Review of the Bethesda System atlas does not improve reproducibility or accuracy in the classification of atypical squamous cells of undetermined significance smears

Smith, Ann E.; Sherman, Mark E.; Scott, David; Tabbara, Sana O.; Dworkin, Lawrence; Olson, June; Thompson, J.; Faser, Christine; Snell, Joy; Schiffman, Mark

doi:10.1002/1097-0142(20000825)90:4<201::aid-cncr1>3.0.co;2-q

Cited by 38 publications

(25 citation statements)

References 16 publications

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“…In a more recent study using the same set of smears from the previous study, the authors reported that a review of the Bethesda System atlas did not improve interobserver reproducibility. 12 In the current study, the overall interobserver agreement in diagnosing gynecologic cytology was good for conventional cervical smears. Our results were better than those reported previously in the literature.…”

Section: Discussionsupporting

confidence: 48%

Interobserver variability

Chhieng

Talley

Roberson

et al. 2002

Cancer

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Section: Discussionsupporting

confidence: 48%

Interobserver variability

Chhieng

Talley

Roberson

et al. 2002

Cancer

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“…14,15 This assessment is highly subjective. 16 In a formal interobserver reproducibility study of 200 slides initially classified as "squamous atypia, " there was not a single slide in which the interpretation of ASCUS was unanimously confirmed, demonstrating that this interpretation is highly subjective and irreproducible. 17 Clearly, interobserver agreement between individual pathologists working in different countries is expected to vary even more than among pathologists within countries, because inherent interpretative variation is further compromised by differences in terminology and clinical practices.…”

Section: Resultsmentioning

confidence: 99%

Use of human papillomavirus DNA testing to compare equivocal cervical cytologic interpretations in the United States, Scandinavia, and the United Kingdom

Scott

Hagmar²,

Maddox³

et al. 2002

Cancer

Self Cite

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“…In one article, investigators stated that study of written criteria and review of a teaching slide set improved reliability in the diagnosis of proliferative breast lesions. 29 However, Smith et al 30 reported that group study sessions using the Bethesda System atlas did not appear to improve reproducibility for cervical ASCUS smears. The Bethesda System gives precise criteria for cytology categories, including ASCUS, and it may not be possible to improve classification of cervical lesions any further based on morphology alone.…”

Section: Discussionmentioning

confidence: 99%

Interobserver agreement in the interpretation of anal intraepithelial neoplasia

Lytwyn

Salit

Raboud

et al. 2005

Cancer

111

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BACKGROUNDAnal carcinoma incidence is increasing, and is highest among men with human immunodeficiency virus (HIV) infection who have sex with men. Anal carcinoma and anal intraepithelial neoplasia (AIN) are ascertained on tissue histology, but requires invasive procedures. Screening for AIN using anal cytology was suggested. The authors evaluated agreement on cytologic and biopsy specimens from HIV‐positive men undergoing anal carcinoma screening.METHODSOne hundred twenty‐nine HIV‐positive men with a history of anal‐receptive intercourse underwent anal cytology, anoscopy, and biopsy. Four pathologists independently assessed cytology and biopsy specimens and reached consensus for discordant cases.RESULTSEach pathologist evaluated 120 cytology and 155 biopsy specimens. The weighted kappa value for overall agreement was 0.54 (95% confidence interval [CI], 0.49–0.59) for cytology specimens and 0.59 (95%CI, 0.55–0.63) for biopsy specimens. The median kappa values for pairwise agreement among pathologists and for agreement with consensus were, respectively, 0.69 and 0.77 for cytology and 0.66 and 0.75 for biopsy. At least 3 pathologists were in agreement for 92 (76.7%) cytology and 134 (86.5%) biopsy specimens. Reliability for the Bethesda classification system was at least moderate, except for the cytologic category of atypical squamous cells of undetermined significance (kappa = 0.12). Fourteen of 29 (48.3%) cytology specimens and 36 of 47 (76.6%) biopsy specimens with consensus interpretation of high‐grade squamous intraepithelial lesions (HSIL) were interpreted originally as HSIL by ≥ 3 pathologists. The kappa value for agreement with consensus distinguishing HSIL from non‐HSIL ranged from 0.55 to 0.88 for cytology specimens and from 0.76 to 0.94 for biopsy specimens.CONCLUSIONSAgreement for cytologic and biopsy interpretations was generally at least moderate. Nevertheless, these results supported the need for disease indicators with greater reliabililty. Cancer 2005. © 2005 American Cancer Society.

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Review of the Bethesda System atlas does not improve reproducibility or accuracy in the classification of atypical squamous cells of undetermined significance smears

Cited by 38 publications

References 16 publications

Interobserver variability

Interobserver variability

Use of human papillomavirus DNA testing to compare equivocal cervical cytologic interpretations in the United States, Scandinavia, and the United Kingdom

Interobserver agreement in the interpretation of anal intraepithelial neoplasia

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