Level of agreement and biopsy correlation using two‐ and three‐tier systems to grade cervical dyskaryosis

Abstract

At present, a three-tier system is used to grade cervical dyskaryosis in the UK, although the two-tier Bethesda system is used in the United States, and the British Society for Clinical Cytology has recommended that a two-tier system be implemented here. In this study, we have retrospectively re-graded 117 conventional cervical smears using both systems to determine the intra- and interobserver variation and compare the cytology grading in both systems with the final histology. The intra and interobserver agreement was moderate using both grading systems, but the agreement between cytology grade and final histology was poor in both the two- and three-tier systems, and slightly worse using two-tier grading. However, when each of the three histological categories is considered separately the two-tier system appears to work better. Therefore, changing the way in which cervical dyskaryosis is graded in the UK may result in poorer agreement between the cervical smear result and the final histological diagnosis if introduced without proper training, monitoring and assessment.

Standardized Interpretation of Chest Radiographs in Cases of Pediatric Pneumonia From the PERCH Study

“…Achieving standardization is important to provide confidence in the use of CXR results, including the interpretation of pneumonia etiology. Our results show measures of observer agreement for the detection of any consolidation that are consistent with other high-quality studies of childhood pneumonia [9, 13, 24], and similar to other subjective diagnostic tests, such as cervical cytopathology [25] and prostatic histopathology [26]. Our experience reaffirms findings that observer agreement is best for consolidation and poorest for findings of other infiltrate [3, 27].…”

Is This the End of the Line for the Moderate Dyskaryotic Smear?

“…Similar to the findings of Anderson et al [7], there was poor agreement between cytologists in addition to corresponding final histopathology results. In practice however, colposcopy as a diagnostic procedure has its limitations, and there is also variability in the reporting of histopathology which will in turn influence the accuracy of the corresponding result [17,18].…”

“…Although this is hoped to translate into improving the management of women with cytological abnormalities, concern remains about possible difficulties in implementation as well as changes to practice if introduced without training or qualification. Anderson et al [7] showed that agreement between cytology grade and final histology was poor using the 2-tier system and slightly worse than when the usual 3-tier system was used. Similarly, in our study, there were discrepancies between the cervical cytology and final histology when 100 moderate smears were regraded into low-grade and high-grade dyskaryosis by 2 independent cytologists.…”

Validity and Reliability of Using a Self-Lavaging Device for Cytology and HPV Testing for Cervical Cancer Screening: Findings from a Pilot Study

“…Agreement for cervical cytology with clinician-collected specimens also tend to be low; one study reported kappas of 0.26 to 0.40 among six cytologists reading the same 70 slides for specimen adequacy alone [22]. Another study of 117 abnormal slides, found kappas of 0.39 to 0.57 among seven cytologists, depending on classification system used [23]. The fairly low kappa in this study may be an indicator of low reliability for cervical cytology in general rather than low reliability from using the Screener specimen, although a larger study is needed to ensure that high grade cases are not systematically missed.…”