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Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(5):222-228
DOI 10.1590/SO100-720320150005183
To estimate the prevalence of bacterial vaginosis (BV), candidiasis and
trichomoniasis and compare the findings of physical examination of the vaginal
secretion with the microbiological diagnosis obtained by cytology study of a
vaginal smear using the Papanicolaou method.
A cross-sectional study of 302 women aged 20 to 87 years, interviewed and
submitted to a gynecology test for the evaluation of vaginal secretion and
collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses
were carried out and specificity, positive predictive value (PPV) and negative
predictive value (NPV) with their respective 95%CI were determined to assess the
accuracy of the characteristics of vaginal secretion in relation to the
microbiological diagnosis of the cytology smear . The kappa index (k) was used to
assess the degree of agreement between the clinical features of vaginal secretion
and the microbiological findings obtained by cytology.
The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%,
respectively. The sensitivity, specificity, PPV and NPV of the clinical
characteristics of vaginal secretion for the cytological diagnosis of BV were 74,
78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV
of the clinical characteristics of vaginal secretion for the cytological diagnosis
of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation
between the clinical evaluation of vaginal secretion and the microbiological
diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was
0.47, 0.23 and 0.28, respectively.
The most common cause of abnormal vaginal secretion was BV. The clinical
evaluation of vaginal secretion presented amoderate to weak agreement with the
microbiological diagnosis, indicating the need for complementary investigation of
the clinical findings of abnormal vaginal secretion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(5):222-228
DOI 10.1590/SO100-720320150005183
To estimate the prevalence of bacterial vaginosis (BV), candidiasis and
trichomoniasis and compare the findings of physical examination of the vaginal
secretion with the microbiological diagnosis obtained by cytology study of a
vaginal smear using the Papanicolaou method.
A cross-sectional study of 302 women aged 20 to 87 years, interviewed and
submitted to a gynecology test for the evaluation of vaginal secretion and
collection of a cytology smear, from June 2012 to May 2013. Sensitivity analyses
were carried out and specificity, positive predictive value (PPV) and negative
predictive value (NPV) with their respective 95%CI were determined to assess the
accuracy of the characteristics of vaginal secretion in relation to the
microbiological diagnosis of the cytology smear . The kappa index (k) was used to
assess the degree of agreement between the clinical features of vaginal secretion
and the microbiological findings obtained by cytology.
The prevalence of BV, candidiasis and trichomoniasis was 25.5, 9.3 and 2.0%,
respectively. The sensitivity, specificity, PPV and NPV of the clinical
characteristics of vaginal secretion for the cytological diagnosis of BV were 74,
78.6, 54.3 and 89.9%, respectively. The sensitivity, specificity, PPV and the NPV
of the clinical characteristics of vaginal secretion for the cytological diagnosis
of candidiasis were 46.4, 86.2, 25.5 and 94%, respectively. The correlation
between the clinical evaluation of vaginal secretion and the microbiological
diagnosis of BV, candidiasis and trichomoniasis, assessed by the kappa index, was
0.47, 0.23 and 0.28, respectively.
The most common cause of abnormal vaginal secretion was BV. The clinical
evaluation of vaginal secretion presented amoderate to weak agreement with the
microbiological diagnosis, indicating the need for complementary investigation of
the clinical findings of abnormal vaginal secretion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):398-403
DOI 10.1590/SO100-720320140004996
To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams.
The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service.
Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated.
An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(9):398-403
DOI 10.1590/SO100-720320140004996
To evaluate the impact of continued education provided by an external quality control laboratory on the indicators of internal quality control of cytopathology exams.
The internal quality assurance indicators for cytopathology exams from 12 laboratories monitored by the External Quality Control Laboratory were evaluated. Overall, 185,194 exams were included, 98,133 of which referred to the period preceding implementation of a continued education program, while 87,061 referred to the period following this intervention. Data were obtained from the Cervical Cancer Database of the Brazilian National Health Service.
Following implementation of the continued education program, the positivity index (PI) remained within recommended limits in four laboratories. In another four laboratories, the PI progressed from below the limits to within the recommended standards. In one laboratory, the PI remained low, in two laboratories, it remained very low, and in one, it increased from very low to low. The percentage of exams compatible with a high-grade squamous intraepithelial lesion (HSIL) remained within the recommended limits in five laboratories, while in three laboratories it progressed from below the recommended levels to >0.4% of the total number of satisfactory exams, and in four laboratories it remained below the standard limit. Both the percentage of atypical squamous cells of undetermined significance (ASC-US) in relation to abnormal exams, and the ratio between ASC-US and intraepithelial lesions remained within recommended levels in all the laboratories investigated.
An improvement was found in the indicators represented by the positivity index and the percentage of exams compatible with a high-grade squamous intraepithelial lesion, showing that the role played by the external quality control laboratory in providing continued education contributed towards improving laboratory staff skills in detecting cervical cancer precursor lesions.