SUMMARY The theoretical and practical reasons for replacing the terms "cervical dysplasia" and "cervical carcinoma in situ" by the single diagnostic entity of "cervical intraepithelial neoplasia" are reviewed and the advantages and drawbacks of this newer terminology discussed. The histological characteristics and cytological features of the various grades of cervical intraepithelial neoplasia are described and the differential diagnosis of this lesion is considered.
SYNOPSIS From surveys conducted by the authors it is concluded that the best and most acceptable quality control methods in cytology are those from within the laboratory. Most Table I demonstrates not only the wide scatter of results presented in the literature but also the range of lesions being assessed, the various methods of sample collection, and the very wide variety of methods used to calculate the results. All this makes comparisons difficult. False negative rates are usually underestimated because they are only discovered when abnormal histology or an abnormal smear follows a previous negative smear. The mobility of populations and failure of follow up can prevent this information reaching the laboratory which put out the false negative report and so prevent complete accuracy when false negative rates are circulated. It is only when a second smear is taken as in the Christie Hospital series that the resulting figures are a true measure of the false negative rate. Errors can occur at all stages and these will be considered under the following headings: (1) biological variability; (2) collection of samples
No abstract
SUMMARY A cluster of five self selected cytodiagnostic laboratories circulated 70 cervical/vaginal smears and 50 sputum smears in a series of five week cycles. Histological sections related to the abnormal smears were also circulated. Proportions of agreement and disagreement were analysed for cervical and sputum smear reports against the original report (and by implication against the consensus); corresponding calculations were made for the histological reports. Cytological and histological correlation was also examined.Agreement for major categories (benign, intraepithelial neoplasia, malignant) was 87% for cervical cytology and 83% for sputum. When the effect of potential random agreement was compensated for by the use of kappa statistics the values of kappa were +0*79 and +0 65, respectively. The corresponding kappa values for gynaecological and respiratory tract histology were +0-78 and +0-82, respectively. Agreement on finer degrees of abnormality was, predictably, less good.Problems arising in this pilot scheme are discussed and suggestions for a simplified scheme are made.To devise an external quality assessment system for cytology analogous to those in other pathology disciplines such as clinical chemistry or haematology is not easy.' 2 The main problem is not, as is often asserted, the difficulty of comparing qualitative as opposed to quantitative results because this also applies in microbiology, where the problem has been solved.3 Nor is it the problem of comparing interpretive opinions where there is no absolute standard of correctness; kappa statistics can be applied to analyse interobserver variation in pattern recognition4 5 and these have been applied satisfactorily in histological observer studies.6 ' The unique difficulty in cytopathology is that it is not possible to produce identical clinical specimens for simultaneous examination by different laboratories.The only solution to this problem is
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