Whole, Turret and step methods of rapid rescreening: is there any difference in performance?

We compared the performance of the Whole, Turret and Step techniques of 100% rapid rescreening (RR) in detection of false-negatives in cervical cytology. We tested RR performance with cytologists trained and among those without training. We revised 1,000 consecutive slides from women participating in an ongoing international screening trial. Two teams of experienced cytologists performed the RR techniques: one trained in RR procedures and the other not trained. The sensitivities in the trained group were Whole 46.6%, Turret 47.4% and Step 50.9%; and in the non-trained group were 38.6, 31.6 and 47.4%, respectively. The kappa coefficient showed a weak agreement between the two groups of cytologists and between the three RR techniques. The RR techniques are more valuable if used by trained cytologists. In the trained group, we did not observe significant differences between the RR techniques used, whereas in the non-trained group, the Step technique had the best sensitivity.

Fatores associados a resultados falso-negativos de exames citopatológicos do colo uterino / Factors associated with false-negative cervical cytopathological results

OBJETIVO: verificar se, no escrutínio de rotina, fatores relacionados com a adequabilidade da amostra, padrão celular e critérios citomorfológicos estão associados a resultados falso-negativos (FN) dos exames citopatológicos. MÉTODOS: trata-se de um estudo caso-controle, no qual o grupo de casos incluiu 100 esfregaços citopatológicos com um resultado FN que foi detectado pela sistemática de controle interno da qualidade com revisão rápida de 100 por cento. Para cada resultado FN detectado foram identificados, pelo mesmo citotécnico, dois esfregaços com um diagnóstico verdadeiro-positivo e este grupo foi considerado controle, totalizando uma casuística de 300 esfregaços. As variáveis analisadas foram estabelecidas de acordo com os critérios definidos para a análise da adequabilidade da amostra, padrão celular e critérios citomorfológicos. Os resultados foram avaliados por análise bivariada e regressão logística com critério de seleção de variáveis stepwise e expressos em OR (95 por cento). RESULTADOS: o número de células atípicas, aspecto da cromatina nuclear, distribuição e apresentação de células atípicas no esfregaço apresentaram risco maior para resultados FN, com OR de 9,6; 4,2; 4,4 e 3,6, respectivamente. Processo inflamatório e presença de sangue no esfregaço mostraram também risco para os resultados FN. CONCLUSÕES: a maioria dos fatores associados à liberação de um resultado FN é dependente das condições e técnicas de coleta de material, pois, em grande parte, a lesão pode não estar adequadamente representada no esfregaço, e também fatores obscurecedores como sangue e processo inflamatório podem prejudicar a análise. Quanto às alterações citomorfológicas, cromatina fina foi a característica que apresentou maior risco para resultados FN.

PURPOSE: to evaluate whether factors related to the adequacy of the sample, cell pattern and cytomorphological criteria are associated with false-negative (FN) results of cervical cytopathology during routine examinations. METHODS: this is a case-control study in which the study group included 100 cytopathologic smears with FN results detected during systematic internal quality control consisting of 100 percent rapid review. For each FN result detected, two smears with a true-positive diagnosis were identified by the same cytotechnician and these constituted the control group, making a total sample size of 300 smears. The variables were established in accordance with the criteria defined for the analysis of sample adequacy, cell pattern and cytomorphological analyzed criteria. The results were evaluated using bivariate analysis and logistic regression with stepwise variable selection criteria expressed in OR (95 percent). RESULTS: the number of atypical cells, the appearance of nuclear chromatin, and the distribution and presentation of atypical cells in the smear were the variables that showed the greatest risk for FN results with OR of 9.6, 4.2, 4.4, and 3.6, respectively. Inflammatory processes and the presence of blood in the smear were also identified as variables that influence the risk of FN results. CONCLUSIONS: the majority of the factors associated with FN results are dependent on the conditions and techniques of sample collection, since in the majority of cases, the lesion may not be adequately represented in the smear. Confounding factors such as blood and inflammatory processes may also impair analysis. With respect to cytomorphological alterations, thin chromatin strand was the variable that indicated the greatest risk of FN results.

[Pap smear, hybrid capture II, and visual inspection in screening for uterine cervical lesions]. / Citologia oncológica, captura de híbridos II e inspeção visual no rastreamento de lesões cervicais.

The objective of this study was to evaluate alterations in Pap smear, hybrid capture II (HCII), and visual inspection with acetic acid (VIA) in 684 women treated at a primary health care unit. The performance and agreement of the exams were evaluated. The study also described social, demographic, and reproductive factors and their association with uterine cervical lesions. Women had specimens taken for Pap smear, HCII, and VIA. When at least one of the tests was positive, colposcopy was performed and targeted biopsies were taken from any suspicious lesions. Performance of tests was evaluated. Women's distribution in relation to social, demographic, and reproductive factors and histological diagnosis was evaluated using the odds ratio. Among 198 women with at least one positive screening test, only 21 showed histological disease. Sensitivities of the tests were similar. VIA and Pap smear presented higher specificity than HCII. Only absence of a previous Pap smear was associated with the presence of histological disease. Pap smear performed better than VIA and HC II. Absence of previous cytology was associated with histological disease.

Citologia oncológica, captura de híbridos II e inspeção visual no rastreamento de lesões cervicais / Pap smear, hybrid capture II, and visual inspection in screening for uterine cervical lesions

Avaliar as alterações na citologia oncológica, na captura híbrida II e na inspeção visual com ácido acético (IVA) a 5 por cento em 684 mulheres atendidas em uma unidade de saúde, e avaliar o desempenho e a concordância entre os exames. Procurar descrever as características sócio-demográficas e reprodutivas (SDR) destas mulheres e sua associação com a presença de doença. As mulheres foram submetidas à coleta de citologia, captura e IVA, e as com exame positivo foram submetidas à colposcopia com biopsia, se necessário. Foi calculado o desempenho dos testes e a associação dos fatores SDR com o diagnóstico histológico foi avaliada por intermédio do cálculo do odds ratio. Embora 198 mulheres apresentassem pelo menos um teste alterado, apenas 21 apresentaram lesão histológica. A sensibilidade dos testes foi semelhante enquanto as especificidades da IVA e da citologia foram maiores que a da captura híbrida II. Apenas a ausência de citologia esteve associada à presença de doença. O desempenho da citologia foi maior que o da IVA, que foi maior que o da captura. A ausência de citologia foi associada com doença histológica.