Objective: To evaluate the performance of laboratories accredited by the National Health System that perform cytopathology examination of the uterine cervix after 10 years of participation in external quality monitoring (eQM). Study Design: Seven laboratories were assessed in this study. To assess the concordance of the representation of epithelia and results, 6,536 examinations (3,433 in 2007 and 3,103 in 2017) were reviewed. Statistical analysis was performed using the κ coefficient as well as the χ2 and the Fisher exact test (p < 0.05). Results: All laboratories showed adequate infrastructure and internal quality monitoring. Regarding the representation of the epithelia, the concordance remained excellent (κ between 0.84 and 0.94). In 2007, 26 false-negative results (FN), 157 false-positive results (FP), and 79 delays in clinical conduct (DCC) were identified (κ = 0.80). In 2017, 24 FN, 42 FP, and 38 DCC were identified (κ = 0.90). Five laboratories showed improvement in concordance from 2007 to 2017. We observed significant improvement in cytomorphological criteria of the results: atypical squamous cells of undetermined significance (p < 0.001), atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (p < 0.016), and low-grade squamous intraepithelial lesion (p < 0.001). We also observed a considerable improvement in the results of cellular abnormalities in glandular epithelium (p < 0.0504). Conclusions: Ten years after the implementation of eQM, improvements in the concordance of results were observed as well as reductions in FN, FP, and DCC in all laboratories monitored.

1.
Bray
F
,
Ferlay
J
,
Soerjomataram
I
,
Siegel
RL
,
Torre
LA
,
Jemal
A
.
Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries
.
CA Cancer J Clin
.
2018
Nov
;
68
(
6
):
394
424
.
[PubMed]
0007-9235
2.
Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes Brasileiras para o Rastreamento do Câncer do Colo do útero 2º edição revista ampliada e revisada
.
Rio de Janeiro
:
Instituto Nacional do Câncer
;
2016
.
114
pp.
3.
Pankaj
S
,
Nazneen
S
,
Kumari
S
,
Kumari
A
,
Kumari
A
,
Kumari
J
, et al
Comparison of conventional Pap smear and liquid-based cytology: A study of cervical cancer screening at a tertiary care center in Bihar
.
Indian J Cancer
.
2018
Jan-Mar
;
55
(
1
):
80
3
.
[PubMed]
0019-509X
4.
Sawaya
GF
,
Smith-McCune
K
.
Cervical Cancer Screening
.
Obstet Gynecol
.
2016
Mar
;
127
(
3
):
459
67
.
[PubMed]
0029-7844
5.
Becerra-Culqui
TA
,
Lonky
NM
,
Chen
Q
,
Chao
CR
:
Patterns and correlates of cervical cancer screening initiation in a large integrated healthcare system.
Am J Obstet Gynecol.
2018
; 218:429.1-9.
6.
Longatto-Filho
A
,
Naud
P
,
Derchain
SF
,
Roteli-Martins
C
,
Tatti
S
,
Hammes
LS
, et al
Performance characteristics of Pap test, VIA, VILI, HR-HPV testing, cervicography, and colposcopy in diagnosis of significant cervical pathology
.
Virchows Arch
.
2012
Jun
;
460
(
6
):
577
85
.
[PubMed]
0945-6317
7.
Baena
A
,
Guevara
E
,
Almonte
M
,
Arias-Stella
J
,
Sasieni
P
,
Sanchez
GI
.
Factors related to inter-observer reproducibility of conventional Pap smear cytology: a multilevel analysis of smear and laboratory characteristics
.
Cytopathology
.
2017
Jun
;
28
(
3
):
192
202
.
[PubMed]
0956-5507
8.
Brown
RF
,
Muller
TR
,
Olsen
A
.
Australian women’s cervical cancer screening attendance as a function of screening barriers and facilitators
.
Soc Sci Med
.
2019
Jan
;
220
:
396
402
.
[PubMed]
0277-9536
9.
Mody
DR
,
Davey
DD
,
Branca
M
,
Raab
SS
,
Schenck
UG
,
Stanley
MW
, et al
Quality assurance and risk reduction guidelines
.
Acta Cytol
.
2000
Jul-Aug
;
44
(
4
):
496
507
.
[PubMed]
0001-5547
10.
Brasil. Ministério da Saúde. Portaria n° 3.388, de 23 de julho de 2013: Redefine a Qualificação Nacional em Citopatologia na prevenção do câncer do colo do útero (QualiCito), no âmbito da Rede de Atenção à Saúde das Pessoas com Doenças Crônicas
.
Brasília
:
Diário Oficial da União
;
2013
.
11
pp.
11.
Bigras
G
,
Wilson
J
,
Russell
L
,
Johnson
G
,
Morel
D
,
Saddik
M
.
Interobserver concordance in the assessment of features used for the diagnosis of cervical atypical squamous cells and squamous intraepithelial lesions (ASC-US, ASC-H, LSIL and HSIL)
.
Cytopathology
.
2013
Feb
;
24
(
1
):
44
51
.
[PubMed]
0956-5507
12.
Nayar
R
,
Wilbur
DC
.
The Pap test and Bethesda 2014
.
Cancer Cytopathol
.
2015
May
;
123
(
5
):
271
81
.
[PubMed]
1934-662X
13.
Ázara
CZ
,
Manrique
EJ
,
Tavares
SB
,
Alves de Souza
NL
,
Magalhães
JC
,
Amaral
RG
.
Reproducibility of cervical cytopathology following an intervention by an external quality control laboratory
.
Diagn Cytopathol
.
2016
Apr
;
44
(
4
):
305
10
.
[PubMed]
8755-1039
14.
Sørbye
SW
,
Suhrke
P
,
Revå
BW
,
Berland
J
,
Maurseth
RJ
,
Al-Shibli
K
.
Accuracy of cervical cytology: comparison of diagnoses of 100 Pap smears read by four pathologists at three hospitals in Norway
.
BMC Clin Pathol
.
2017
Aug
;
17
(
1
):
18
.
[PubMed]
1472-6890
15.
Brasil. Ministério da Saúde. Instituto Nacional do Câncer José Alencar Gomes da Silva; Coordenação de Prevenção e Vigilância; Divisão de Detecção Precoce e Apoio à Organização de Rede: Manual de gestão da qualidade para laboratório de citopatologia
.
Rio de Janeiro
:
INCA
;
2016
.
160
pp.
16.
Nayar
R
,
Wilbur
DC
.
The Bethesda System for reporting cervical cytology: definitions, criteria, and explanatory notes
. 3rd ed.
Cham
:
Springer
;
2015
.
17.
EPI INFO
.
Epidemiology Program Office Division of Public Health Surveillance and Informatics.
Latest Version: Epi Info Tm Version 3.5.4;
2012
. Available at: URL: http://www.cdc.gov/epiinfo. Accessed on December 15, 2017.
18.
Landis
JR
,
Koch
GG
.
The measurement of observer agreement for categorical data
.
Biometrics
.
1977
Mar
;
33
(
1
):
159
74
.
[PubMed]
0006-341X
19.
Branca
M
,
Longatto-Filho
A
.
Recommendations on Quality Control and Quality Assurance in Cervical Cytology
.
Acta Cytol
.
2015
;
59
(
5
):
361
9
.
[PubMed]
0001-5547
20.
Ázara
CZ
,
Manrique
EJ
,
Alves de Souza
NL
,
Rodrigues
AR
,
Tavares
SB
,
Amaral
RG
.
External quality control of cervical cytopathology: interlaboratory variability
.
Acta Cytol
.
2013
;
57
(
6
):
585
90
.
[PubMed]
0001-5547
21.
Kurtycz
DF
,
Staats
PN
,
Chute
DJ
,
Russell
D
,
Pavelec
D
,
Monaco
SE
, et al
Bethesda Interobserver Reproducibility Study-2 (BIRST-2): bethesda System 2014
.
J Am Soc Cytopathol
.
2017
Jul - Aug
;
6
(
4
):
131
44
.
[PubMed]
2213-2945
22.
Lepe
M
,
Eklund
CM
,
Quddus
MR
,
Paquette
C
.
Atypical Glandular Cells: Interobserver Variability according to Clinical Management
.
Acta Cytol
.
2018
;
62
(
5-6
):
397
404
.
[PubMed]
0001-5547
23.
Dhamne
S
,
Soundars
E
,
Zarrin-Khameh
N
.
Pathologic findings in women with atypical glandular cells on Pap test
.
J Am Soc Cytopathol
.
2016
Jan - Feb
;
5
(
1
):
50
5
.
[PubMed]
2213-2945
24.
Bansal
B
,
Gupta
P
,
Gupta
N
,
Rajwanshi
A
,
Suri
V
.
Detecting uterine glandular lesions: role of cervical cytology
.
Cytojournal
.
2016
Feb
;
13
(
1
):
3
.
[PubMed]
1742-6413
25.
Chebib
I
,
Rao
RA
,
Wilbur
DC
,
Tambouret
RH
.
Using the ASC:SIL ratio, human papillomavirus, and interobserver variability to assess and monitor cytopathology fellow training performance
.
Cancer Cytopathol
.
2013
Nov
;
121
(
11
):
638
43
.
[PubMed]
1934-662X
26.
Sherman
ME
,
Dasgupta
A
,
Schiffman
M
,
Nayar
R
,
Solomon
D
: The Bethesda Interobserver Reproducibility Study (BIRST). A Web-based Assessment of the Bethesda 2001 System for Classifying Cervical Cytology Cancer.
2007
;111,15–25.
27.
Magalhães
JC
,
Ázara
CZ
,
Tavares
SB
,
Manrique
EJ
,
Amaral
RG
.
Impact of Implementing 100% Rapid Review as a Quality Control Tool in Cervical Cytology
.
Acta Cytol
.
2018
;
62
(
2
):
115
20
.
[PubMed]
0001-5547
28.
Sachan
PL
,
Singh
M
,
Patel
ML
,
Sachan
R
.
A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation
.
Asia Pac J Oncol Nurs
.
2018
Jul-Sep
;
5
(
3
):
337
41
.
[PubMed]
2347-5625
29.
Xie
F
,
Li
Z
,
Zhang
L
,
Zhang
H
,
Qi
D
,
Zhao
D
, et al
Systemic cervical cytology training and quality control programs can improve the interpretation of Papanicolaou tests
.
J Am Soc Cytopathol
.
2019
Jan - Feb
;
8
(
1
):
27
33
.
[PubMed]
2213-2945
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