Concordance in the Interpretation of Cervical Cytology for the Early Diagnosis of Cervical Cancer

Abstract

Objective: To identify the diagnostic concordance in the interpretation of cervical smears. Material and Methods: Cross-sectional study from October 2011 to January 2013. 50 samples were read by every 4 cyto-technologists who are the total staffs that read and interpret cytological specimens from a public health institution of the city of San Luis Potosí, México. The cytological diagnosis was confirmed by a certified pathologist. Checklist was developed to determine the quality of the interpretation composed of three sections: adequate sample, inadequate sample and cytological diagnosis. The diagnostic report was made by Bethesda System 2001 classification. Diagnostic concordance was measured through the Kappa coefficient. To establish the differences in cytological diagnosis between each cyto-technologist, chi square test was applied. Results: The concordance is acceptable in the classification of samples as inadequate (k = 0.66). The negative diagnosis was a significant concordance between each cytotechnologist and pathologist; however, no case had very good concordance. In the epithelial abnormalities, only the cytotechnologist 2 had significant concordance with the pathologist, however, its concordance is low. In the case of glandular abnormalities, only cytotechnologist 1 had no significant concordance with the pathologist. The percentage of true negatives was 30%, true positives 20%, false negatives 50% and false positives 0 %. There are significant differences between the readings of cyto-technologist 1 and 2 (p < 0.008), between 1 to 4 (p < 0.001), between 2 and 3 (p < 0.05), and finally between 3 and 4 (p < 0.003). Conclusions: The concordance between cyto-technologists and pathologists is below the required minimum level set by national and international standards.

Conventional Microscopical versus Digital Whole-Slide Imaging-Based Diagnosis of Thin-Layer Cervical Specimens: A Validation Study

“…To decrease these rates for CLM and for WSI by CT and pathologists, more practical training and education are needed. [ 20 30 31 32 33 ] Overall and compared to the published literature on the subject, 2 cohorts of approximately 500 cases each which were enriched for high-grade cases comprise the largest study group used in digital cytology so far. The results of our study allow to give directions for further steps to prepare the introduction of digital cytology as a routine diagnostic technique.…”

“…At the time of this writing, there were few published studies investigating the use of WSI in primary cytology diagnostics. [ 8 10 18 19 20 21 22 23 30 31 ] Steinberg and Ali achieved an accuracy of 98.3% comparing WSI with CLM examination by six participants of ten selected thin-layer cervical slides. [ 19 ] A next study investigated the accuracy of 24 experienced cytologists in the examination of WSI from 24 cervical thin-layer slides which appeared to be equal to glass slide microscopy when participants were able to focus through the full thickness of the slide.…”

<p>Histopathological Diagnosis of Cervical Biopsies: Reduction of Sampling Errors with the Evaluation of a Third Histologic Level</p>

“…It should be mentioned that, in the present study, the professionals who analyzed the biopsies (double blind) were certified pathologists; however, staff training should be considered 5 since, in some studies, such as the study conducted by Gutíerrez-Enríquez, 6 differences in cytological diagnosis between cytotechnologists and pathologists were evident. They found that, in their evaluations of epithelial abnormalities, only one of the cytotechnologists had significant concordance with the pathologists; however, the concordance was low.…”

“…The authors concluded that the concordance between cytotechnologists and pathologists is below the required minimum level set by national and international standards. 6…”

“…Nevertheless, certain methodological improvements have been suggested; previous studies have reported that the sensitivity of a histopathological study may increase by making a greater number of cuts at different levels in the paraffin block of the cervical biopsy. [4][5][6] Based on the above, the objective of this work was to determine the variation in a histopathological diagnosis 7,8 when examining three more levels in the paraffin blocks of biopsies from patients infected with Human Papillomavirus (HPVI), at different CIN and CC stages. The purpose was to obtain a more accurate diagnosis at a histopathological level by examining more levels in the biopsy paraffin blocks and comparing them with the initial diagnoses.…”