醫療人員執行採樣之抹片品質、陽性率及準確度之差異評估

Evaluation of Pap Smear Quality, Positive Rate and Accuracy among Different Smear Takers

目的：擬評估不同採樣醫療人員所作抹片的採樣品質、陽性率及準確度的差異性。方法：收集台灣東部某醫學中心病理機構的抹片判讀資料，共31,339份；以及1,236件個案在抹片採檢日後一年內對應病理切片追蹤結果。將癌篩抹片登記判讀結果與切片判讀結果重新簡化分類後，分析不同採樣人員所執行採樣的抹片，其抹片品質與陽性率之差異，及其對於準確度的可能影響。結果：品質尚可與品質良好之抹片，分佔所有抹片的16.9%與82.26%。品質尚可之抹片中，有44.34%的案例無子宮內頸成份。將品質尚可的抹片分為有或無子宮內頸成份組兩相比較時，前者陽性率是後者的8.92倍，足見無子宮內頸成份顯著影響抹片的陽性率。在公衛護士採檢的抹片中，品質良好所佔比例低於全國平均值(68.62% vs. 74.4%)，品質尚可者有62.93%的案例無子宮內頸成份。此外，本研究案例之陽性個案追蹤率僅47.37%，遠低於國內平均值(93.8%)。結論：本研究結果顯示，家庭醫學科醫師與婦產科醫師的採檢品質相當，但公衛護士抹片採檢技術方面的訓練可再加強。

Purpose: This study investigated cervical Pap smears of different health care professionals with regard to the adequacy of specimens, diagnostic yield, and accuracy. Methods: We examined the correlation between 31,339 registered and interpreted Pap smears from one pathology laboratory in a medical center in eastern Taiwan and 1236 corresponding histopathological biopsy reports from an electronic cancer registry database within one year of these smears. For analytic purposes and to facilitate comparison, we grouped together cytological interpretations and pathological diagnoses. We compared the rate of positive smears taken by different health care professionals and specimen quality. Results: In our database, 16.9% of smears were suboptimal (with presence of limiting factors) and 82.3% were satisfactory. Among the suboptimal smears, 44.3% were compromised by the lack of an endocervical component. The positive rate of suboptimal smears with an endocervical component is 8.92-fold greater than those without the endocervical component. This confirms the importance of the endocervical component in diagnostic yield. The satisfactory rate of cervical smears taken by public health nurses is 68.62%, lower than the national average of 74.4%. Furthermore, 62.9% of the suboptimal smears taken by public health nurses did not have an endocervical component. The case tracking rate among positive smears is 47.4%, considerably lower than the national average (93.8%). Conclusions: Further training and quality control should be provided to public health nurses, especially with regard to Pap smear techniques and the need to include an endocervical component.