Analyzing Quality Control of Biopsies and Loop Electrosurgical Excisional Procedure Specimens Performed at the Cervical Cancer Prevention Program in the State of Paraná, Brazil

Abstract

Introduction: Proper monitoring and treatment of neoplastic and pre-neoplastic cervical lesions depend of the correct histopathological diagnosis. The establishment of mechanisms for quality control for this diagnostic procedure is essential for guaranteeing precision to the exams. Objective: To compare the first diagnosis of biopsies and surgical specimens removed by loop electrosurgical excisional procedure, given by a laboratory of the basic network, with the reviewed diagnosis given by the Quality Control Center from the Associacao Paranaense de Patologia, identifying the most common diagnostic mistakes. Method: An observational cross-sectional study was carried out with a databank review from the Quality Control Center, regarding the year 2010, in order to evaluate the general agreement percentage for each laboratory and the most common disagreements in diagnosis of biopsies and surgical specimens from loop electrosurgical excisional procedure of the cervix. Concordance rate was measured with Kappa Index. Results: The agreement rate between first and quality control diagnoses was 98.6%, which varied among laboratories between 92.9% and 100%. The most common diagnosis discrepancies found were between low-grade squamous intraepithelial lesion and cervicitis (36.3%), and low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion (27.3%). For all the diagnostic categories studied, the Kappa Index was 0.99. Conclusion: The most common misdiagnoses were between low-grade squamous intraepithelial lesion and cervicitis (overdiagnosis) and between low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion (underdiagnosis). The high agreement rate found was considered excellent.