ABSTRACT
O objetivo foi avaliar o desempenho da citologia em meio líquido (CML) versus a citologia convencional (CC), no SUS. Trata-se de um estudo comparativo entre dados históricos de CC (31.500) e amostras prospectivas de CML (9.764). Todas as amostras seguiram os critérios de controle de qualidade interno do LCO-IAL. O processamento das amostras de CML foi realizado de acordo com as recomendações do fabricante (BD Sure Path). Foi utilizado o teste-Z com 5% de significância para comparação entre as proporções (p < 0,05). Foram diagnosticados como positivos 7,80% dos casos pela técnica de CC e 11,57% pela CML, com diferença significativa nos casos de atipia de células escamosas possivelmente não neoplásica - ASC-US (4,52% para 6,98%), lesão intra-epitelial de baixo grau - LSIL (1,82% para 3,48%) e atipia de células glandulares - AGC-US/H (0,54% para 0,26%). Houve diferença estatística no percentual de amostras insatisfatórias (3,50% para 0,25%). A técnica de CML reduz artefatos de confecção e fixação das amostras, ocasionando redução de amostras insatisfatórias e aumento do percentual de diagnósticos positivos. Concluímos que é viável a implantação da CML no SUS, devido à padronização e melhora da qualidade das amostras...
Subject(s)
Cell Biology , Efficiency , Unified Health SystemABSTRACT
OBJECTIVE: To verij5 the efficacy of the quality control (QC) program in a cytologic laboratwy with a rapid rescreening (RR) protocol. STUDY DESIGN: RR, according to the Turret RR method, of all samples initially screened as negative at the Laboratory of Cytology, Adolfo Lutz Institute, was performed. The slides were reviewed for 60 seconds. Suspect smears were fully checked by 2 reviewers to determine the final diagnoses. A total of 2954 sequential cytologic results were considered in this study. Of the 2954, 2568 (86.9%) were considered initially negative according to our internal QC, and these cases underwent RR. Also, 10% were randomly selected from these negative cases for full reviewing. The internal QC in our laboratory includes review of cases selected according to clinical and cytomorphologic criteria. RESULTS: Among the 2954 total cases, QC detected 386 (13%) atypias with final diagnoses reported according to The Bethesda System 2001 as follows: 82 (2.18%) low grade squamous intraepithelial lesions (LSILs), 35 (1.18%) high grade squamous intraepithelial lesions (HSILs), 2 (0.06%) squamous cell carcinomas, 105 (3.5%) atypical cells of undetermined significance (ASC-US), 4 (0.12%) atypical endocervical cells (AECs) and 158 (5.3%) unsatisfactory samples. RR of 2568 smears initially considered negative selected 194 (7.5%) slides. Of the 194, 146 (75.3%) were negative, 28 (14.4%) ASC-US, 5 (2.6%) AEC, 1 (0.5%) LSIL and 14 (7.2%) unsatisfactory. Full review of a 10% random fraction of the 2568 cases interpreted as negative did not detect lesions but did detect 5 (1.95%) unsatisfactory samples. CONCLUSION: Internal QC used in our laboratory based on clinical and cytomorphologic criteria to select cases for review proved to be an efficient method of detecting HSIL and cervical cancer. The consensus basis of this program strongly limits the false positive and false negative rates and also provides subjects with continuing education. One hundred percent RR is more efficient than 10% full reviewing in detecting cervical abnormalities.
