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Quality issues in cervical screening and cytology
6.1 Discuss the term quality and what it means in a cervical screening programme.
- Provide a definition of the term Quality including QC, QA and QM
- Discuss the influence these have on screening test results
- Discuss the implications on patient outcomes of high and low quality screening services
6.2 Describe the tools used for Quality Control on cytology primary screening and discuss their relative strengths and weaknesses.
- Rescreening high risk cases
- Limited value – fewer errors likely to be made and therefore detected in such cases therefore less benefit to patients and less information about screener performance
- Rescreening random cases
- Limited value – only 10-15% of errors likely to be detected therefore less benefit to patients and less information about screener performance
- Rapid review
- All negative and inadequate samples reviewed
- Less intensive screening therefore some errors may be missed
- The expectation of negative may lead to missing errors
- No method of assessing quality of QC procedure
- Rapid preview
- All samples pre-viewed
- Less intensive screening therefore some abnormalities may be missed
- No expectation of negative leading to missing errors
- Allows a method of assessing quality of QC procedure
6.3 Discuss triage in HPV primary screening and how the quality is monitored.
- Cytology and HPV genotyping can be used as triage methods
- Cytology monitored by QC methods with calculations of screening sensitivity, EQA schemes, education etc.
- HPV monitored by QC methods, EQA schemes, education etc.
6.4 Discuss the purpose of the multi-disciplinary meeting (MDT) and how this is achieved
- To diagnose and suggest appropriate treatment for the patient
- Review of initial findings/diagnoses
- Assessment of the individual circumstances of each patient
- Assessment of risk/benefit of treatment/management options