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 |
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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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