Ázara Cinara Zago Silveira, Manrique Edna Joana Claudio, Tavares Suelene Brito do Nascimento, Alves de Souza Nadja Lindany, Magalhães Juliana Cristina, Amaral Rita Goreti
External Quality Control Laboratory, School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Brazil.
Diagn Cytopathol. 2016 Apr;44(4):305-10. doi: 10.1002/dc.23445. Epub 2016 Feb 5.
This study assessed the effects of a continued education program on the agreement between cervical cytopathology exams interpreted by local laboratories and interpretation made by an external quality control laboratory (LabMEQ).
Overall, 9,798 exams were analyzed between 2007 and 2008, prior to implementation of a continued education program, and 10,028 between 2010 and 2011, following implementation. Continued education consisted of theoretical and practical classes held every two months. The chi-square test and the kappa coefficient were used in the statistical analysis.
Following implementation of continued education, the rate of false-negative results, and those leading to delays in clinical management fell in eight laboratories and the rate of false-positive results in five. Agreement between the results reported by the laboratories and the findings of LabMEQ, evaluated according to clinical management, remained excellent in three laboratories (kappa >0.80 and <1.0), went from good (kappa >0.60 and <0.80) to excellent in seven and from excellent to good in two. Agreement regarding the identification of metaplastic epithelium was poor (kappa = 0.25) but progressed to excellent following the implementation of continued education (kappa = 0.950). Agreement between cytopathology results improved significantly following implementation of continued education in cases reported as unsatisfactory (P < 0.001), atypical squamous cells of undetermined significance, cannot exclude high-grade squamous intraepithelial lesion (P < 0.001), low-grade squamous intraepithelial lesion (P < 0.001), and glandular atypia (P < 0.001).
Continued education contributed towards improving the reproducibility of cervical cytopathology, decreased the rates of false-negative and false-positive results, and reduced delays in clinical management.
本研究评估了一项继续教育项目对当地实验室解读的宫颈细胞病理学检查结果与外部质量控制实验室（LabMEQ）解读结果之间一致性的影响。
总体而言，在2007年至2008年实施继续教育项目之前分析了9798份检查，在2010年至2011年实施之后分析了10028份。继续教育包括每两个月举办的理论和实践课程。统计分析采用卡方检验和kappa系数。
实施继续教育后，八个实验室的假阴性结果率以及导致临床管理延迟的结果率下降，五个实验室的假阳性结果率下降。根据临床管理评估，实验室报告的结果与LabMEQ的结果之间的一致性在三个实验室中仍然极佳（kappa>0.80且<1.0），在七个实验室中从良好（kappa>0.60且<0.80）提升至极佳，在两个实验室中从极佳降至良好。关于化生上皮识别的一致性较差（kappa = 0.25），但在实施继续教育后提升至极佳（kappa = 0.950）。在报告为不满意（P < 0.001）、意义不明确的非典型鳞状细胞、不能排除高级别鳞状上皮内病变（P < 0.001）、低级别鳞状上皮内病变（P < 0.001）和腺上皮异型性（P < 0.001）的病例中，实施继续教育后细胞病理学结果之间的一致性显著改善。
继续教育有助于提高宫颈细胞病理学的可重复性，降低假阴性和假阳性结果率，并减少临床管理中的延迟。
