Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFG |
Texto Completo: | http://repositorio.bc.ufg.br/tede/handle/tde/1781 |
Resumo: | Introduction: The External Quality Monitoring (MEQ) was developed from recommendations of the National Cancer Institute, in order to evaluate the performance of cytopathology diagnostic of the cervix and provide subsidies for continuing education to professionals in laboratories that provide services to public health. Objectives: To evaluate the results of Pap cervical smear between the laboratories accredited by the Single Health System (SUS) according to the diagnostic of the Unit of External Quality Monitoring (UMEQ), checking the frequency of the results of Pap cervical smear, the discordant cases, false positives (FP), false negative (FN) and diagnostic agreement. Methods: A total of 14 laboratories accredited by the SUS indicated by the Municipal Secretary of Health in Goiânia-GO participated in this study. It was reviewed the period from January 2007 to December 2008, Pap cervical smear tests selected by the Information System of Cancer of the cervix including all positive cases, all unsatisfactory ones and at least 5% of negative test results which should achieve at least 10% of the monthly routine of each laboratory, totaling 10,053 tests. These were reviewed by professionals from UMEQ / Faculty of Pharmacy from Federal University of Goiás. It was considered discordant cases in which there was a change in clinical management in accordance with the criteria established by the Ministry of Health. To place the cytological cervical results the Bethesda System was used. The magnitude of agreement was evaluated between the diagnoses using the kappa coefficient. The level of agreement considering its respective confidence intervals of 95% depending on the need to assign different weights to the disagreements were classified as follows: less than 0 - very bad agreement, 0 to 0.2, bad agreement; from 0.2 to 0.4 - reasonable agreement, from 0.4 to 0.6 - good agreement, from 0.6 to 0.8 - very good agreement and from 0.8 to 1.0 excellent. Results: There was disagreement between the UMEQ and laboratories of origin in 763 (7,59%) cases, of these 110 (1,1%) were FN distributed in: 37 (0,37%) atypical squamous cells of undetermined significance (ASC-US), 22 (0,22%) intraepithelial low-grade squamous lesions (LSIL), 30 (0,30%) atypical squamous cells cannot exclude a high-grade lesion (ASC-H), 12 (0,13%) squamous intraepithelial lesions of high grade (HSIL), an (0,01%) intraepithelial lesion of high-grade with suspicious features for invasion, six (0,07%) atypical glandular cells and two (0,02%) adenocarcinomas in situ. There was a delay in clinical management in 245 (2,44%) cases, of these 85 (0,84%) were initially classified as ASC-US and 160 (1,50%) as LSIL.The cases of ASC-US were distributed in: 53 (0,53%) ASC-H, 31 (0,31%) HSIL and an (0,01%) atypical glandular. The cases of LSIL were distributed in: 19 (0,19%) ASC-H, 139 (1,38%) HSIL and two (0,02%) atypical glandular cells. It was considered 283 (2,82%) FP cases and 125 (1,24%) initially negative cases that were reclassified as unsatisfactory. The agreement between the laboratories of origin and the UMEQ was excellent (Kappa = 0.81). It was found that for the evaluation of agreement of each laboratory, the majority showed very good agreement. The agreement of the sample adequacy was considered reasonable (Kappa = 0.30). Conclusion: Most laboratories showed very good agreement, however, it is worth mentioning that MEQ is an exercise of improvement needed to establish the standardization of diagnostic criteria and improve the accuracy of cervical smear. |
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AMARAL, Rita Goretihttp://lattes.cnpq.br/3665611660713029GUIMARÃES, Janaína Valadareshttp://lattes.cnpq.br/0986934969522024http://lattes.cnpq.br/7910794828374913ÁZARA, Cinara Zago Silveira2014-07-29T15:29:21Z2010-08-122010-03-03ÁZARA, Cinara Zago Silveira. Evaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Quality. 2010. 109 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2010.http://repositorio.bc.ufg.br/tede/handle/tde/1781Introduction: The External Quality Monitoring (MEQ) was developed from recommendations of the National Cancer Institute, in order to evaluate the performance of cytopathology diagnostic of the cervix and provide subsidies for continuing education to professionals in laboratories that provide services to public health. Objectives: To evaluate the results of Pap cervical smear between the laboratories accredited by the Single Health System (SUS) according to the diagnostic of the Unit of External Quality Monitoring (UMEQ), checking the frequency of the results of Pap cervical smear, the discordant cases, false positives (FP), false negative (FN) and diagnostic agreement. Methods: A total of 14 laboratories accredited by the SUS indicated by the Municipal Secretary of Health in Goiânia-GO participated in this study. It was reviewed the period from January 2007 to December 2008, Pap cervical smear tests selected by the Information System of Cancer of the cervix including all positive cases, all unsatisfactory ones and at least 5% of negative test results which should achieve at least 10% of the monthly routine of each laboratory, totaling 10,053 tests. These were reviewed by professionals from UMEQ / Faculty of Pharmacy from Federal University of Goiás. It was considered discordant cases in which there was a change in clinical management in accordance with the criteria established by the Ministry of Health. To place the cytological cervical results the Bethesda System was used. The magnitude of agreement was evaluated between the diagnoses using the kappa coefficient. The level of agreement considering its respective confidence intervals of 95% depending on the need to assign different weights to the disagreements were classified as follows: less than 0 - very bad agreement, 0 to 0.2, bad agreement; from 0.2 to 0.4 - reasonable agreement, from 0.4 to 0.6 - good agreement, from 0.6 to 0.8 - very good agreement and from 0.8 to 1.0 excellent. Results: There was disagreement between the UMEQ and laboratories of origin in 763 (7,59%) cases, of these 110 (1,1%) were FN distributed in: 37 (0,37%) atypical squamous cells of undetermined significance (ASC-US), 22 (0,22%) intraepithelial low-grade squamous lesions (LSIL), 30 (0,30%) atypical squamous cells cannot exclude a high-grade lesion (ASC-H), 12 (0,13%) squamous intraepithelial lesions of high grade (HSIL), an (0,01%) intraepithelial lesion of high-grade with suspicious features for invasion, six (0,07%) atypical glandular cells and two (0,02%) adenocarcinomas in situ. There was a delay in clinical management in 245 (2,44%) cases, of these 85 (0,84%) were initially classified as ASC-US and 160 (1,50%) as LSIL.The cases of ASC-US were distributed in: 53 (0,53%) ASC-H, 31 (0,31%) HSIL and an (0,01%) atypical glandular. The cases of LSIL were distributed in: 19 (0,19%) ASC-H, 139 (1,38%) HSIL and two (0,02%) atypical glandular cells. It was considered 283 (2,82%) FP cases and 125 (1,24%) initially negative cases that were reclassified as unsatisfactory. The agreement between the laboratories of origin and the UMEQ was excellent (Kappa = 0.81). It was found that for the evaluation of agreement of each laboratory, the majority showed very good agreement. The agreement of the sample adequacy was considered reasonable (Kappa = 0.30). Conclusion: Most laboratories showed very good agreement, however, it is worth mentioning that MEQ is an exercise of improvement needed to establish the standardization of diagnostic criteria and improve the accuracy of cervical smear.O Monitoramento Externo da Qualidade (MEQ) foi elaborado a partir de recomendações do Instituto Nacional do Câncer, com o intuito de avaliar o desempenho dos diagnósticos citopatológicos do colo do útero e fornecer subsídios para educação continuada aos profissionais dos laboratórios que prestam serviços à rede pública de saúde. Objetivos: Avaliar os resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde (SUS) de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade (UMEQ), verificando a frequência dos resultados dos exames citopatológicos do colo do útero, dos casos discordantes, falsopositivos (FP), falso-negativos (FN) e a concordância diagnóstica. Métodos: Participaram deste estudo 14 laboratórios credenciados pelo SUS indicados pela Secretária Municipal de Saúde de Goiânia-GO. Foram revisados, no período de janeiro de 2007 a dezembro de 2008, exames citopatológicos do colo do útero selecionados pelo Sistema de Informações do Câncer do Colo do Útero incluindo todos os casos positivos, todos os insatisfatórios e no mínimo 5% dos exames negativos devendo atingir no mínimo 10% da rotina mensal de cada laboratório, totalizando 10.053 exames. Estes foram revisados por profissionais da UMEQ/ Faculdade de Farmácia da Universidade Federal de Goiás. Foram considerados discordantes os casos em que houve mudança de conduta clínica de acordo com os critérios estabelecidos pelo Ministério da Saúde. Para a classificação dos resultados citopatológicos do colo do útero utilizou-se o Sistema de Bethesda. Avaliou-se a magnitude da concordância entre os diagnósticos utilizando o coeficiente Kappa. O nível de concordância ponderado com seus respectivos intervalos de confiança de 95% em função da necessidade de se atribuir diferentes pesos para as discordâncias foi classificado da seguinte forma: menor que 0 - concordância péssima; de 0 a 0,2-concordância ruim; de 0,2 a 0,4- concordância razoável; de 0,4 a 0,6- concordância boa; de 0,6 a 0,8- concordância muito boa e de 0,8 a 1,0- excelente. Resultados: Houve discordância entre a UMEQ e os laboratórios de origem em 763 (7,59%) casos, destes, 110 (1,1%) foram FN distribuídos em: 37 (0,37%) células escamosas atípicas de significado indeterminado (ASC-US), 22 (0,22%) lesões intra-epiteliais escamosas de baixo grau (LSIL), 30 (0,30%) células escamosas atípicas não é possível excluir uma lesão de alto grau (ASC-H), 12 (0,13%) lesões intraepiteliais escamosas de alto grau (HSIL), uma (0,01%) lesão intra-epitelial de alto grau com características suspeitas de invasão, seis (0,07%) atipias glandulares e dois (0,02%) adenocarcinomas in situ. Houve retardo na conduta clínica em 245 (2,44%) casos, destes, 85 (0,84%) foram inicialmente classificados como ASC-US e 160 (1,50%) como LSIL. Os casos de ASC-US distribuíram-se em: 53 (0,53%) ASC-H, 31 (0,31%) HSIL e uma (0,01%) atipia glandular. Os casos de LSIL distribuíram-se em: 19 (0,19%) ASC-H, 139 (1,38%) HSIL e duas (0,02%) atipias glandulares. Foram considerados 283 (2,82%) casos FP e 125 (1,24%) casos inicialmente negativos foram reclassificados como insatisfatórios. A concordância entre os laboratórios de origem e a UMEQ foi excelente (Kappa=0,81). Verificou-se que para a avaliação da concordância de cada laboratório, a maioria apresentou concordância muito boa. A concordância da adequabilidade da amostra foi considerada razoável (Kappa=0,30). Conclusão: A maioria dos laboratórios apresentou concordância muito boa, no entanto, vale ressaltar que o MEQ é um exercício de aprimoramento necessário para se estabelecer a padronização dos critérios diagnósticos e melhoria da acurácia dos exames citopatológicos.Made available in DSpace on 2014-07-29T15:29:21Z (GMT). No. of bitstreams: 1 dissertacao cinara.pdf: 960645 bytes, checksum: 9e3f7530f507e4177c883e16350478e2 (MD5) Previous issue date: 2010-03-03application/pdfhttp://repositorio.bc.ufg.br/TEDE/retrieve/4623/dissertacao%20cinara.pdf.jpgporUniversidade Federal de GoiásMestrado em Ciências da SaúdeUFGBRCiências da Saúde - Medicinacâncer do colo do úterocontrole externo da qualidadefalso-negativoscancer of the cervixexternal quality controlfalse-negativeCNPQ::CIENCIAS DA SAUDEAvaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da QualidadeEvaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Qualityinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFGinstname:Universidade Federal de Goiás (UFG)instacron:UFGORIGINALdissertacao cinara.pdfapplication/pdf960645http://repositorio.bc.ufg.br/tede/bitstreams/cd4c4ff1-9f67-4097-8f06-675762ae3ddb/download9e3f7530f507e4177c883e16350478e2MD51THUMBNAILdissertacao cinara.pdf.jpgdissertacao cinara.pdf.jpgGenerated Thumbnailimage/jpeg4193http://repositorio.bc.ufg.br/tede/bitstreams/799d781b-7102-4b79-a15e-593af3195b46/download6517b5ba82e52690eaf816620d7eebf4MD52tde/17812014-07-30 03:15:23.232open.accessoai:repositorio.bc.ufg.br:tde/1781http://repositorio.bc.ufg.br/tedeRepositório InstitucionalPUBhttp://repositorio.bc.ufg.br/oai/requesttasesdissertacoes.bc@ufg.bropendoar:2014-07-30T06:15:23Repositório Institucional da UFG - Universidade Federal de Goiás (UFG)false |
dc.title.por.fl_str_mv |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
dc.title.alternative.eng.fl_str_mv |
Evaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Quality |
title |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
spellingShingle |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade ÁZARA, Cinara Zago Silveira câncer do colo do útero controle externo da qualidade falso-negativos cancer of the cervix external quality control false-negative CNPQ::CIENCIAS DA SAUDE |
title_short |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
title_full |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
title_fullStr |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
title_full_unstemmed |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
title_sort |
Avaliação dos resultados dos exames citopatológicos do colo do útero dos laboratórios credenciados pelo Sistema Único de Saúde de acordo com o diagnóstico da Unidade de Monitoramento Externo da Qualidade |
author |
ÁZARA, Cinara Zago Silveira |
author_facet |
ÁZARA, Cinara Zago Silveira |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
AMARAL, Rita Goreti |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/3665611660713029 |
dc.contributor.advisor-co1.fl_str_mv |
GUIMARÃES, Janaína Valadares |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/0986934969522024 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7910794828374913 |
dc.contributor.author.fl_str_mv |
ÁZARA, Cinara Zago Silveira |
contributor_str_mv |
AMARAL, Rita Goreti GUIMARÃES, Janaína Valadares |
dc.subject.por.fl_str_mv |
câncer do colo do útero controle externo da qualidade falso-negativos |
topic |
câncer do colo do útero controle externo da qualidade falso-negativos cancer of the cervix external quality control false-negative CNPQ::CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
cancer of the cervix external quality control false-negative |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
description |
Introduction: The External Quality Monitoring (MEQ) was developed from recommendations of the National Cancer Institute, in order to evaluate the performance of cytopathology diagnostic of the cervix and provide subsidies for continuing education to professionals in laboratories that provide services to public health. Objectives: To evaluate the results of Pap cervical smear between the laboratories accredited by the Single Health System (SUS) according to the diagnostic of the Unit of External Quality Monitoring (UMEQ), checking the frequency of the results of Pap cervical smear, the discordant cases, false positives (FP), false negative (FN) and diagnostic agreement. Methods: A total of 14 laboratories accredited by the SUS indicated by the Municipal Secretary of Health in Goiânia-GO participated in this study. It was reviewed the period from January 2007 to December 2008, Pap cervical smear tests selected by the Information System of Cancer of the cervix including all positive cases, all unsatisfactory ones and at least 5% of negative test results which should achieve at least 10% of the monthly routine of each laboratory, totaling 10,053 tests. These were reviewed by professionals from UMEQ / Faculty of Pharmacy from Federal University of Goiás. It was considered discordant cases in which there was a change in clinical management in accordance with the criteria established by the Ministry of Health. To place the cytological cervical results the Bethesda System was used. The magnitude of agreement was evaluated between the diagnoses using the kappa coefficient. The level of agreement considering its respective confidence intervals of 95% depending on the need to assign different weights to the disagreements were classified as follows: less than 0 - very bad agreement, 0 to 0.2, bad agreement; from 0.2 to 0.4 - reasonable agreement, from 0.4 to 0.6 - good agreement, from 0.6 to 0.8 - very good agreement and from 0.8 to 1.0 excellent. Results: There was disagreement between the UMEQ and laboratories of origin in 763 (7,59%) cases, of these 110 (1,1%) were FN distributed in: 37 (0,37%) atypical squamous cells of undetermined significance (ASC-US), 22 (0,22%) intraepithelial low-grade squamous lesions (LSIL), 30 (0,30%) atypical squamous cells cannot exclude a high-grade lesion (ASC-H), 12 (0,13%) squamous intraepithelial lesions of high grade (HSIL), an (0,01%) intraepithelial lesion of high-grade with suspicious features for invasion, six (0,07%) atypical glandular cells and two (0,02%) adenocarcinomas in situ. There was a delay in clinical management in 245 (2,44%) cases, of these 85 (0,84%) were initially classified as ASC-US and 160 (1,50%) as LSIL.The cases of ASC-US were distributed in: 53 (0,53%) ASC-H, 31 (0,31%) HSIL and an (0,01%) atypical glandular. The cases of LSIL were distributed in: 19 (0,19%) ASC-H, 139 (1,38%) HSIL and two (0,02%) atypical glandular cells. It was considered 283 (2,82%) FP cases and 125 (1,24%) initially negative cases that were reclassified as unsatisfactory. The agreement between the laboratories of origin and the UMEQ was excellent (Kappa = 0.81). It was found that for the evaluation of agreement of each laboratory, the majority showed very good agreement. The agreement of the sample adequacy was considered reasonable (Kappa = 0.30). Conclusion: Most laboratories showed very good agreement, however, it is worth mentioning that MEQ is an exercise of improvement needed to establish the standardization of diagnostic criteria and improve the accuracy of cervical smear. |
publishDate |
2010 |
dc.date.available.fl_str_mv |
2010-08-12 |
dc.date.issued.fl_str_mv |
2010-03-03 |
dc.date.accessioned.fl_str_mv |
2014-07-29T15:29:21Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
ÁZARA, Cinara Zago Silveira. Evaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Quality. 2010. 109 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2010. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tde/1781 |
identifier_str_mv |
ÁZARA, Cinara Zago Silveira. Evaluation of the results of cervical screening cervical laboratories accredited by the Health System in accordance with the diagnosis of the Monitoring Unit of External Quality. 2010. 109 f. Dissertação (Mestrado em Ciências da Saúde - Medicina) - Universidade Federal de Goiás, Goiânia, 2010. |
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http://repositorio.bc.ufg.br/tede/handle/tde/1781 |
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por |
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Universidade Federal de Goiás |
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UFG |
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Ciências da Saúde - Medicina |
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Universidade Federal de Goiás |
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