Quality of vaginal smear for cervical cancer screening: a concordance study
Keywords:
cytology, vaginal smears, mass screening, uterine cervical neoplasms, observer variation, Colombia
Abstract
Introduction. Cervical cancer is the leading cause of cancer deaths in the female population in Colombia. The low impact of Papanicolaou smears in reducing cervical cancer mortality in some countries has been attributed to their low reproducibility and high rates of false negatives.Objective. To evaluate the quality of the Papanicolaou smears in four regions of Colombia comparing the original report given by provincial cytologists or pathologists with a second report made by a team of expert pathologists from the Instituto Nacional de Cancerología of Colombia.
Materials and methods. A sample of 4,863 Papanicolau smears was selected by a simple stratified randomized sampling method. Three strata were defined according to the original cytological report as negative, positive and unsatisfactory. All slides were newly interpreted with Bethesda 2001 by two independent experienced pathologists blinded to the first results. Non-weighted kappa values were calculated for degree of agreement.
Results. Overall, the concordance between the two evaluations was very low with a kappa value of 0.03 (95% CI: 0-0.06). With regard to abnormalities in squamous cells, evaluation concordance was moderate with a value of 0.47 (95% CI: 0.41- 0.53); a trend was noted suggesting higher levels of concordance in the evaluations from the Tolima and Magdalena Provinces.
Conclusion. Problems related with the quality of Papanicolau smears or the accurate reading thereof may be factors that explain the low impact of massive screening in cervical cancer mortality in Colombia.
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References
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14. Wiesner-Ceballos C, Murillo RH, Pineros M, Tovar-Murillo SL, Cendales R, Gutiérrez MC. Control del cáncer cervicouterino en Colombia: la perspectiva de los actores del sistema de salud. Rev Panam Salud Pública. 2009;25:1-8.
15. Murillo R, Piñeros M, Hernández G. Atlas de mortalidad en Colombia. Santa Fe de Bogotá: Instituto Nacional de Cancerología, Instituto Geográfico Agustín Codazzi; 2003.
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19. Stoler MH, Schiffman M, Atypical Squamous Cells of Undetermined Significance-Low-grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA. 2001;285:1500-5.
20. Wiesner C, Tovar S, Piñeros M, Cendales R. Murillo R. La oferta de servicios para tamización de cáncer de cuello uterino. Rev Colomb Cancerol. 2009;13:134-44.
21. Murillo R, Cendales R, Wiesner C, Piñeros M, Tovar S. Efectividad de la citología cérvico-uterina para la detección temprana de cáncer de cuello uterino en el marco del sistema de salud de Colombia. Biomédica. 2009;29:354-61.
22. República de Colombia. Decreto 1544 de 1998 (agosto 4) diario oficial no. 43.357, del 6 de agosto de 1998 Ministerio de Salud Pública por el cual se reglamenta parcialmente la ley 09 de 1979 y se dictan otras disposiciones. Bogotá: Ministerio de Salud Pública; 1998.
23. Díaz M, Parra EA. Guía para el control de calidad para la toma, procesamiento e interpretación en muestras de cuello uterino. Bogotá D.C.; Instituto Nacional de Salud; 2008.
24. Naylor B. The century for cytopathology. Acta Cytol. 2000;44:709-25.
25. Zarbo RJ, Jones BA, Friedberg RC, Valenstein PN, Renner SW, Schifman RB, et al. Q-tracks: a College of American Pathologists program of continuous laboratory monitoring and longitudinal tracking. Arch Pathol Lab Med. 2002;126:1036-44.
2. Kitchener H, Castle P, Cox J. Achievements and limitations of cervical cytology screening. Vaccine. 2006;24:63-70.
3. Madlensky A, Goel V, Polzar J, Ashbury FD. Assesing the evidence for organized cancer screening programmes. Eur J Cancer. 2003;39:1648-53.
4. Miller A, Goel V. Screening. En: Detels R, McEwen J, Beaglehole R, Tanaka H, editors. Oxford Textbook of Public Health. The Methods of Public Health. Fourth edition. Oxford: Oxford University Press; 2002.
5. WHO. Cervical cancer screening in developing countries: report of a WHO consultation. Geneva: World Health Organization; 2002.
6. Organización Panamericana de la Salud. Manual de procedimientos del laboratorio de citologías: Washington, DC: OPS; 2002.
7. Capurro I, Rojo JA, Pino T, Velásquez C, Garay J, Venegas M. Programa de detección y control de cáncer de cuello uterino en servicio salud Araucania Sur. Rev Chil Obstet Ginecol. 2006;71:307-12.
8. Salinas-Martínez AM, Villarreal-Ríos E, Garza-Elizondo ME, Fraire-Gloria JM, López-Franco JJ, Barboza-Quintana O. Calidad del programa de detección oportuna de cáncer cervicouterino en el estado de Nuevo León. Salud Pública Méx. 1997;39:187-94.
9. Lazcano-Ponce E, Nájera-Aguilar P, Alonso-de-Ruiz P, Buiatti E, Hernández-Ávila M. Programa de detección oportuna de cáncer cervical en México. Propuesta de reorganización. Rev Inst Nal Cancerol Mex. 1996;42:141-58.
10. Piñeros M, Cendales R, Murillo R, Wiesner C, Tovar S. Cobertura de la citología de cuello uterino y factores relacionados en Colombia, 2005. Rev Salud Pública. 2007;9:327-41.
11. Instituto Nacional de Cancerología. Cáncer en cifras. Mortalidad nacional por tipo de cáncer. Instituto Nacional de Cancerología 2005. Fecha de consulta: 27 de agosto de 2009. Bogotá, D.C.: INC. Disponible en: http://www.cancer.gov.co/documentos/794_cancer.pdf.
12. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002 cancer incidence, mortality and prevalence worldwide. IARC Cancer Base Nº 5, version 2.0. Lyon: IARC Press; 2004.
13. Murillo R, Almonte M, Pereria A, Ferrer E, Gamboa OA, Jerónimo J, et al. Cervical cancer screening programs in Latin America and the Caribbean. Vaccine. 2008;26(Suppl.11):L37-48.
14. Wiesner-Ceballos C, Murillo RH, Pineros M, Tovar-Murillo SL, Cendales R, Gutiérrez MC. Control del cáncer cervicouterino en Colombia: la perspectiva de los actores del sistema de salud. Rev Panam Salud Pública. 2009;25:1-8.
15. Murillo R, Piñeros M, Hernández G. Atlas de mortalidad en Colombia. Santa Fe de Bogotá: Instituto Nacional de Cancerología, Instituto Geográfico Agustín Codazzi; 2003.
16. Migliore G, Rossi E, Aldovini A, Mudu P, Alderisio M, Giovagnoli MR, et al. Variation in the assessment of adequacy in cervical smears. Cythopathology. 2001;12:377-82.
17. Yobs AR, Plott AE, Hicklin MD, Coleman SA, Johnston WW, Ashton PR, et al. Retrospective evaluation of gynecologic cytodiagnosis. II. Interlaboratory reproducibility as shown in rescreening large consecutive samples of reported cases. Acta Cytol. 1987;31:900-10.
18. Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. Forum Group Members; Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-9.
19. Stoler MH, Schiffman M, Atypical Squamous Cells of Undetermined Significance-Low-grade Squamous Intraepithelial Lesion Triage Study (ALTS) Group. Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study. JAMA. 2001;285:1500-5.
20. Wiesner C, Tovar S, Piñeros M, Cendales R. Murillo R. La oferta de servicios para tamización de cáncer de cuello uterino. Rev Colomb Cancerol. 2009;13:134-44.
21. Murillo R, Cendales R, Wiesner C, Piñeros M, Tovar S. Efectividad de la citología cérvico-uterina para la detección temprana de cáncer de cuello uterino en el marco del sistema de salud de Colombia. Biomédica. 2009;29:354-61.
22. República de Colombia. Decreto 1544 de 1998 (agosto 4) diario oficial no. 43.357, del 6 de agosto de 1998 Ministerio de Salud Pública por el cual se reglamenta parcialmente la ley 09 de 1979 y se dictan otras disposiciones. Bogotá: Ministerio de Salud Pública; 1998.
23. Díaz M, Parra EA. Guía para el control de calidad para la toma, procesamiento e interpretación en muestras de cuello uterino. Bogotá D.C.; Instituto Nacional de Salud; 2008.
24. Naylor B. The century for cytopathology. Acta Cytol. 2000;44:709-25.
25. Zarbo RJ, Jones BA, Friedberg RC, Valenstein PN, Renner SW, Schifman RB, et al. Q-tracks: a College of American Pathologists program of continuous laboratory monitoring and longitudinal tracking. Arch Pathol Lab Med. 2002;126:1036-44.
How to Cite
1.
Cendales R, Wiesner C, Murillo RH, Piñeros M, Tovar S, Mejía JC. Quality of vaginal smear for cervical cancer screening: a concordance study. biomedica [Internet]. 2010 Mar. 1 [cited 2024 May 11];30(1):107-15. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/158
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