de Morais Leonarda Silvestre Faria, Magalhães Juliana Cristina, Braga Iara da Silva, Marega Luiza Alessandra, Tavares Suelene Brito do Nascimento, Amaral Rita Goreti
School of Medicine, Federal University of Goiás, Goiânia, Brazil.
School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
Acta Cytol. 2020;64(3):224-231. doi: 10.1159/000502433. Epub 2019 Sep 3.
To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM).
Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ2 and the Fisher exact test (p < 0.05).
All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomorphological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504).
Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.
评估参与外部质量监测（eQM）10年后，由国家卫生系统认可的进行子宫颈细胞病理学检查的实验室的表现。
本研究评估了7个实验室。为评估上皮细胞表现形式和结果的一致性，回顾了6536次检查（2007年3433次，2017年3103次）。采用κ系数以及χ2检验和Fisher精确检验进行统计分析（p<0.05）。
所有实验室均显示出充足的基础设施和内部质量监测。关于上皮细胞的表现形式，一致性仍然极佳（κ在0.84至0.94之间）。2007年，识别出26例假阴性结果（FN）、157例假阳性结果（FP）和79次临床行为延迟（DCC）（κ=0.80）。2017年，识别出24例FN、42例FP和38例DCC（κ=0.90）。5个实验室在2007年至2017年间一致性有所改善。我们观察到结果的细胞形态学标准有显著改善：意义不明确的非典型鳞状细胞（p<0.001）、不能排除高级别鳞状上皮内病变的非典型鳞状细胞（p<0.016）和低级别鳞状上皮内病变（p<0.001）。我们还观察到腺上皮细胞异常结果有相当大的改善（p<0.0504）。
实施eQM 10年后，在所有监测的实验室中，观察到结果一致性有所改善，同时FN、FP和DCC有所减少。
