Assuring the quality of cervical cytology laboratories

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Assuring the quality of cervical cytology
laboratories

• Dr Karin Denton
• Consultant cytopathologist
• Director of Quality Assurance

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Cervical Screening Quality Assurance in the UK
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Bristol
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Is cervical screening in England working?

• From 1988 1997 there was a 42 fall in
  incidence
• In 1999 there were 2424 new cases
• In 2002 there were 927 deaths
• The NHS CSP saves an estimated 1300 lives and
  prevents 3900 cases/year

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Regional
National
Screening program director
QA Director
Speciality Leads Cytology. Colposcopy, Recall
National QA groups
Speciality Groups
Local working groups
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Role of Quality Assurance groups

• National groups set standards
• Local groups
• Monitor performance against standards
• Support and co-ordinate remedial action
• Propagate good practice

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Setting quality standards for Cervical Cytology
laboratories

• There are 2 types of standard
• Process
• Outcome

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Process standards

• Working environment
• Staff
• Cervical smear report
• Laboratory protocols

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Working environment

• Concept is that staff will work better if
  comfortable
• Evidence base ?
• Ergonomic microscopes
• Heat, light, security

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Staff

• Qualifications
• Hours spent screening, productivity
• Continuing professional development
• Evidence base variable

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Smear report

• Standard nomenclature
• Content of the report
• Time to produce report
• Who gets the report

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Laboratory protocols

• Technical (staining)
• Internal and external quality assurance

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External Quality Assurance(EQA)

• Annual slide circulation
• Complex protocol for identifying poor performance
• Compared to peers
• Also technical EQA comparing staining performance

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Internal Quality Assurance

• Based on rapid review of 100 slides
• Differences in primary screening and final
  diagnosis recorded
• Screeners must attain 90 sensitivity for all
  grades and 95 sensitivity for high grade
• Protocol for action in the event of poor
  performance

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• Internal quality control by rapid review is most
  important way of monitoring quality
• Depends on good Information Technology and
  standardised ways of calculating the figures

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Laboratory Outcome measures

• Reporting rates for abnormal and inadequate
  smears
• Positive Predictive value (specificity)

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How do we monitor process and outcome

• Questionaires
• Laboratory Quality Assurance visits

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Quality Assurance Visits

• 3 yearly cycle
• Visit is multidisciplinary
• No National protocol as yet
• Inspection of laboratory, interviews with staff

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Making Quality Assurance work

• Authority
• Usually staff are well aware of shortcomings
• Improvements usually require increased spending
• Owning institutions must respect the authority of
  the Quality Assurance Team

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• Openness
• All outcome data is published nationally
• Detailed process and outcome data published
  within professional groups

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Where can you find out more?

• www.cancerscreening.nhs.uk
• All published quality guidelines
• Links to National statistical bulletin
• Reports on progress of the NHS Cervical screening
  program
• New developments including Liquid Based Cytology
  and HPV testing