%) isolates were identified as S. pneumoniae by lytA PCR and sequencing. Discussion: In this research, an accurate and rapid real-time PCR method was used, which is based on lytA gene for diagnosis of bacteria so that it can be diagnosed. Based on the sequencing results, the sensitivity for detection of lytA gene was 100% (5/5).

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