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DOI: 10.5146/tjpath.2016.01380
What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts
İlknur Çetinaslan TÜRKMEN1, Alp USUBÜTÜN2, Aslı ÇAKIR1, Özlem AYDIN3, Filiz Aka BOLAT4, Metin AKBULUT5, Serdar ALTINAY6, Sema ARICI7, Figen ASLAN8, Müzeyyen ASTARCI9, Emine Kılıç BAĞIR10, Yılmaz BAŞ11, Nuray BAŞSÜLLÜ12, Betül ÇELİK13, Handan ÇETİNER14, Bengü ÇOBANOĞLU15, Abdullah AYDIN15, Hale DEMİR16, Hayriye Tatlı DOĞAN17, Kamile Gülçin EKEN18, Selma Şengiz ERHAN19, Gülgün ERDOĞAN20, Kıvılcım Eren ERDOĞAN21, Funda EREN22, Şafak ERSÖZ23, Pınar FIRAT24, İclal GÜRSES25, Nihan HABERAL26, Dudu Solakoğlu KAHRAMAN27, Gülçin Harman KAMALI19, Yasemin Yuyucu KARABULUT28, Mehmet KEFELİ29, Meral KOYUNCUOĞLU30, R. Doğan KÖSEOĞLU31, Bahar MÜEZZİNOĞLU32, Binnur ONAL33, Sevgen ÖNDER2, Zuhal ÖZCAN34, Elife KIMILOĞLU34, Hatice ÖZER35, F. Cavide SÖNMEZ7, Sevinç ŞAHİN36, Nurhan ŞAHİN37, Tülin YALTA38
1Department of Pathology, Istanbul Medipol University Faculty of Medicine, İstanbul
2Hacettepe University Faculty of Medicine, Ankara
3Acibadem University Faculty of Medicine, İstanbul
4Başkent University ERH, ADANA
5Pamukkale University Faculty of Medicine, DENİZLİ
6Bagcilar ERH, Istanbul
7Bezmialem Vakif University Faculty of Medicine, Istanbul
8Dumlupinar University Evliya Celebi ERH, KÜTAHYA
9Abant Izzet Baysal University Faculty of Medicine, BOLU
10Cukurova University Faculty of Medicine, ADANA
11Hitit University Çorum ERH, ÇORUM
12Bilim University Faculty of Medicine, Istanbul
13Antalya ERH, ANTALYA
14Zeynep Kamil ERH, İSTANBUL
15Medeniyet University Goztepe ERH, İSTANBUL
16Istanbul University Cerrahpaşa Medical Faculty, İSTANBUL
17Yildirim Beyazit University Ankara Ataturk ERH, ANKARA
18Sisli Hamidiye Etfal ERH, İSTANBUL
19Okmeydani ERH, İSTANBUL
20Akdeniz University Faculty of Medicine, ANTALYA
21Mersin State Hospital, MERSİN
22Marmara University Faculty of Medicine, İSTANBUL
23Karadeniz Technical University Faculty of Medicine, TRABZON
24Istanbul University Faculty of Medicine, İSTANBUL
25Mersin University Faculty of Medicine, MERSİN
26Baskent University Faculty of Medicine, ANKARA
27Tepecik ERH, İZMİR
28Cankiri State Hospital, ÇANKIRI
29Ondokuz Mayis University Faculty of Medicine, SAMSUN
30Dokuz Eylul University Faculty of Medicine, İZMİR
31Gaziosmanpasa University Faculty of Medicine, TOKAT
32Kocaeli University Faculty of Medicine, KOCAELİ
33Diskapi ERH, ANKARA
34Taksim ERH, İSTANBUL
35Cumhuriyet University Faculty of Medicine, SİVAS
36Bozok University Faculty of Medicine, YOZGAT
37Inonu University Faculty of Medicine, MALATYA
38Trakya University Faculty of Medicine, EDİRNE, TURKEY
Keywords: Cervical Smear, Epithelial cell abnormality, Turkey

Objective: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories.

Material and Method: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire.

Results: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers.

Conclusion: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.


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