Archives of Pathology & Laboratory Medicine · 2003 · 56 citations · 25 references
MedicineGynecologyPathologyCytopathologyDiagnostic PathologySurgical PathologyCervical CytologyCervicovaginal CytologyGynecologic CytologyGynecologic PathologyCervical Squamous LesionsCumulative Frequency DistributionsCytology-histology CorrelationDiagnostic Categories In CytologyGynecologic CytopathologyPositive Predictive ValuePositive Predictive Value AnalysisPrecision
Cytologic interpretation accuracy has been studied, but its reproducibility remains poorly defined. The study aims to assess and compare the reproducibility of gynecologic cytology interpretations within the College of American Pathologists Interlaboratory Comparison Program. The authors analyzed 40,098 PAP slide responses from 2001, calculated exact match rates between reference and pathologist interpretations, generated cumulative distributions, and applied χ² tests to compare reproducibility across diagnostic categories and HSIL versus LSIL. Interpretations of negative, infectious, and LSIL lesions showed high reproducibility, whereas HSIL, adenocarcinoma, and squamous cell carcinoma had lower exact match rates, and HSIL was significantly less reproducible than LSIL, suggesting LSIL may be a more appropriate endpoint for measuring laboratory precision.
Abstract Context.—Numerous studies address the accuracy or positive predictive value of cytologic interpretations for defined histopathologic entities. The reproducibility (precision) of cytologic interpretation is less well defined. Objective.—To establish and compare the reproducibility (precision) of cytologic interpretation in gynecologic cytopathology, as reflected in the educational program of the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology (PAP). Methods.—The pathologists' interpretations for both validated (25 745 responses) and educational conventional (14 353 responses) slides in the PAP program for 2001 were analyzed. The frequency of exact matches between the reference and pathologists' interpretation for each of the cytologic interpretative categories was identified, and the cumulative distributions of exact match rates were derived. χ2 Tests by reference interpretations were used for cytodiagnostic categories, least and most reproducible groupings, and high-grade (HSIL) versus low-grade (LSIL) squamous intraepithelial lesions. Results.—Pathologists' interpretations of negative, Candida, Trichomonas, herpes, and LSIL were characterized by a high degree of exact matching, while interpretations of repair, HSIL, adenocarcinoma, and squamous cell carcinomas were characterized by a lesser degree of exact matching (reproducibility). Pathologists' cytologic interpretations of HSIL were significantly less reproducible than those of LSIL. Conclusion.—The cytologic interpretations of the most significant categories (HSIL, squamous cell carcinoma, and adenocarcinoma) are less precise than those of specific infection (Candida, Trichomonas, and yeast), negative, and LSIL categories. Cytologic interpretations of LSIL are made with greater precision than those of HSIL and may represent a more appropriate endpoint to measure the precision performance of gynecologic cytology laboratories.
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Biostatistics: A Methodology for the Health Sciences.
L. D. Fisher, G. Van Belle · Biometrics · 1997 · 133 citations