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Qualitative analysis of value judgments in interpreting cervicovaginal smears using the Bethesda system
L Workman1, M R Schwartz, L B McCullough
1Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA. lw691219@bcm.tmc.edu
Context:
We hypothesize that there are unrecognized value judgments that influence cytopathologists in interpreting borderline cervicovaginal smears and that these judgments contribute to the well-documented variation among cytopathologists regarding such diagnoses.
Objective:
To identify and map these values.
Design:
Survey consisting of Kodachromes and histories for 5 borderline smears. Respondents were asked to give their diagnoses, recommendations for treatment, and reasoning.
Results:
We demonstrated a wide variation in interpretation of borderline smears similar to previous studies. We then used inductive qualitative analysis to identify the clinical reasoning and value judgments that influenced the responses.
Conclusions:
We mapped those diagnostic value judgments that should be used in evaluation borderline cases. We believe this map can be used to rigorously manage and standardize the use of such judgments.