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Variation in the assessment of adequacy in cervical smears
G Migliore1, E Rossi, A Aldovini
1Laboratory of Epidemiology and Biostatistics, Cytopathology Unit, National Institute of Health, Rome, Italy.
Insights
This study on cervical smear adequacy found high interobserver reproducibility among expert cytologists using the Bethesda System. Consistent assessment of smear adequacy is achievable with strict adherence to established criteria.
Area of Science:
- Cytopathology
- Gynecologic Pathology
- Diagnostic Accuracy
Background:
- The Bethesda System for Reporting Cervical Cytology (TBS-RC) provides standardized criteria for evaluating cervical smears.
- Assessing the adequacy of cervical smears is crucial for reliable interpretation and patient management.
- Interobserver variability in smear adequacy assessment can impact diagnostic quality.
Purpose of the Study:
- To evaluate the interobserver reproducibility of cervical smear adequacy diagnoses.
- To assess adherence to The Bethesda System criteria among cytologists.
- To determine the reliability of different adequacy categories.
Main Methods:
- 358 cervical smears from three Italian centers were independently and blindly reviewed by four cytologists.
- Smears were assessed using standard microscopy (10x objective) and cellularity evaluation (4x objective).
- The Bethesda System criteria were applied for adequacy assessment.
Main Results:
- Proportions of 'adequate' smears ranged from 60-70%, 'satisfactory but limited' from 27-38%, and 'inadequate' from 2-4%.
- Full agreement was reached on 311 slides (86.9%), with disagreement on 47 slides.
- The 'inadequate smear' category showed lower reliability, though overall kappa values were acceptable.
Conclusions:
- High interobserver reproducibility in assessing cervical smear adequacy is achievable.
- Strict adherence to The Bethesda System criteria by expert cytologists enhances reproducibility.
- Standardized criteria contribute to reliable diagnostic outcomes in cervical cytology.
Objective:
To assess the interobserver reproducibility of the diagnosis of 'adequacy' of cervical smears according to the Bethesda System criteria in cervical smears.
Study Design:
358 cervical smears were obtained from three Italian cytopathological centres in 1998-99. All centres provided consecutively collected smears. The cervical smears were independently and blindly assessed by four cytologists. The screening was performed using a 10x objective and an additional evaluation of the percentage of cellularity was performed using a 4x objective.
Results:
The proportion of smears assessed by the four cytologists as 'adequate' ranged from 60% to 70%, the proportion of 'satisfactory for evaluation but limited by' ranged from 27% to 38%, and the proportion of 'inadequate smears' ranged from 2% to 4%. Full agreement in the assessment of smear adequacy was observed in 311 slides and disagreement was observed only in 47. The category 'inadequate smear' was less reliable than the other two; however, the kappa value observed was acceptable.
Conclusion:
The present study shows that it is possible to achieve a high reproducibility in the assessment of smear adequacy, at least among expert cytologists who follow the Bethesda System criteria strictly.
