Team Reading (Peer Review) of Suspicious/Positive Slides for Continuous Quality Improvement in Cervical-Vaginal Cytology: A Comparison between Methods and Indicators

Autor: Paolo Giorgi Rossi, Paola Capparucci, Gabriella Manca, Eloisa Mania, Antonella Di Luzio, Tommaso Filippini, Antonio Placidi
Rok vydání: 2016
Předmět:
Adult
0301 basic medicine
Pathology
medicine.medical_specialty
Histology
Quality management
Cytodiagnosis
media_common.quotation_subject
MEDLINE
Uterine Cervical Neoplasms
Cervix Uteri
Cervical intraepithelial neoplasia
Sensitivity and Specificity
Pathology and Forensic Medicine
03 medical and health sciences
0302 clinical medicine
Atypical Squamous Cells of the Cervix
Cervical Intraepithelial Neoplasia
Colposcopy
DNA
Viral
Early Detection of Cancer
Female
Humans
Middle Aged
Papillomaviridae
Papillomavirus Infections
Quality Improvement
Squamous Intraepithelial Lesions of the Cervix
Vagina
Vaginal Smears
Reading (process)
medicine
Medical physics
Vaginal cytology
media_common
medicine.diagnostic_test
business.industry
Local health unit
General Medicine
Uterine Cervical Dysplasia
medicine.disease
030104 developmental biology
030220 oncology & carcinogenesis
business
Quality assurance
Zdroj: Acta Cytologica. 60:458-464
ISSN: 1938-2650
0001-5547
Popis: Aim: In 2013, the Local Health Unit Roma 2 ex C screening laboratory introduced a new set of indicators for quality assurance. We compare 2 sets of indicators based on routine multiple readings (peer review) for their ability to identify problems in single-reader accuracy. Methods: All suspect slides were blindly reviewed by all the cytologists of the laboratory. The standard set of indicators includes interreader Cohen's kappa, positivity rate and atypical squamous cell of undetermined significance/squamous intraepithelial lesion (ASC-US/SIL) ratio. The new set included sensitivity for cervical intraepithelial neoplasia of grade 2 or worse (CIN2+), positive predictive value (PPV) and percentage of positive high-risk (HR)-HPV cases among ASC-US. In order to estimate sensitivity and PPV, we considered all women for whom there was a consensus of negative cytology, negative HR-HPV test, negative colposcopy or negative histology true negative. Results: Kappa values ranged from 0.521 to 0.753, with narrow 95% confidence intervals (CIs). Positivity rate ranged from 73.9 to 85.7 and the ASC-US/SIL ratio from 0.61 to 0.81. Sensitivity for CIN2+ at the low-grade SIL threshold ranged from 85.8 to 94.2, PPV ranged from 14.8 to 19.4, and both had a broad 95% CI. Readers with low sensitivity did not show low kappa values. The percentage proportion of HR-HPV-positives (HR-HPV+) among ASC-US ranged from 39.9 to 43.8% with a narrow 95% CI. Conclusion: The proportion of HR-HPV+ among ASC-US cases is a powerful indicator to address in training.
Databáze: OpenAIRE
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