To assess and analyze the quality aspects between cytology labs, focusing on quality of samples, satisfactory/unsatisfactory results, TAT from testing sample to result and the variance between reporting per cytocategory.
SEHIB (Surveillance of Effects of Human Papillomavirus Immunization in Belgium) was a study to mainly generate baseline data at introduction of the prophylactic HPV vaccination and to provide a surveillance framework for measuring the impact of HPV vaccination in Belgium. To do this, 8 cytopathology lab were used – 4 universities and 4 peripheral labs. The study started in November 2010 recruiting women (< 30 > years of age) and the last patient was seen July 2014. In total 6,630 specimens were included in the study, 90% of these collected in phase 1 are representative of screening samples and 10% collected in phase 2 were linked to abnormal screening or follow-up samples. Phase 2 samples were only collected in the university laboratories.
Alongside the molecular and cytological analysis performed, key performance indicators of these 8 labs were measured and upon evaluation confirmed substantial localized variances in service delivery and testing among the following topics:
- TAT interval between sample collection and cytological interpretation ranged from a mean of 2.4-13 days.
- A variance in unsatisfactory samples ranged between 0.17-12.36% overall and increased when only evaluating screening Pap smears, 0.26-17.41%.
- Distribution of cervical epithelial abnormalities, comparing NILM to epithelial abnormalities, ranged from 0.62-11.93%.
There are opportunities for service delivery improvements in the following above-mentioned areas. The rates of cervical epithelial abnormalities observed, although in line with international benchmarks, show substantial localized discrepancies. This alongside the subjectivity and variance in diagnosis of NILM versus epithelial abnormalities questions the robustness and the quality assessment of cytological cervical screening strategy.