不同巴氏涂片试验制剂中阴道毛滴虫的鉴定：美国病理学家学院教育实验室间比较计划中的时间趋势。

Identification of Trichomonas vaginalis in different Papanicolaou test preparations: trends over time in the College of American Pathologists educational Interlaboratory Comparison Program.

机构信息

Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA.

出版信息

Arch Pathol Lab Med. 2013 Aug;137(8):1043-6. doi: 10.5858/arpa.2012-0036-CP.

DOI:10.5858/arpa.2012-0036-CP

PMID:23899059

Abstract

CONTEXT

The College of American Pathologists' Interlaboratory Comparison Program in Gynecologic Cytology has seen an increase in enrollment in liquid-based Papanicolaou test challenges with a decrease for conventional Papanicolaou tests. Trichomonas vaginalis can be difficult to identify in all preparation types.

OBJECTIVES

To evaluate 20 years of participant results from the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology for Trichomonas to ascertain whether performance has changed because of the introduction of liquid-based Papanicolaou and proficiency testing.

DESIGN

Concordance rates for the target diagnosis of Trichomonas vaginalis were evaluated for 167,956 participant responses (1990-2010). A nonlinear mixed model was fit with participant type, preparation type, and a 2-level program year (1990-2005 and 2006-2010) reflecting before and after proficiency testing began. A repeated-measures component allowed modeling of the slide-specific performance to ensure that the overall results were not based on the performance of a few slides.

RESULTS

Cytotechnologists had higher concordance with the target diagnosis than did pathologists (89.8% [72,992 of 81,319] versus 83.4% [72,271 of 86,637], P < .001) and better performance for each preparation type (P = .003). Concordance initially dropped after the introduction of proficiency testing (P < .001) for conventional and liquid-based (SurePath) preparations by both participant types, followed by quick, parallel improvement.

CONCLUSIONS

Performance is high in the detection of Trichomonas vaginalis in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology. Liquid-based Papanicolaou and proficiency testing minimally affected participant performance. Cytotechnologists performed better over time and across preparation types than did pathologists, although pathologists showed performance results parallel to that of the cytotechnologists. Awareness of the performance differences by pathologists and cytotechnologists, as well as their difference in proficiency among liquid-based techniques, may help ensure accurate results in clinical practice.

摘要

背景

美国病理学家学会（College of American Pathologists，CAP）的妇科细胞学室间质评计划中，液基巴氏涂片检测的参与率有所增加，而传统巴氏涂片检测的参与率则有所下降。阴道毛滴虫在所有制片类型中都难以识别。

目的

评估 20 年来美国病理学家学会妇科细胞学室间质评计划中参与者的结果，以确定阴道毛滴虫的检测性能是否因液基巴氏涂片和能力验证的引入而发生了变化。

设计

对 167956 例参与者的检测结果进行了目标诊断为阴道毛滴虫的符合率评估（1990-2010 年）。采用非线性混合模型，将参与者类型、制片类型和 2 级计划年份（1990-2005 年和 2006-2010 年）纳入其中，以反映能力验证开始前后的情况。重复测量成分允许对特定玻片的性能进行建模，以确保总体结果不是基于少数玻片的性能。

结果

细胞技术专家的诊断符合率高于病理学家（89.8%[72,992/81319]与 83.4%[72,271/86637]，P<0.001），并且在每种制片类型上的表现都更好（P=0.003）。在传统和液基（SurePath）制片类型中，参与者类型的符合率在能力验证引入后均最初下降（P<0.001），随后迅速平行提高。

结论

美国病理学家学会妇科细胞学室间质评计划中阴道毛滴虫的检测性能较高。液基巴氏涂片和能力验证对参与者的表现影响很小。细胞技术专家的表现随着时间的推移和制片类型的变化而提高，优于病理学家，尽管病理学家的表现与细胞技术专家相似。病理学家和细胞技术专家应意识到性能差异，以及他们在液基技术方面的熟练程度差异，这可能有助于确保在临床实践中获得准确的结果。