title: Reproducibility of cervical cytopathology following an intervention by an external quality control laboratory.
abstract: BACKGROUND
  This study assessed the effects of a continued education program on the agreement between cervical cytopathology exams interpreted by local laboratories and interpretation made by an external quality control laboratory (LabMEQ).
  
  
  METHODS
  Overall, 9,798 exams were analyzed between 2007 and 2008, prior to implementation of a continued education program, and 10,028 between 2010 and 2011, following implementation. Continued education consisted of theoretical and practical classes held every two months. The chi-square test and the kappa coefficient were used in the statistical analysis.
  
  
  RESULTS
  Following implementation of continued education, the rate of false-negative results, and those leading to delays in clinical management fell in eight laboratories and the rate of false-positive results in five. Agreement between the results reported by the laboratories and the findings of LabMEQ, evaluated according to clinical management, remained excellent in three laboratories (kappa >0.80 and <1.0), went from good (kappa >0.60 and <0.80) to excellent in seven and from excellent to good in two. Agreement regarding the identification of metaplastic epithelium was poor (kappa = 0.25) but progressed to excellent following the implementation of continued education (kappa = 0.950). Agreement between cytopathology results improved significantly following implementation of continued education in cases reported as unsatisfactory (P < 0.001), atypical squamous cells of undetermined significance, cannot exclude high-grade squamous intraepithelial lesion (P < 0.001), low-grade squamous intraepithelial lesion (P < 0.001), and glandular atypia (P < 0.001).
  
  
  CONCLUSIONS
  Continued education contributed towards improving the reproducibility of cervical cytopathology, decreased the rates of false-negative and false-positive results, and reduced delays in clinical management.
authors: External Quality Control Laboratory, School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
authors: Cinara Zago Silveira
authors: CZ
authors: Ázara
authors: Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Brazil.
authors: Edna Joana Claudio
authors: EJ
authors: Manrique
authors: External Quality Control Laboratory, School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
authors: Suelene Brito do Nascimento
authors: SB
authors: Tavares
authors: External Quality Control Laboratory, School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
authors: Nadja Lindany
authors: NL
authors: Alves de Souza
authors: Postgraduate Program in Health Sciences, School of Medicine, Federal University of Goiás, Goiânia, Brazil.
authors: Juliana Cristina
authors: JC
authors: Magalhães
authors: External Quality Control Laboratory, School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.|School of Pharmacy, Federal University of Goiás, Goiânia, Brazil.
authors: Rita Goreti
authors: RG
authors: Amaral
mesh_terms: D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology*; D003937:Diagnosis, Differential; D004496:Education, Continuing; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007753:Laboratories; D008403:Mass Screening; D010338:Pathology, Clinical; D011786:Quality Control; D015203:Reproducibility of Results; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
keywords: continued education; cytodiagnosis; false-negative results; false-positive results; quality control in gynecological cytopathology