P-19 THE LABORATORY AND CLINICAL ADVANTAGES OF PROMPT CERVICAL SMEAR HISTOLOGY MISMATCH AUDIT
| Autor: | F. B. Payne, K. A. Adam, Louise Smart, M. E. McKean, M. Y. Lorimer |
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| Rok vydání: | 2006 |
| Předmět: | |
| Zdroj: | Cytopathology. 17:27-27 |
| ISSN: | 1365-2303 0956-5507 |
| Popis: | ABC guidelines require correlation of cervical biopsy and smear results for calculation of positive predictive values. This need only involve retrospective review of cytology with histology considered the ‘gold standard’. Because NHSCSP recommend longer follow up for high than low grade CIN, it is important that high grade CIN is not underdiagnosed. We undertook prompt mismatch review, including both smear and biopsy review to fulfil an improved audit function and facilitate appropriate patient management. Method: All colposcopy referral smears were entered into an Access database and correlated with the subsequent colposcopic biopsy. All non-correlating smears were reviewed independently and a consensus result reached. When the consensus remained high grade the histology was reviewed similarly and, if upgraded, a supplementary report was issued. Results: Over 6 months, 578 women referred to colposcopy with abnormal cytology had biopsies. In 491 (83%) cases, the referral smear and biopsy correlated within one grade. Of 51 smear (9%) ‘undercalls’ relative to the biopsy, 29 (5%) were upgraded to correlate on review. Of 36 smears (6%) classed as ‘overcalls’, 7 were true cytological overcalls and downgraded. 10 biopsies were upgraded, 5 from low to high grade CIN. 19 (3%) high grade smears remained non-correlating. Correlation increased to 91% after smear and histology review. Conclusion: This system of mismatch correlation enables clinicians to receive amended results early enough for modification of treatment and follow up based on an accurate CIN grade. Tabulated results highlight non-correlating cases where the biopsy may be non-representative and identify cases for clinico-pathological conferences. Multi-observer review of true cytology undercalls and overcalls has an educational role and improved accuracy of CIN grading increases PPVs. Although labour intensive, this approach offers significant advantages and audit criteria may be refined to focus on relevant issues. |
| Databáze: | OpenAIRE |
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