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Interobserver variability of cervical smears with squamous-cell abnormalities: a Philadelphia study
N A Young1, S Naryshkin, B F Atkinson
1Department of Pathology, Hahnemann University, Philadelphia, PA 19102.
Diagnostic Cytopathology
|December 1, 1994
Summary
The Bethesda System (TBS) for reporting Pap smear results shows subjectivity in classifying squamous lesions. Expert cytopathologists exhibited significant disagreement, impacting reproducibility in proficiency testing.
Area of Science:
- Cytopathology
- Gynecologic Pathology
- Diagnostic Accuracy
Background:
- The Bethesda System (TBS) is crucial for standardizing Pap smear reports.
- Reproducibility in classifying squamous lesions is essential for reliable cytologic diagnoses.
Purpose of the Study:
- To evaluate the inter-observer reproducibility of squamous lesion classification using The Bethesda System.
- To identify the extent of diagnostic discrepancies among expert cytopathologists.
Main Methods:
- Twenty slides with varying squamous lesion morphologies were distributed to five expert cytopathologists.
- Participants classified slides according to The Bethesda System criteria.
- Agreement and disagreement levels were analyzed, including discrepancies within and across diagnostic categories.
Main Results:
- Unanimous agreement was achieved in only 35% (7/20) of cases.
- 35% (7/20) of cases showed disagreement within one diagnostic category.
- 30% (6/20) of cases had disagreements spanning more than one category.
- Written comments often mitigated the clinical impact of diagnostic discrepancies.
Conclusions:
- Significant subjectivity exists in classifying squamous abnormalities lacking classic morphology under The Bethesda System.
- The observed lack of reproducibility highlights challenges in cytopathology proficiency testing.
- Standardization efforts must account for inherent subjectivity in interpreting borderline cases.