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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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(4):182-187
DOI 10.1590/S0100-7203201400040004
To evaluate the impact of training professionals involved in the screening for cervical cancer in Basic Health Units in the city of Goiânia (GO).
This was and intervention study in which the following data contained in the cervical cytopathology test form were examined: the woman's personal data, anamnesis, clinical examination and identification of the professional responsible for the collection. Professional training was evaluated by comparing the forms referring to the period from January 2007 to April 2009, before training, with the forms referring to the period from July 2010 to December 2012, after training. The Pearson χ2 test was used to analyze the results of training, with the 5% level of significance.
After training, there was a significantly increased frequency of recording patient schooling (from 67.2 to 92.6%, p<0.001), telephone number (from 78.9 to 98.7%, p<0.001), cervical inspection (from 86.8 to 96.6%, p<0.001), and signs suggestive of sexually transmitted diseases (from 80.8 to 93.5%, p<0.001). There was a reduction in the frequency of performing the exam within an interval of less than one year (p<0.001) and of one year (p<0.001). There was a reduction in the frequency of Pap smear testing in women under 25 years of age, from 22.0 to 17.9% (p<0.001). There was a significant increase in the proportion of satisfactory samples from 70.4 to 80.2% (p<0.001). A reduction of confounding factors was observed. The desiccation frequency was 2.9% before training and 2.0% after training (p<0.001). There was an increase in the frequency of representation of endocervical cells from 79.5 to 88.5% (p<0.001).
After training, there was a significant improvement in completing the application form, the performance of such tests regarding frequency and the age range recommended by the Ministry of Health, and the adequacy of the sample.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(4):182-187
DOI 10.1590/S0100-7203201400040004
To evaluate the impact of training professionals involved in the screening for cervical cancer in Basic Health Units in the city of Goiânia (GO).
This was and intervention study in which the following data contained in the cervical cytopathology test form were examined: the woman's personal data, anamnesis, clinical examination and identification of the professional responsible for the collection. Professional training was evaluated by comparing the forms referring to the period from January 2007 to April 2009, before training, with the forms referring to the period from July 2010 to December 2012, after training. The Pearson χ2 test was used to analyze the results of training, with the 5% level of significance.
After training, there was a significantly increased frequency of recording patient schooling (from 67.2 to 92.6%, p<0.001), telephone number (from 78.9 to 98.7%, p<0.001), cervical inspection (from 86.8 to 96.6%, p<0.001), and signs suggestive of sexually transmitted diseases (from 80.8 to 93.5%, p<0.001). There was a reduction in the frequency of performing the exam within an interval of less than one year (p<0.001) and of one year (p<0.001). There was a reduction in the frequency of Pap smear testing in women under 25 years of age, from 22.0 to 17.9% (p<0.001). There was a significant increase in the proportion of satisfactory samples from 70.4 to 80.2% (p<0.001). A reduction of confounding factors was observed. The desiccation frequency was 2.9% before training and 2.0% after training (p<0.001). There was an increase in the frequency of representation of endocervical cells from 79.5 to 88.5% (p<0.001).
After training, there was a significant improvement in completing the application form, the performance of such tests regarding frequency and the age range recommended by the Ministry of Health, and the adequacy of the sample.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):248-253
DOI 10.1590/S0100-72032012000600002
PURPOSE: To verify whether women with atypias of undetermined significance and precursor lesions or invasive cervical outcomes were referred to Medium Complexity Units (MCU) following the guidelines recommended by the Brazilian Ministry of Health. METHODS: Retrospective study based on the cytopathological outcomes of users of the Unified Health System, seen at Basic Health Assistance Units (BHAU) and referred to MCUs in the municipality of Goiânia, state of Goiás, from 2005 to 2006. We assessed 832 records according to the recommendations of the Brazilian Ministry of Health, as established by the Brazilian Nomenclature for Cervical Cytopathologic Outcomes and Recommended Clinical Practice. To check the distribution of variables such as reasons for referral, results of colposcopy and histopathology and clinical procedures we calculated absolute and relative frequencies, mean, minimum and maximum values. RESULTS: We understood 72.7% of the referrals were not in accordance with the recommendations of the Ministry of Health. There were 605 women with test results classified as atypical squamous cells of undetermined significance, possibly non-neoplasms, and squamous intraepithelial lesion of low level which were sent to MCU, and of these 71.8% were submitted to colposcopy, and 64.7% had histopathological examination which results were classified as 31.0% with non-neoplasms and 44.6% as NIC I. Out of 211 women with results classified as more severe squamous lesions, 86.3% were submitted to colposcopy and 68.7% of these had histopathological examinations. CONCLUSIONS: The results of this study revealed high rates of inappropriate referrals to MCU, which required a high percentage of unnecessary procedures. The recommendations of the Ministry of Health were followed by BHAU and the majority of women received counseling/treatment as recommended.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2012;34(6):248-253
DOI 10.1590/S0100-72032012000600002
PURPOSE: To verify whether women with atypias of undetermined significance and precursor lesions or invasive cervical outcomes were referred to Medium Complexity Units (MCU) following the guidelines recommended by the Brazilian Ministry of Health. METHODS: Retrospective study based on the cytopathological outcomes of users of the Unified Health System, seen at Basic Health Assistance Units (BHAU) and referred to MCUs in the municipality of Goiânia, state of Goiás, from 2005 to 2006. We assessed 832 records according to the recommendations of the Brazilian Ministry of Health, as established by the Brazilian Nomenclature for Cervical Cytopathologic Outcomes and Recommended Clinical Practice. To check the distribution of variables such as reasons for referral, results of colposcopy and histopathology and clinical procedures we calculated absolute and relative frequencies, mean, minimum and maximum values. RESULTS: We understood 72.7% of the referrals were not in accordance with the recommendations of the Ministry of Health. There were 605 women with test results classified as atypical squamous cells of undetermined significance, possibly non-neoplasms, and squamous intraepithelial lesion of low level which were sent to MCU, and of these 71.8% were submitted to colposcopy, and 64.7% had histopathological examination which results were classified as 31.0% with non-neoplasms and 44.6% as NIC I. Out of 211 women with results classified as more severe squamous lesions, 86.3% were submitted to colposcopy and 68.7% of these had histopathological examinations. CONCLUSIONS: The results of this study revealed high rates of inappropriate referrals to MCU, which required a high percentage of unnecessary procedures. The recommendations of the Ministry of Health were followed by BHAU and the majority of women received counseling/treatment as recommended.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):402-407
DOI 10.1590/S0100-72032007000800004
PURPOSE: to evaluate the efficiency of the 100% rapid rescreening in the detection of false-negative results and to verify whether the results vary according to the adequacy of the sample and the woman’s age group. METHODS: to evaluate the efficiency of the rapid rescreening, the 5,530 smears classified as negative by the routine screening, after being submitted to the rapid rescreening of 100%, were compared with the rescreening of the smears on the basis of clinical criteria and 10% random rescreening. For statistical analysis, the variables were evaluated descriptively and the c² test and the Cochran-Armitage test were applied to compare results. RESULTS: of the 141 smears identified as suspicious according to the rapid rescreening method, 84 (59.6%) cases were confirmed in the final diagnosis, of which 36 (25.5%) were classified as atypical squamous cells of undetermined significance, five (3.5%) as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion, 34 (24.1%) as low-grade squamous intraepithelial lesion, six (4.3%) as high-grade squamous intraepithelial lesion, and three (2.1%) as atypical glandular cells. Of the 84 suspect smears confirmed in the final diagnosis, 62 (73.8%) smears were classified as adequate and 22 (26.2%) as adequate but with some limitation, but no significant difference was observed with the woman’s age. CONCLUSIONS: the results of this study show that rapid rescreening is an efficient option for internal quality control for the detection of false-negative cervical smear results. In addition, it should be noted that rapid rescreening performed better when the sample was classified as adequate for analysis; however, it did not vary according to the woman’s age group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):402-407
DOI 10.1590/S0100-72032007000800004
PURPOSE: to evaluate the efficiency of the 100% rapid rescreening in the detection of false-negative results and to verify whether the results vary according to the adequacy of the sample and the woman’s age group. METHODS: to evaluate the efficiency of the rapid rescreening, the 5,530 smears classified as negative by the routine screening, after being submitted to the rapid rescreening of 100%, were compared with the rescreening of the smears on the basis of clinical criteria and 10% random rescreening. For statistical analysis, the variables were evaluated descriptively and the c² test and the Cochran-Armitage test were applied to compare results. RESULTS: of the 141 smears identified as suspicious according to the rapid rescreening method, 84 (59.6%) cases were confirmed in the final diagnosis, of which 36 (25.5%) were classified as atypical squamous cells of undetermined significance, five (3.5%) as atypical squamous cells that cannot exclude high-grade squamous intraepithelial lesion, 34 (24.1%) as low-grade squamous intraepithelial lesion, six (4.3%) as high-grade squamous intraepithelial lesion, and three (2.1%) as atypical glandular cells. Of the 84 suspect smears confirmed in the final diagnosis, 62 (73.8%) smears were classified as adequate and 22 (26.2%) as adequate but with some limitation, but no significant difference was observed with the woman’s age. CONCLUSIONS: the results of this study show that rapid rescreening is an efficient option for internal quality control for the detection of false-negative cervical smear results. In addition, it should be noted that rapid rescreening performed better when the sample was classified as adequate for analysis; however, it did not vary according to the woman’s age group.
