Cervical Pap Smear Cytology at Kamuzu Central Hospital in Malawi: A Quality Assurance Study

Abstract

Abstract 53 Background: Cervical cancer remains the most common cancer in women of the developing world, largely as a result of a lack of screening. The gold standard screening test for cervical cancer, the Pap smear, has been effective in reducing cervical cancer incidence and mortality by identifying precancerous and cancerous lesions; however, little is known about quality assurance practices for gynecologic cytopathology in resource-limited settings. The goal of this study was to document baseline clinical and laboratory characteristics in the hope of improving the efficacy of cervical cancer screening and informing future quality improvement initiatives. Methods: A retrospective study of cervical cytology at Kamuzu Central Hospital, Malawi, from January 1, 2013, to April 30, 2016, was conducted. Results: Of 2,809 Pap smears processed, 2,396 (85.3%) samples were diagnostic, with 92.3% of nondiagnostic smears (381 of 413) deemed unsatisfactory because of improper collection techniques. The 18-month patient follow-up rate for unsatisfactory Pap smear was found to be 23.0% (n = 95), with repeat smears reflecting a similar satisfactory rate (n = 82; 86%). Of diagnostic Pap smears, 6.1% (n = 147) were premalignant, whereas 2.0% (n = 48) were malignant. Cytology-histology correlation was also investigated one the basis of the corresponding samples collected concurrently. Of 70 pairs, 55 pairs (78.6%) were concordant, whereas six (8.6%) and nine (12.9%) were majorly and minorly discordant, respectively. The sensitivity and specificity of the Pap smear as a screening test were 83.8% and 81.8%, respectively. Conclusion: The Pap smear is a sensitive and specific screening method for cervical cancer in our setting. We hope that documentation of baseline quality and services of cervical cytology will inform future quality assurance programs and assist other laboratories in the development of similar programs in resource-limited settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Daniel Liauw No relationship to disclose Bal Mukunda Dhungel No relationship to disclose Tamiwe Tomoka No relationship to disclose Robert Krysiak No relationship to disclose Coxcilly Kampani No relationship to disclose Fred Chimzimu No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Consulting or Advisory Role: Alexion Pharmaceuticals