Reproducibility of diagnostic criteria associated with atypical breast cytology

Weigner, Julie; Zardawi, Ibrahim M.; Braye, Stephen; McElduff, Patrick

doi:10.1111/cyt.12496

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…1 They used j index and reported that the interobserver agreement was poor for all criteria except tubules which performed badly also, the intraobserver variability for the two cytologists showed that one cytologist achieved moderate intraobserver agreement for all the criteria except cohesion which was poor, whilst the second cytologist showed poor agreement for all criteria. The purpose of the authors was to assess the interobserver and intraobserver variability when identifying the cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment.…”

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confidence: 99%

Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

Naderi

Sabour

2018

Cytopathology

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We were interested to read the paper by Weigner J et al 1 published in the February 2018 issue of Cytopathology. The purpose of the authors was to assess the interobserver and intraobserver variability when identifying the cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment. 1 They used j index and reported that the interobserver agreement was poor for all criteria except tubules which performed badly also, the intraobserver variability for the two cytologists showed that one cytologist achieved moderate intraobserver agreement for all the criteria except cohesion which was poor, whilst the second cytologist showed poor agreement for all criteria. 1 First, it is crucial to know that there is no value of j that can be regarded universally as an indication of good agreement. Two important weaknesses of j value to assess agreement of a qualitative variable are as follows: it depends upon the prevalence in each category, which means it can be possible to have different j value having the same percentage for both concordant and discordant cells! Table 1 shows that in both (a) and (b) situations, the prevalence of concordant cells is 80% and discordant cells is 20%; however, we get different j value (.38 and .60), respectively. j value also depends upon the number of categories. 2-6 Applying weighted j in such a situation is preferable giving us an unbiased result. [2][3][4][5] They concluded that interobserver and intraobserver variability remains a significant challenge for cytologists and despite attempts to define significant criteria associated with C3, good reproducibility could not be achieved. Such a sweeping conclusion may be a misleading message due to inappropriate use of statistical test. Briefly, for reliability analysis, appropriate tests should be applied with clinically relevant interpretation. 2-6 O R C I D S. Sabour 1. Weigner J, Zardawi I, Braye S, McElduff P. Reproducibility of diagnostic criteria associated with atypical breast cytology. Cytopathology. 2018;29:28-34. 2. Szklo M, Nieto FJ. Epidemiology beyond the basics, 2nd edn. Manhattan, NY: Jones and Bartlett Publisher; 2007. 3. Sabour S. Reproducibility of endometrial cytology by the Osaki study group method: methodological issues. Cytopathology. 2017;28:441-442. 4. Sabour S. Reliability of immunocytochemistry and fluorescence in situ hybridization on fine-needle aspiration cytology samples of breast cancers: methodological issues. Diagn Cytopathol. 2016;44:1128-1129. 5. Sabour S. Reliability of the ASA physical status scale in clinical practice: methodological issues. Br J Anaesth. 2015;114:162-163. 6. Sabour S. Spinal instability neoplastic scale: methodologic issues to avoid misinterpretation. AJR Am J Roentgenol. 2015;204: W493.

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Section: Dear Editormentioning

confidence: 99%

Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

Naderi

Sabour

2018

Cytopathology

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“…ing cytological criteria associated with 'atypical' diagnoses. 56 Even in these cases, however, poor agreement values were observed for all criteria (presence of myoepithelial cells, cohesiveness, cystic background, papillary fragments and tubular structures), thereby highlighting the morphological complexity of this indeterminate category.…”

Section: Weigner Et Al Who Assessed Interobserver Variability In Iden...mentioning

confidence: 83%

Interobserver variability in cytopathology: How much do we agree?

Acanfora,

Carillo,

Dello Iacovo

et al. 2024

Cytopathology

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Interobserver variability remains a major challenge for cytopathologists despite the development of standardized reporting and classification systems. Indeed, whereas moderate‐to‐good interobserver agreement is generally achievable when the differential diagnosis between benign and malignant entities is straightforward, high levels of variability make the diagnostic interpretation of atypical and suspicious samples not consistent. This review explores the landscape of interobserver agreement in cytopathology across different anatomical sites.

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“…We thank Naderi and Sabour for their interest in our article . They question the statistical methodology we employed in our article.…”

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“…They question the statistical methodology we employed in our article. We would like to point out that the aim of our study was to assess interobserver and intraobserver variability when identifying the cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment …”

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Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

et al. 2018

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They question the statistical methodology we employed in our article. We would like to point out that the aim of our study was to assess interobserver and intraobserver variability when identifying the cytological criteria, which were found to have a statistically significant association with C3 within a workplace environment. 1 Previously, we identified and selected the most useful cytomorphological criteria to predict histological outcomes arising from the C3 reporting category. 2 We focused on five criteria for the intraobserver and interobserver study. Each participating cytologist attended a teaching session where the criteria were defined and examples shown. For ease of use and data collection, a worksheet was devised with yes/no answers for the participants to record their results. Their responses were then entered into a database. The recorded information included the presence or absence of myoepithelial cells/bare bipolar nuclei, cohesiveness, cystic background, tubules, and papillary fragments.First, it should be pointed out that a weighted j does not address the issue that Naderi and Sabour are attempting to make regarding what they claim is a weakness of the unweighted j; that is, a weighted j will still give different values when the level of agreement is fixed but the prevalence is differentin the same way that the j does. If fact, this is the strength of the j in that it takes into account the level of agreement you would expect by chance, as Cohen stated in his 1960 paper. 3 Second, a weighted j will give the same value as an unweighted j when there are only two categories for each variable. In our data, all criteria/variables only had two categories (presence or absence of the selected criteria). Furthermore, weighted j is applicable when there is order to the categories which is not the case in our study. 4 It is also difficult to decide which weight to use when applying weighted j and the most appropriate weights to use is not often subjective. Therefore, we still consider that the j statistic was the most appropriate method to apply in our situation. The methodology used for this study was intended to assess the observer variability in recognising select criteria whilst working in a typical laboratory environment. The statistical appraisal of the data supports the subjective nature of FNA breast cytology and highlights the complex decisionmaking process when providing clinically relevant interpretation of cytological samples. O R C I D J. Weigner 1. Weigner J, Zardawi I, Braye S, McElduff P. Reproducibility of diagnostic criteria associated with atypical breast cytology. Cytopathology.

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Reproducibility of diagnostic criteria associated with atypical breast cytology

Cited by 3 publications

References 29 publications

Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

Interobserver variability in cytopathology: How much do we agree?

Reproducibility of diagnostic criteria associated with atypical breast cytology: A methodological issue

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