External quality assessment of cervical vaginal cytology laboratory screening in the Caribbean - abstract

ABSTRACT

A model external quality assessment of cervical/vaginal cytology laboratory screening (PAP Smear) programme was piloted during 1996 to assess the proficiency of cytopathologists and cytotechnologists and to provide an opportunity for review/and reassessment of results as an integral component of continuous quality improvement of cytology services in the Caribbean. Eight pathologists and 22 cytotechnologists/technicians from seven Caribbean laboratories participated in this survey which consisted or reviewing eight reference slides provided by the Laboratory Proficiency Testing Program (LPTP, Ontario). The overall agreement with the LPTP results ranged from 5 percent to 63 percent in cytotechnologists as compared to cytopathologists (13 percent to 73 percent). The percentage agreement for severe dysplasia was between 22 percent (cytotechnologists) and 25 percent (cytopathologists), while better rates were observed for invasive carcinoma (60 - 63 percent). Inflammatory effects ere missed by both cytotechnologists (73 percent) and cytopathologists (49 percent). Moderate dysplasia was missed by both categories of laboratory professionals. There was a wide inter-laboratory variation of results as compared eith the LPTp (0 to 100 percent). Generally, laboratory professionals have placed greater emphasis on cervical biopsy, repeat smear, and provided guarded reports on PAP smears. The data show that there is a wide variation in the interpretation and reporting of cervico-vaginal cytology smears in Caribbean laboratories. Hence, there is an urgent need for continuous quality assessment and improvement of cervical cancer cytology screening services in the Caribbean (AU).