Weissbrod D, Torres M, Rodríguez A, Ureña I, Estrada J, Reyes M E, Carreto A J
National Institute of Epidemiologic Diagnosis and Reference (Instituto Nacional de Diagnóstico y Referencia Epidemiológicos-INDRE), Mexico City, Mexico.
Bull Pan Am Health Organ. 1996 Dec;30(4):339-47.
From August 1994 to June 1995, laboratories in 28 Mexican states and the Federal District submitted a total of 10098 diagnosed Pap test slides to Mexico's National Institute of Epidemiologic Diagnosis and Reference (INDRE) for reexamination by conventional methods and also by the automated PAPNET system in Suffern, New York, U.S.A. The aim was to determine the degree of agreement obtained by these various methods. Most of the slides examined (at least 78%) yielded negative results or merely indicated an inflammatory process; 8% to 14% indicated mild or moderate cervical dysplasia; and 2% to 3% indicated conditions ranging from severe dysplasia to invasive cervical cancer. Comparison of the state laboratory and INDRE diagnoses yielded a Kappa correlation coefficient of 0.62, near the lower limit of agreement, the agreement being poorest in cases where it was necessary to distinguish between degrees of abnormality. Although state laboratory underestimation appeared lowest with respect to cases of atypia and of mild, moderate, and severe dysplasia (between 12% and 20%), these percentages are alarming because it is at these stages that the patient may be treated to prevent evolution to carcinoma. While the Kappa correlation coefficient was better (0.80) when the INDRE and PAPNET diagnoses were compared, PAPNET showed only limited ability to distinguish between various pathologic alterations, and the percentages of underestimates (false negatives) obtained with PAPNET were also high. Overall, the results indicate a need to improve the quality of cervical cytology diagnoses at state public health laboratories in Mexico through stepped-up training and supervision. They also indicate that the use of PAPNET involves greater difficulty than does manual microscopic examination of cervical smears, and that a way still needs to be found to detect and review the false negative results generated by PAPNET before approving use of this technology.
1994年8月至1995年6月，墨西哥28个州和联邦区的实验室共向墨西哥国家流行病学诊断和参考研究所（INDRE）提交了10098份经诊断的巴氏涂片玻片，以便通过传统方法以及美国纽约州萨芬的自动化PAPNET系统进行重新检查。目的是确定这些不同方法所获得的一致程度。大多数检查的玻片（至少78%）得出阴性结果或仅表明有炎症过程；8%至14%表明有轻度或中度宫颈发育异常；2%至3%表明有从重度发育异常到浸润性宫颈癌等不同情况。州实验室诊断与INDRE诊断的比较得出卡帕相关系数为0.62，接近一致程度的下限，在需要区分异常程度的情况下一致性最差。虽然州实验室对非典型性以及轻度、中度和重度发育异常病例的低估似乎最低（在12%至20%之间），但这些百分比令人担忧，因为正是在这些阶段可以对患者进行治疗以防止发展为癌症。当比较INDRE和PAPNET诊断时，卡帕相关系数更好（0.80），但PAPNET区分各种病理改变的能力有限，并且PAPNET获得的低估（假阴性）百分比也很高。总体而言，结果表明需要通过加强培训和监督来提高墨西哥州公共卫生实验室宫颈细胞学诊断的质量。结果还表明，使用PAPNET比手动显微镜检查宫颈涂片更困难，并且在批准使用这项技术之前，仍需找到一种方法来检测和复查由PAPNET产生的假阴性结果。
