Variations in interpretation of gynecologic cytology photomicrographs

This was a study of variations in interpretations of photomicrographs of gynecologic cytology specimens. Two photomicrographs from each of 20 gynecologic cytology specimens were examined by 10 cytotechnologists and 10 pathologists. In only two cases was there agreement among all participants regarding the primary entity illustrated. The greatest agreement in interpretation was for benign entities such as repair reaction, koilocytotic changes, benign endocervical cells, and herpes simplex. There was little uniformity in the recognition of intraepithelial neoplasia and invasive carcinoma, or these lesions are difficult to illustrate using photomicrographs. Most abnormal cases were identified at least as atypical, but in many cases the range of responses was great -- for example, atypical squamous metaplasia to squamous carcinoma. There was more uniformity among cytotechnologists than pathologists in the recognition of the cytologic entities presented. The results of this study illustrate the difficulty of selecting photomicrographs for testing purposes and the lack of uniformity in the interpretation of such photomicrographs.