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Kani V, K K, Sonti S. Assessment of Pre-analytical Errors and Fostering Strategies to Enhance Accurate Results and Efficient Turnaround Times in the Cytology Laboratory of a Tertiary Care Hospital. Cureus 2024; 16:e56592. [PMID: 38646273 PMCID: PMC11031617 DOI: 10.7759/cureus.56592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Pre-analytical errors in cytology laboratories can significantly impact the accuracy of diagnostic results and turnaround times, ultimately affecting patient care. This article presents an evaluation of pre-analytical errors and proposes fostering strategies to enhance accuracy and efficiency in the cytology laboratory of a tertiary care hospital. The background discusses the importance of pre-analytical processes in ensuring reliable cytological diagnoses and the common errors encountered in specimen collection, handling, and transportation. Strategies for error reduction and improvement in turnaround times include staff education, standardization of procedures, utilization of appropriate collection and transport devices, implementation of quality control measures, and utilization of automation technologies. By addressing pre-analytical errors and implementing fostering strategies, cytology laboratories can optimize diagnostic accuracy, improve patient care outcomes, and enhance overall laboratory efficiency. Aims and objectives This study aims to assess the prevalence and nature of pre-analytical errors in the cytology laboratory of a tertiary care hospital to understand the extent of the issue, identify the specific factors contributing to pre-analytical errors like specimen collection, handling, and transportation processes, and pinpoint areas for improvement. It seeks to evaluate the impact of pre-analytical errors on the accuracy of cytological results and the efficiency of turnaround times, highlighting the consequences for patient care. Furthermore, the study aims to develop targeted strategies to minimize pre-analytical errors and enhance the accuracy of cytological results. Materials and methods This study was conducted at the Cytology Laboratory of our hospital from January 2023 to December 2023 after getting proper approval from the Institutional Review Board (IRB approval number 101/02/2024/PG/SRB/SMCH). It is a retrospective analytical study, and a total of 5412 samples from patients of the outpatient (OP) department, inpatient (IP) department, and community health outreach program facilities received in the cytology laboratory were analyzed during the study period. The inclusion criteria were the test samples sent specifically for cytological analysis. The samples sent for biochemical or microbiological examination were excluded. The frequency of sample distribution and rejected samples were calculated and the results were correlated. Results A total of 5,412 samples received in the cytology laboratory were analyzed during the study period. The majority of the samples were Papanicolaou smears (2,352, 43.5%), followed by fluid cytology (1,008, 18.6%) and ultrasound-guided fine-needle aspiration cytology (FNAC, 984, 18.2%). Of the total number of samples, 225 (4.16%) were repeated and 27 (0.5%) were rejected. Conclusions Pre-analytical, analytical, and post-analytical processes are the three key factors that determine the dependability and precision of cytological test results. Detecting critical alerts such as the positivity of malignancy underscores the paramount importance of result accuracy. Implementing good laboratory practices and conducting both external and internal audits can reduce the frequency of preventable errors in a cytology laboratory, thereby ensuring enhanced precision and expedited outputs.
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Affiliation(s)
- Vallal Kani
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Kavitha K
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sulochana Sonti
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Zago RA, Camilo-Júnior DJ, Pires D'Ávilla SCG, Xavier-Júnior JCC. The impact of transformation zone representation on the frequency of abnormal cervical cytological results. Eur J Obstet Gynecol Reprod Biol 2023; 289:173-176. [PMID: 37688813 DOI: 10.1016/j.ejogrb.2023.08.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To compare the frequency of abnormal cervical cytological results with and without representation of the transformation zone (TZ) in a medium-sized city in Brazil according to the Bethesda categorization. METHODS We performed an analytical observational study evaluating cytological results over 15 years from conventional smears collected within the Public Brazilian Health System in Araçatuba, Brazil. Tests were stratified by age and cytological result according to Brazilian guidelines and the Bethesda System. RESULTS There were 261,881 examinations, 159,251 with and 102,630 without TZ representation. The global frequency of abnormal results was higher in smears with TZ representation (crude odds ratio [OR] 4.03; 95% confidence interval [CI] [3.71-4.38]). Considering only women between 25 and 64 years (the target of the national guidelines), there were higher results for high-grade squamous intraepithelial lesions (OR 11.54; 95% CI 6.74-19.78), low-grade squamous intraepithelial lesions (OR 2.82; 95% CI 2.17-3.67) atypical squamous cell in which high-grade intraepithelial lesion cannot be excluded (OR 6.90; 95% CI 4.91-9.66) and atypical squamous cell of undetermined significance (OR 3.53; 95% CI 3.11-4.01) among cases with TZ representation. CONCLUSION Samples with TZ representation were associated with higher rates of abnormal results. Health professionals should be regularly trained to understand the weakness of cytological examinations when the TZ is not represented, especially in developing countries.
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Affiliation(s)
- Renata Alfena Zago
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil
| | - Deolino João Camilo-Júnior
- Pathology Institute of Araçatuba, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil
| | - Solange Correa Garcia Pires D'Ávilla
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil; São José do Rio Preto Medical School (FAMERP), São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil
| | - José Cândido Caldeira Xavier-Júnior
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil, Guatemala Street no. 414, Araçatuba, São Paulo 16071-045, Brazil; Pathology Institute of Araçatuba, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil; Botucatu Medical School. Paulista State University, Botucatu, São Paulo, Brazil, Floriano Peixoto Street no. 808, Araçatuba, São Paulo 16015-000, Brazil.
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Kholová I, Negri G, Nasioutziki M, Ventura L, Capitanio A, Bongiovanni M, Cross PA, Bourgain C, Edvardsson H, Granados R, Lipiński A, Obermann EC, Pinamonti M, Sidlova H, Strojan Fležar M, van Kemenade FJ, Vrdoljak-Mozetic D, Fassina A, Cochand-Priollet B. Inter- and intraobserver agreement in whole-slide digital ThinPrep samples of low-grade squamous lesions of the cervix uteri with known high-risk HPV status: A multicentric international study. Cancer Cytopathol 2022; 130:939-948. [PMID: 35833701 PMCID: PMC10084192 DOI: 10.1002/cncy.22624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND High-risk human papilloma virus (HR HPV) testing and liquid-based cytology are used for primary cervical screening. Digital cytology, based on whole-slide scanned samples, is a promising technique for teaching and diagnostic purposes. The aim of our study was to evaluate the interobserver and intraobserver variation in low-grade squamous lesions, HR HPV status bias, and the use of whole-slide scanned digital cervical cytology slides. METHODS Fifteen expert cytopathologists evaluated 71 digitalized ThinPrep slides (31 atypical squamous cells of undetermined significance [ASC-US], 21 negative for intraepithelial lesion or malignancy, and 19 low-grade squamous intraepithelial lesion cases). HR HPV data were accessible only in the second round. RESULTS In interobserver analysis, Kendall's coefficient of concordance was 0.52 in the first round and 0.58 in the second round. Fleiss' kappa values were 0.29 in the first round and 0.31 in the second round. In the ASC-US category, Fleiss kappa increased from 0.19 to 0.22 in the second round and the increase was even higher expressed by Kendall's coefficient: from 0.42 to 0.52. In intraobserver analysis, personal scores were higher in the second round. CONCLUSIONS The interobserver and intraobserver variability in low-grade squamous lesions was within fair agreement values in the present study, in line with previous works. The comparison of two rounds showed that expert cytopathologists are generally unbiased by the knowledge of HR HPV data, but that being informed of the HR HPV status leads to a better agreement. Stain quality and back discomfort were highlighted as factors affecting digital cytopathology use.
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Affiliation(s)
- Ivana Kholová
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Pathology, Fimlab Laboratories, Tampere, Finland
| | | | - Maria Nasioutziki
- Faculty of Medicine, Aristotle University of Thessaloniki and Molecular Cytopathology Department, Hippokration General Hospital, Thessaloniki, Greece
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Arrigo Capitanio
- Department of Pathology, University Hospital Linköping, Linköping, Sweden
| | | | - Paul A Cross
- South of Tyne Pathology Department, Queen Elizabeth Hospital, Gateshead, England
| | | | - Henrik Edvardsson
- Department of Pathology and Cytology, Karolinska University Laboratory, Karolinska Hospital Huddinge, Stockholm, Sweden
| | | | - Artur Lipiński
- Department of Pathology and Oncological Cytology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Henrieta Sidlova
- St. Elisabeth Cancer Institute Hospital, Bratislava, Slovak Republic
| | | | - Folkert J van Kemenade
- Erasmus MC University Medical Center, Department of Pathology, Rotterdam, the Netherlands
| | | | - Ambrogio Fassina
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
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