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Interlaboratory reproducibility in reporting inadequate cervical smears--a multicentre multinational study
S Ciatto1, M P Cariaggi, A P Minuti
1Centro per lo Studio e la Prevenzione Oncologica, Firenze, Italy.
Summary
Cytologist agreement is high for identifying inadequate vaginal smears but poor for suboptimal smears. Standardized criteria are needed for reporting suboptimal smear quality.
Area of Science:
- Cytopathology
- Gynecologic Pathology
Background:
- Vaginal smear quality assessment is crucial for accurate cervical cancer screening.
- Inter-laboratory variation in smear quality reporting necessitates standardized criteria.
Purpose of the Study:
- To evaluate inter-cytologist agreement on classifying vaginal smears as inadequate or suboptimal.
- To assess the reliability of 'inadequate' and 'suboptimal' smear rates for quality comparison.
Main Methods:
- 300 vaginal smears were interpreted by 13 cytologists across six European laboratories.
- Smears were seeded to achieve approximately 10% inadequate and 20% suboptimal rates.
- Agreement was assessed using majority reporting and Kappa statistics.
Main Results:
- 76.7% of smears were adequate, 14.3% inadequate, and 9.0% suboptimal by majority report.
- High agreement (Kappa) was observed for reporting inadequate smears.
- Agreement was poor for reporting suboptimal smears among most cytologists.
Conclusions:
- 'Inadequate smear' rates are reliable for inter-laboratory quality comparison due to high agreement.
- Current criteria for 'suboptimal smears' lack precision, hindering reliable quality assessment.
- Development of precise reporting criteria is essential for the consistent evaluation of suboptimal smears.