1
|
Kim D, Sundling KE, Virk R, Thrall MJ, Alperstein S, Bui MM, Chen-Yost H, Donnelly AD, Lin O, Liu X, Madrigal E, Michelow P, Schmitt FC, Vielh PR, Zakowski MF, Parwani AV, Jenkins E, Siddiqui MT, Pantanowitz L, Li Z. Digital cytology part 2: artificial intelligence in cytology: a concept paper with review and recommendations from the American Society of Cytopathology Digital Cytology Task Force. J Am Soc Cytopathol 2024; 13:97-110. [PMID: 38158317 DOI: 10.1016/j.jasc.2023.11.005] [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: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Digital cytology and artificial intelligence (AI) are gaining greater adoption in the cytology laboratory. However, peer-reviewed real-world data and literature are lacking in regard to the current clinical landscape. The American Society of Cytopathology in conjunction with the International Academy of Cytology and the Digital Pathology Association established a special task force comprising 20 members with expertise and/or interest in digital cytology. The aim of the group was to investigate the feasibility of incorporating digital cytology, specifically cytology whole slide scanning and AI applications, into the workflow of the laboratory. In turn, the impact on cytopathologists, cytologists (cytotechnologists), and cytology departments were also assessed. The task force reviewed existing literature on digital cytology, conducted a worldwide survey, and held a virtual roundtable discussion on digital cytology and AI with multiple industry corporate representatives. This white paper, presented in 2 parts, summarizes the current state of digital cytology and AI practice in global cytology practice. Part 1 of the white paper is presented as a separate paper which details a review and best practice recommendations for incorporating digital cytology into practice. Part 2 of the white paper presented here provides a comprehensive review of AI in cytology practice along with best practice recommendations and legal considerations. Additionally, the cytology global survey results highlighting current AI practices by various laboratories, as well as current attitudes, are reported.
Collapse
Affiliation(s)
- David Kim
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kaitlin E Sundling
- The Wisconsin State Laboratory of Hygiene and Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Renu Virk
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Susan Alperstein
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Marilyn M Bui
- The Department of Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Amber D Donnelly
- Diagnostic Cytology Education, University of Nebraska Medical Center, College of Allied Health Professions, Omaha, Nebraska
| | - Oscar Lin
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Xiaoying Liu
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emilio Madrigal
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Pamela Michelow
- Division of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Pathology, National Health Laboratory Services, Johannesburg, South Africa
| | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe R Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | | | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
2
|
Rezende MT, Bianchi AGC, Carneiro CM. Cervical cancer: Automation of Pap test screening. Diagn Cytopathol 2021; 49:559-574. [PMID: 33548162 DOI: 10.1002/dc.24708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer progresses slowly, increasing the chance of early detection of pre-neoplastic lesions via Pap exam test and subsequently preventing deaths. However, the exam presents both false-negatives and false-positives results. Therefore, automatic methods (AMs) of reading the Pap test have been used to improve the quality control of the exam. We performed a literature review to evaluate the feasibility of implementing AMs in laboratories. METHODS This work reviewed scientific publications regarding automated cytology from the last 15 years. The terms used were "Papanicolaou test" and "Automated cytology screening" in Portuguese, English, and Spanish, in the three scientific databases (SCIELO, PUBMED, MEDLINE). RESULTS Of the resulting 787 articles, 34 were selected for a complete review, including three AMs: ThinPrep Imaging System, FocalPoint GS Imaging System and CytoProcessor. In total, 1 317 148 cytopathological slides were evaluated automatically, with 1 308 028 (99.3%) liquid-based cytology slides and 9120 (0.7%) conventional cytology smears. The AM diagnostic performances were statistically equal to or better than those of the manual method. AM use increased the detection of cellular abnormalities and reduced false-negatives. The average sample rejection rate was ≤3.5%. CONCLUSION AMs are relevant in quality control during the analytical phase of cervical cancer screening. This technology eliminates slide-handling steps and reduces the sample space, allowing professionals to focus on diagnostic interpretation while maintaining high-level care, which can reduce false-negatives. Further studies with conventional cytology are needed. The use of AM is still not so widespread in cytopathology laboratories.
Collapse
Affiliation(s)
- Mariana T Rezende
- Postgraduate Program in Biotechnology, Biological Sciences Research Center (NUPEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Cytology Laboratory, Clinical Analysis Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Andrea G C Bianchi
- Computing Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Cláudia M Carneiro
- Postgraduate Program in Biotechnology, Biological Sciences Research Center (NUPEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Cytology Laboratory, Clinical Analysis Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| |
Collapse
|
3
|
Pimple SA, Mishra GA, Deodhar KK. Evidence based appropriate triage strategies for implementing high risk HPV as primary technology in cervical cancer screening. ACTA ACUST UNITED AC 2020; 72:96-105. [PMID: 32403908 DOI: 10.23736/s0026-4784.20.04511-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary cervical cancer screening by HPV testing for high risk human papillomavirus (hrHPV) is expected to replace cytology-based programs in many parts of the world. Its high sensitivity and negative predictive value permit longer screening intervals up to beyond five years. However, low positive predictive value can lead to unnecessary referrals and overtreatment since most hrHPV infections are transient and will not develop disease. Therefore risk stratification is needed to effectively triage and identify women among the hrHPV positives, who are at an increased risk of cervical (pre)cancer who need further diagnostic evaluation to decide on further management. Several triage strategies like HPV16/18 genotyping, p16/Ki67 dual staining and DNA methylation markers (CADM1, MAL and miR-124-2) have been evaluated to determine suitable triage options. Triage with p16/Ki-67 dual-stain provided better long-term risk stratification than cytology with significant reduction in cumulative 5 years CIN3+ risk in p16/Ki-67 negative women. DNA methylation assays have shown higher specificity than cytology and higher sensitivity than HPV16/18 genotyping with added advantages of reproducibility and application on self-collected samples. Based on current evidence, Pap cytology with or without additional HPV16/18 genotyping remains the most recommended triage strategies for primary HPV screening. Other strategies will need more longitudinal studies to provide evidence of risk reduction in test negative results. WHO recommends Visual Inspection with Acetic Acid (VIA) for triaging HPV-positive women in LMIC settings. An optimal triage strategy that can be integrated with primary HPV screening should be able to segregate and reassure the large majority of women who are at very low risk of cervical cancer.
Collapse
Affiliation(s)
- Sharmila A Pimple
- Department of Preventive Oncology, Center for Cancer Epidemiology (CCE), Tata Memorial Center, Mumbai, India - .,Homi Bhabha National Institute (HBNI), Mumbai, India -
| | - Gauravi A Mishra
- Department of Preventive Oncology, Center for Cancer Epidemiology (CCE), Tata Memorial Center, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kedar K Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| |
Collapse
|
4
|
Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M. Prevention of Cervical Cancer: Guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017) - Part 1 with Introduction, Screening and the Pathology of Cervical Dysplasia. Geburtshilfe Frauenheilkd 2019; 79:148-159. [PMID: 30792545 PMCID: PMC6379164 DOI: 10.1055/a-0818-5440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 12/16/2022] Open
Abstract
Aims Annual opportunistic screening for cervical carcinoma has been carried out in Germany since 1971. The creation of this S3 guideline meets an important need, outlined in the National Cancer Plan, with regard to screening for cervical cancer, as the guideline aims to provide important information and support for planned organized screening for cervical cancer in Germany. Methods With the financial support of German Cancer Aid, 21 professional societies developed evidence-based statements and recommendations (classified using the GRADE system) for the screening, management and treatment of precancerous conditions of the cervix. Two independent scientific institutes compiled systematic reviews for this guideline. Recommendations The first part of this short summary presents the pathological basis and considers various questions related to screening for cervical cancer. As also reported in earlier reviews, the meta-analysis by Kleijnen Systematic Reviews showed that HPV-based screening offers better protection against invasive cervical cancer compared to cytology-based screening. The authors of this guideline therefore recommend - in accordance with the guideline of the Joint National Committee of Germany (Gemeinsamer Bundesauschuss, G-BA) - that women aged 35 and above should be examined at regular intervals (at least every 3 years) and undergo HPV-based screening. Co-testing can also be carried out. Women between the ages of 20 and 35 should have cytological screening every 2 years.
Collapse
Affiliation(s)
- Peter Hillemanns
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Christian Dannecker
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, München, Germany
| | - Stefanie Klug
- Lehrstuhl für Epidemiologie, Technische Universität München, München, Germany
| | - Ulrike Seifert
- Tumorepidemiologie, Universitäts KrebsCentrum (UCC), Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany
| | - Thomas Iftner
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Juliane Hädicke
- Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Thomas Löning
- Institut für Pathologie, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - Lars Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Dietmar Schmidt
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, Mannheim, Germany
| | - Hans Ikenberg
- CytoMol - MVZ für Zytologie und Molekularbiologie, Frankfurt, Germany
| | - Manfred Steiner
- Facharzt für Frauenheilkunde und Geburtshilfe, Ihringen, Germany
| | - Ulrich Freitag
- Facharzt für Frauenheilkunde und Geburtshilfe, Wismar, Germany
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria.,Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i. T., Austria
| | - Willi Sauerbrei
- Institut für Med. Biometrie und Statistik (IMBI), Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld, Krefeld, Germany
| | - Karsten Münstedt
- Frauenklinik, Ortenau Klinikum Offenburg-Gengenbach, Offenburg, Germany
| | - Achim Schneider
- Medizinisches Versorgungszentrum im Fürstenberg-Karree, Berlin, Germany
| | - Andreas Kaufmann
- Klinik für Gynäkologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Joachim Weis
- Klinik für Tumorbiologie, Klinik für Onkologische Rehabilitation - UKF Reha gGmbH, Freiburg, Germany
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Mathias Fehr
- Gynäkologie & Geburtshilfe in Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | | | - Olaf Reich
- Privatklinik Graz Ragnitz, Graz, Austria
| | - Marc Arbyn
- Cancer Center, Sciensano, Brüssel, Belgium
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, United Kingdom
| | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement, Marburg, Germany
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft, Berlin, Germany
| | - Matthias Jentschke
- Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany
| |
Collapse
|
5
|
Chandra S, Chandra H, Kusum A, Singh Gaur D. Study of the Pre-Analytical Phase of an ISO 15189: 2012-Certified Cytopathology Laboratory: A 5-Year Institutional Experience. Acta Cytol 2018; 63:56-62. [PMID: 30566946 DOI: 10.1159/000494567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/16/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Total quality management, which basically involves pre-analytical, analytical, and postanalytical phases, is relatively more difficult in cytopathology due to descriptive reports and subjective variability. The pre-analytical phase of total quality management constitutes a major burden of errors in the laboratory and it has not been widely studied in cytopathology except in cervical Pap smears. The present study was therefore conducted to study the pre-analytical phase over 5 years from April 2013 until May 2018 at an ISO 15189: 2012-certified cytopathology laboratory, in a resource-limited setting. It was also intended to study the level of satisfaction of the patients and the training of the professionals provided in the cytology lab so as to improve and maintain high quality standards. METHODS The study included all the documents relating to the quality program used in the last 5 years in a medical institute situated in the north sub-Himalayan region of India. All the data were recorded and analysed for pre-analytical analysis of the total quality management system. RESULTS In total, 20,130 samples were received for cytological investigation. The total number of errors which were detected in the cytopathology lab were 1,430, constituting 7.1% of the total investigations done. The pre-analytical phase errors comprised 57% of the total errors (815/1,430), analytical errors constituted 11% (157/1,430), while postanalytical errors represented 32% (458/1,430). Incompletely filled requisition forms constituted the most common pre-analytical error (38%). There was a gradual decrease in the errors with time, but with a sudden increase between January to June 2015 due to new technicians joining during that period. CONCLUSION Pre-analytical quality management is an essential component for maintaining the quality and reducing the errors in the cytopathology lab. Documentation, continuous training, and maintenance of internal and external quality control with quality charts are the key for successful quality management. The identification of non-conformance with root-cause analysis and provision of scope for continuous improvement is vital for quality improvement in the lab. Patient satisfaction is an important aspect of quality in the lab, which should be combined with the satisfaction of the personnel working in the lab.
Collapse
Affiliation(s)
- Smita Chandra
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India,
| | - Harish Chandra
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, India
| | - Anuradha Kusum
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| | - Dushyant Singh Gaur
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India
| |
Collapse
|
6
|
Lucena FA, Costa RFA, Stein MD, Andrade CEMC, Cintra GF, Vieira MA, Dufloth RM, Fregnani JHTG, Dos Reis R. Pelvic radiotherapy for cervical cancer affects importantly the reproducibility of cytological alterations evaluation. BMC Clin Pathol 2018; 18:11. [PMID: 30323716 PMCID: PMC6173841 DOI: 10.1186/s12907-018-0078-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/26/2018] [Indexed: 12/28/2022] Open
Abstract
Background to evaluate the intraobserver and interobserver reproducibility of cervical cytopathology according to previous knowledge of whether patients received radiotherapy (RT) treatment or not. Methods The study analyzed a sample of 95 cervix cytological slides; 24 with cytological abnormalities (CA) and presence of RT; 21 without CA and presence of RT; 25 without CA and without previous RT; 25 with CA and without previous RT. Two cytopathology (CP) evaluations of the slides were carried out. For the first CP re-evaluation, the cytotechnologist was blinded for the information of previous RT. For the second CP re-evaluation, the cytotechnologist was informed about previous RT. The results were analyzed through inter and intraobserver agreement using the unweighted and weighted kappa. Results Post radiotherapy effects were identified in 44.4% of cases that undergone previous pelvic RT. The agreement for RT status was 66.32% (unweighted K = 0.31, 95%CI: 0.13; 0.49, moderate agreement). The intraobserver agreement, regarding the cytological diagnoses, regardless of radiotherapy status, was 80.32% (weighted K = 0.52, 95%CI: 0.34; 0.68). In no RT group, the intraobserver agreement was 70% (weighted K = 0.47, 95%CI: 0.27;0.65) and in patients that received RT, the intraobserver agreement was 84.09% (unweighted K = 0.37, 95%CI: 0.01;0.74). The interobserver agreement between cytopathology result (abnormal or normal) in the group with RT, considering normal and abnormal CP diagnosis was 14.0% and 12.5%, respectively. There was no association between the cytological alterations and the median time between the end of RT and the cytological diagnosis. Conclusion This study showed that RT has an important impact in CP diagnosis because the agreement, also in interobserver and intraobserver analysis, had high discrepancy in patients that received RT. Also, demonstrated that it is difficult to recognize the presence of RT in cytological slides when this information is not provided.
Collapse
Affiliation(s)
- Fernanda A Lucena
- Faculty of Health Science of Barretos Dr. Paulo Prata, Avenida Loja Maçônica Renovadora 68, Nº 100, Barretos, 14785-002 São Paulo Brazil
| | - Ricardo F A Costa
- Faculty of Health Science of Barretos Dr. Paulo Prata, Avenida Loja Maçônica Renovadora 68, Nº 100, Barretos, 14785-002 São Paulo Brazil
| | - Maira D Stein
- 2Department of Pathology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - Carlos E M C Andrade
- 3Department of Gynecologic Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - Geórgia F Cintra
- 3Department of Gynecologic Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - Marcelo A Vieira
- 3Department of Gynecologic Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - Rozany M Dufloth
- 4Post-Graduation Program in Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - José Humberto T G Fregnani
- 4Post-Graduation Program in Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| | - Ricardo Dos Reis
- 3Department of Gynecologic Oncology, Barretos Cancer Hospital, Rua Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos, 14784-400 São Paulo Brazil
| |
Collapse
|
7
|
Thrall MJ. Automated screening of Papanicolaou tests: A review of the literature. Diagn Cytopathol 2018; 47:20-27. [DOI: 10.1002/dc.23931] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/20/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Michael J. Thrall
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital, 6565 Fannin M227; Houston Texas 77030
| |
Collapse
|
8
|
Branca M, Longatto-Filho A. Recommendations on Quality Control and Quality Assurance in Cervical Cytology. Acta Cytol 2015; 59:361-9. [PMID: 26569109 DOI: 10.1159/000441515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/06/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to critically evaluate the importance of quality control (QC) and quality assurance (QA) strategies in the routine work of uterine cervix cytology. STUDY DESIGN We revised all the main principles of QC and QA that are already being implemented worldwide and then discussed the positive aspects and limitations of these as well as proposing alternatives when pertinent. RESULTS A literature review was introduced after highlighting the main historical revisions, and then a critical evaluation of the principal innovations in screening programmes was conducted, with recommendations being postulated. CONCLUSIONS Based on the analysed data, QC and QA are two essential arms that support the quality of a screening programme.
Collapse
Affiliation(s)
- Margherita Branca
- Unit of Cytopathology, National Centre of Epidemiology, Surveillance and Promotion of Health, National Institute of Health (ISS), Rome, Italy
| | | |
Collapse
|
9
|
Longatto-Filho A, Levi JE, Martins TR, Cohen D, Cury L, Villa LL, Eluf-Neto J. Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of São Paulo, Brazil. Acta Cytol 2015; 59:273-7. [PMID: 26279162 DOI: 10.1159/000435801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/08/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the performance of the current conventional Pap smear with liquid-based cytology (LBC) preparations. STUDY DESIGN Women routinely undergoing their cytopathological and histopathological examinations at Fundação Oncocentro de São Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of São Paulo with similar sociodemographic characteristics. RESULTS A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the two methods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of high-grade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). CONCLUSIONS LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs.
Collapse
Affiliation(s)
- Adhemar Longatto-Filho
- Laboratx00F3;rio de Investigax00E7;x00E3;o Mx00E9;dica (LIM) 14, Faculdade de Medicina, Universidade de Sx00E3;o Paulo, Sx00E3;o Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
10
|
Stein MD, Fregnani JHTG, Scapulatempo-Neto C, Longatto-Filho A. Cervicovaginal cytology in patients undergoing pelvic radiotherapy using the Focalpoint system: results from the RODEO study. Diagn Pathol 2015; 10:1. [PMID: 25591792 PMCID: PMC4304134 DOI: 10.1186/s13000-014-0231-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluate the performance of the Focalpoint system in identifying and classifying cervical cytology alterations from samples collected from patients treated with Radiotherapy (RT). METHODS The reproducibility of manual and automated screening by cytotechnologists using the BD Focalpoint GS Imaging System was examined. Samples were collected from May 2010 to August 2011. RESULTS A total of 378 treated with RT and 8,967 cytology samples from patients without previous RT, were evaluated. The kappa values for cytological diagnoses read manually and automated in cases without previous RT were as follows: < ASC-H vs. ≥ ASC-H = 0.71; < LSIL vs. ≥ LSIL = 0.66; and < HSIL vs. ≥ HSIL = 0.67. The kappa for cytological diagnoses in post-RT women have showed: < ASC-H vs. ≥ ASC-H = 0.71; < LSIL vs. ≥ LSIL = 0.65; < HSIL vs. ≥ HSIL = 0.57. CONCLUSIONS There was no significant difference among the kappa values we found. Post-RT cytology showed small diagnostic agreement between manual and automated examination. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_231.
Collapse
Affiliation(s)
- Maíra Degiovani Stein
- Pathology Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
| | - José Humberto T G Fregnani
- Pathology Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil. .,Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
| | - Cristovam Scapulatempo-Neto
- Pathology Department, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil. .,Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil.
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil. .,Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of São Paulo, 01246-903, São Paulo, Brazil. .,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. .,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal.
| |
Collapse
|