Cervical Cytology Screening Audit: An Assessment of the Outcome at - PowerPoint PPT Presentation

Cervical Cytology Screening Audit: An Assessment of the Outcome at Biopsy of High Risk HPV Positive Triage Cases. Jemma Armstrong

Overview • Aims of the Audit • Method • Results • Future study • Questions

Audit overview • To determine the outcome of all cytology cases reported as having borderline nuclear changes or mild dyskaryosis which tested positive for high risk HPV. • Looked at related histology to assess outcome. • Final outcome categorised as high grade CIN, low grade CIN, inadequate or undetermined.

Aims of Audit • Use in clinical practice – allow clinicians to provide valuable information to patients. • Indication of our performance of HPV triage cases over time. • Comparison to available data to assess performance.

Method • Accessed quarterly master sheets of all cytology cases from 2012 – 2014. • Sorted into HPV positive triage cases to build dataset. • Used Winpath to obtain relevant histology result relating to cases. • Recorded all relevant information onto spread sheet.

Method Continued • Concluded a final decision for each case ( e.g. CIN2 +/ungraded = HG) • Calculated frequency of each outcome for each year. • Then calculated a single combined outcome.

Results Summary • 2234 HPV positive triage cases of which 76.2% had a related histology. • An outcome has not been determined in the further 23.8%. • Of those who had a punch biopsy, LLETZ or other related histology 55.1% (n=937) showed low grade CIN, correlating with the cytology smear result. • Results showed improvement over time.

Results Overall Outcome of HPV Trigae Cervical Cytology Cases High Grade 19.4% Low Grade 55.1% No related histology Related Histology 23.8% 76.2% No CIN 19% Inadequate 6.4%

Results Outcome of High Risk HPV Positive Cervical Cytology Cases at Biopsy over time (2012-2014) 70 Increase from 48 – 59.2% 60 50 Frequency (%) 40 2012 Decreased from 30 2013 21.5 – 16.5% 2014 20 Increased from 10 21.4 – 24.8% Decreased from 10.2 – 5.2% 0 No biopsy High Grade Low Grade No CIN Inadequate Outcome

Comparison to Sentinel Pilot CDDFT Pilot • 76.2% had a biopsy. • 62% had a biopsy. • Of which 55.1% were • Of which 27.1% were reported as Low grade graded as CIN1. (CIN1). • 21.4% were CIN2 or • 19.4% were reported as higher. CIN2 or higher. • 49% were negative form • 19% were negative for CIN. CIN.

Further Study • Further separation of biopsy types and outcome. • Explore data set where no biopsy was taken, to determine outcome of these cases allowing further comparison to pilot study. • Look at 3 year smear reports of high risk HPV negative triage cases.