期刊
CANCER CYTOPATHOLOGY
卷 111, 期 1, 页码 15-25出版社
WILEY
DOI: 10.1002/cncr.22423
关键词
Bethesda System; cytology; cervix; screening; Internet; reproducibility
BACKGROUND. The Bethesda System (TBS) along with its companion atlas was updated in 2001 to improve standardization, clarity, and reproducibility of cervical cytology reporting. METHODS. The authors used a novel web-based format to compare assessments of 77 images demonstrating a range of classical and borderline cytologic changes by a self-selected group of United States cytotechnologists (n = 216) and pathologists (n = 185). RESULTS. Participants were highly experienced, with 71.2% of cytotechnologists and 53.0% of pathologists reporting > 10 years of practice. The mean percentage of exact agreement with the panel was slightly though significantly higher for cytotechnologists (57.0%) compared with pathologists (53.4%), adjusted for experience (P=.004); cervical cytology percentage effort (P=.0005); or cervical accession volume (P=.0002). Compared with the TBS panel, exact agreement was achieved for 55.1% of image ratings compared with 82.3% agreement at the level of Negative vs non-Negative for images with a single-panel interpretation. Agreement with the panel was highest for images classified as Low-Grade Squamous Intraepithelial Lesion and lowest for Atypical Squamous Cells qualified as either of Undetermined Significance or Cannot Exclude a High-Grade Squamous Intraepithelial Lesion. Reviewers were less sensitive in identifying high-grade glandular lesions than they were in identifying high-grade squamous lesions at any threshold (P <.001). CONCLUSIONS. Morphologic appearances of images were more important determinants than participants' academic or professional degrees with regard to inter-observer reproducibility in classifying cervical cytology images. Experienced cytotechnologists and pathologists performed similarly Participants achieved higher sensitivity for identifying high-grade squamous lesions than they did for high-grade glandular lesions. These findings demonstrated that web-based studies may be useful in assessing interobserver agreement in classifying images.
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