RESUMO
OBJECTIVE: To compare the efficiency of two methods for routine quality assurance in gynecologic cytology: random rescreening of 10% of negative gynecologic smears and rapid rescreening of all negative gynecologic smears. STUDY DESIGN: All gynecologic smears considered to be negative or benign and diagnosed between November 1, 1996, and December 31, 1997, were rescreened using the rapid, partial rescreening technique. Results were compared to those of the 10% random rescreening method. RESULTS: Comparing the 10% review of negatives to the rapid rescreening in two comparable periods of three months, the former required review by the supervisor of 160 cases in order to find a true false negative. With rapid rescreening, the supervisor had to review fewer than eight cases to find a true false negative. Also, rapid rescreening found about four times more true false negatives than random 10% review. CONCLUSION: Rapid rescreening of all negative gynecologic smears proved more efficient than 10% random rescreening.
Assuntos
Programas de Rastreamento/normas , Patologia Clínica/normas , Esfregaço Vaginal/normas , Análise Custo-Benefício , Reações Falso-Negativas , Feminino , Ginecologia/economia , Ginecologia/normas , Custos de Cuidados de Saúde , Hospitais Urbanos/economia , Hospitais Urbanos/normas , Humanos , Laboratórios Hospitalares/economia , Laboratórios Hospitalares/normas , Programas de Rastreamento/economia , Patologia Clínica/economia , Controle de Qualidade , Esfregaço Vaginal/economiaRESUMO
The Endopap Endometrial Sampler was used in 1,465 women, either just before endometrial biopsy or curettage (in 760 symptomatic patients) or as an office procedure (in 705 women). The samples were inadequate for interpretation in only 8.7% of the cases. Although all malignant lesions were identified by this screening technique, about one-fourth were initially classified cytologically as hyperplasia. Endometrial hyperplasias presented the greatest difficulties in interpretation, with only slightly over half of the proven cases correctly assessed on the endometrial sample. In an attempt to improve the accuracy of the cytologic diagnosis of hyperplasias, ten morphologic features were examined retrospectively in 207 cases. Five of the criteria were shown to provide an increased probability of correctly diagnosing endometrial hyperplasias on the cytologic sample: (1) the overlapping of cells in the glandular clusters or sheets, (2) the presence of nucleoli, (3) anisokaryosis, (4) granularity of chromatin and (5) the presence of sheets of stromal cells. The more of these criteria observed in a given case, the better was the chance of cytologically identifying a hyperplasia in the Endopap sample.
Assuntos
Hiperplasia Endometrial/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Uterinas/diagnóstico , Nucléolo Celular/ultraestrutura , Cromatina/ultraestrutura , Hiperplasia Endometrial/patologia , Feminino , Humanos , Lesões Pré-Cancerosas/patologia , Coloração e Rotulagem , Neoplasias Uterinas/patologiaRESUMO
A new endometrial sampling device, the Endopap, was tested in a series of 851 patients. This sampler is of simple design, without moving parts, inexpensive and easy to use. Cellular samples proved adequate in 90% of the cases, usually with very abundant material. Endometrial cancer shed atypical cells in all 20 cases studied. However, only about half the patients with adenomatous hyperplasia were correctly identified by the endometrial sample. This fact seems to reflect the lack of adequate morphologic criteria for the recognition of endometrial hyperplasia; this situation prevails with all types of endometrial cell samplers.