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Cuschieri K, Fellner MD, Arroyo Mühr LS, Padalko E, Correa RM, Dillner J, Gultekin M, Picconi MA. Quality assurance in human papillomavirus testing for primary cervical screening. Int J Gynecol Cancer 2023; 33:802-811. [PMID: 36914171 PMCID: PMC10176393 DOI: 10.1136/ijgc-2022-004197] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
The recommendation for cervical screening is that it should be based on human papillomavirus (HPV) molecular testing. For all screening programs, attention to quality assurance is required to fully realize the benefits. Internationally recognized quality assurance recommendations for HPV-based screening are needed that are ideally applicable for a variety of settings, including in low- and middle-income countries. We summarize the main points of quality assurance for HPV screening, with a focus on the selection, implementation, and use of an HPV screening test, quality assurance systems (including internal quality control and external quality assessment), and staff competence. While we recognize that it might not be possible to fulfill all points in all settings, an awareness of the issues is essential.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - María Dolores Fellner
- Argentinian HPV Reference Laboratory, National Institute of Infectious Diseases-ANLIS "Dr Malbran", Buenos Aires, Argentina
| | - Laila Sara Arroyo Mühr
- International HPV Reference Center, Medical Diagnostics Karolinska, Karolinska Universitetssjukhuset, Stockholm, Sweden .,Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elizaveta Padalko
- Belgian HPV Reference Laboratory, University Hospital Ghent, Ghent, Belgium
| | - Rita Mariel Correa
- Argentinian HPV Reference Laboratory, National Institute of Infectious Diseases-ANLIS "Dr Malbran", Buenos Aires, Argentina
| | - Joakim Dillner
- International HPV Reference Center, Medical Diagnostics Karolinska, Karolinska Universitetssjukhuset, Stockholm, Sweden.,Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Murat Gultekin
- Turkish HPV Reference Laboratory, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Maria Alejandra Picconi
- Argentinian HPV Reference Laboratory, National Institute of Infectious Diseases-ANLIS "Dr Malbran", Buenos Aires, Argentina
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An Adequate Pharmaceutical Quality System for Personalized Preparation. Pharmaceutics 2023; 15:pharmaceutics15030800. [PMID: 36986661 PMCID: PMC10059061 DOI: 10.3390/pharmaceutics15030800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
The pharmacy compounding of personalized preparations has evolved a great deal, and with it, the way of working and the legal requirements have also evolved. An adequate pharmaceutical quality system for personalized preparations presents fundamental differences with respect to the system designed for industrial medicines since the size, complexity, and characteristics of the activity of the manufacturing laboratory and the applications and uses of the manufactured medicines must be taken into account. Legislation must advance and adapt to the needs of personalized preparations, filling the deficiencies currently found in this field. The limitations of personalized preparation in its pharmaceutical quality system are analysed and a method based on a proficiency testing program specially designed to overcome these limitations is proposed: the Personalized Preparation Quality Assurance Program (PACMI). This method makes it possible to expand the samples and destructive tests, and dedicate more resources, facilities, and equipment. It allows for more in-depth knowledge of the product and the processes used, and for proposed improvements that increase the overall quality for improved patient health. PACMI introduces tools used in risk management in order to guarantee the quality of an essentially heterogeneous service: personalized preparation.
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Garland SM, Dimech W, Collignon P, Cooley L, Nimmo GR, Smith DW, Baird R, Rawlinson W, Costa A, Higgins G. The new screening program to prevent cervical cancer using HPV DNA: getting the balance right in maintaining quality. J Pathol Clin Res 2018; 4:207-212. [PMID: 30058126 PMCID: PMC6175713 DOI: 10.1002/cjp2.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/09/2018] [Accepted: 07/20/2018] [Indexed: 01/26/2023]
Abstract
Along with the reduction in human papillomavirus (HPV) infection and cervical abnormalities as a result of the successful HPV vaccination program, Australia is adopting a new screening strategy. This involves a new paradigm moving from cervical cytological screening to molecular nucleic acid technology (NAT), using HPV DNA assays as primary screening methodology for cervical cancer prevention. These assays must strike a balance between sufficient clinical sensitivity to detect or predict high-grade cervical intraepithelial lesions, the precursor to cervical cancer, without being too sensitive and detecting transient infection not destined for disease. Ensuring the highest quality HPV NAT is thus a priority in order to reduce the possibility of falsely negative screens and manage the risk associated with false positive HPV NAT test results. How to do this needs informed discussion and on-going refinement of the screening algorithm. This is of relevance as more countries move to more sensitive HPV NAT tests for secondary prevention of cervical cancer and as more HPV assays become available.
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Affiliation(s)
- Suzanne M Garland
- Department of Microbiology and Infectious DiseasesRoyal Women's HospitalParkvilleAustralia
- Infection and Immunity Murdoch Children's Research InstituteParkvilleAustralia
- Department of Obstetrics and GynaecologyUniversity of MelbourneParkvilleAustralia
| | - Wayne Dimech
- National Serology Reference Laboratory, Australia (NRL)FitzroyAustralia
| | - Peter Collignon
- Infectious Diseases and MicrobiologyCanberra HospitalGarranAustralia
- Medical SchoolAustralian National UniversityAustralia
| | - On behalf of the Australian Clinical Microbiologists Infectious Diseases Group
- Department of Microbiology and Infectious DiseasesRoyal Hobart HospitalHobartAustralia
- Department of Microbiology, Pathology Queensland Central LaboratoryHerstonAustralia
- Department of Microbiology, Griffith University School of MedicineSouthportAustralia
- Department of Microbiology, PathWest Laboratory Medicine WANedlandsAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaNedlandsAustralia
- Territory Pathology, Infectious Diseases, Royal Darwin HospitalDepartment of Health and FamiliesTiwiAustralia
- Virology, Serology and OTDS Laboratories, NSW Health PathologyRandwickAustralia
- Department of Microbiology, The Royal Children's HospitalParkvilleAustralia
- Microbiology and Infectious Disease, South Australia PathologyNorth TerraceAustralia
| | - Louise Cooley
- Department of Microbiology and Infectious DiseasesRoyal Hobart HospitalHobartAustralia
| | - Graeme R Nimmo
- Department of Microbiology, Pathology Queensland Central LaboratoryHerstonAustralia
- Department of Microbiology, Griffith University School of MedicineSouthportAustralia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WANedlandsAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaNedlandsAustralia
| | - Rob Baird
- Territory Pathology, Infectious Diseases, Royal Darwin HospitalDepartment of Health and FamiliesTiwiAustralia
| | - William Rawlinson
- Virology, Serology and OTDS Laboratories, NSW Health PathologyRandwickAustralia
| | - Anna‐Maria Costa
- Department of Microbiology and Infectious DiseasesRoyal Women's HospitalParkvilleAustralia
- Department of Microbiology, The Royal Children's HospitalParkvilleAustralia
| | - Geoff Higgins
- Microbiology and Infectious Disease, South Australia PathologyNorth TerraceAustralia
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