Atypical Glandular Cells: Interobserver Variability according to Clinical Management

2018 ◽  
Vol 62 (5-6) ◽  
pp. 397-404 ◽  
Author(s):  
Marcos Lepe ◽  
Claire M. Eklund ◽  
M. Ruhul Quddus ◽  
Cherie Paquette
Keyword(s):  
Clinical Management ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
Diagnostic Uncertainty ◽  
Diagnostic Categories ◽  
Atypical Cells ◽  
Glandular Cells ◽  
Atypical Glandular Cells ◽  
Bethesda System

Objective: The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aids in classification of atypical cells in cervical cytology. There is limited literature regarding reproducibility and interobserver variability in the application of the 2014 AGC criteria. Our aim is to assess the interobserver variability of AGC with a focus on how diagnostic categories link with guideline-driven management. Study Design: Three observers re-reviewed 51 previously diagnosed AGC Papanicolaou tests. The diagnoses were categorized as follows: (1) according to guideline-specified management, and (2) as glandular vs. squamous lesions. The κ statistic was used to evaluate interobserver agreement. Results: The interobserver variability per guideline management by weighted 2-observer κ ranged from 0.009 to 0.530, with half of the interobserver pairings meeting the threshold for at least fair-moderate agreement. For categorization as glandular, squamous, or both, unweighted κ yielded at best fair interobserver agreement (κ = 0.250) in 1 pairing, with low κ scores in the remainder of reviewer pairs (range 0.015–0.152). Conclusions: There is significant interobserver variability in the diagnosis of AGC. The AGC cases when divided by clinical management had fair-moderate interobserver agreement, suggesting that diagnostic variability likely has a real effect on patient care. This diagnostic uncertainty should be understood by cytologists and clinicians.

Incidence of Atypical Glandular Cells of Uncertain Significance in Cervical Cytology Following Introduction of the Bethesda System

1997 ◽  
Vol 67 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Gary L. Eddy ◽  
Serdar H. Ural ◽  
Kenneth B. Strumpf ◽  
Martha A. Wojtowycz ◽  
Pamela S. Piraino ◽  
...  
Keyword(s):  
Cervical Cytology ◽  
Uncertain Significance ◽  
Glandular Cells ◽  
Atypical Glandular Cells ◽  
Bethesda System ◽  
The Bethesda System

scholarly journals Bethesda System Reporting Rates for Conventional Papanicolaou Tests and Liquid-Based Cytology in a Large Chinese, College of American Pathologists–Certified Independent Medical Laboratory: Analysis of 1 394 389 Papanicolaou Test Reports

2015 ◽  
Vol 139 (3) ◽  
pp. 373-377 ◽  
Author(s):  
Baowen Zheng ◽  
R. Marshall Austin ◽  
Xiaoman Liang ◽  
Zaibo Li ◽  
Congde Chen ◽  
...  
Keyword(s):  
Medical Laboratory ◽  
Papanicolaou Test ◽  
Test Methodology ◽  
Glandular Cells ◽  
Atypical Glandular Cells ◽  
International College ◽  
Bethesda System ◽  
Liquid Based Cytology ◽  
The Bethesda System ◽  
Reporting Rates

Context Reports that use the Bethesda System categories for Chinese Papanicolaou test results are rare. Objective To document and analyze rates reported in the Bethesda System for conventional Papanicolaou tests and liquid-based cytology between 2007 and 2012 in China's largest College of American Pathologists–accredited laboratory. Design Results from 1 394 389 Papanicolaou tests, rendered between 2007 and 2012 by the Guangzhou Kingmed Diagnostics Cytology Laboratory, were documented by the Bethesda System report categories and Papanicolaou test methodology, which included both conventional Papanicolaou tests and 4 different liquid-based cytology preparations. Results Results were documented for 326 297 conventional Papanicolaou tests and 1 068 092 liquid-based cytology specimens, which included 928 884 ThinPrep (Hologic, Bedford, Massachusetts), 63 465 SurePath (BD Diagnostics, Franklin Lakes, New Jersey), 50 422 Liqui-Prep (LGM International, Melbourne, Florida), and 25 321 Lituo liquid-cytology (Lituo Biotechnology Co, Hunan, China) specimens. Abnormality rates reported were significantly higher with liquid-based cytology than they were with conventional Papanicolaou tests in all the Bethesda System categories (P < .001). Reporting rates were within the 2006 benchmark ranges from the College of American Pathologists, except for atypical glandular cells (low) and unsatisfactory rates for conventional Papanicolaou tests (low). Conclusion Participation in the international College of American Pathologists Laboratory Accreditation Program provides laboratory quality standards not otherwise available in many international settings.

Interobserver variability in assessing dysplasia and architecture in colorectal adenomas: a multicentre Canadian study

2014 ◽  
Vol 67 (9) ◽  
pp. 781-786 ◽  
Author(s):  
Allison Osmond ◽  
Hector Li-Chang ◽  
Richard Kirsch ◽  
Dimitrios Divaris ◽  
Vincent Falck ◽  
...  
Keyword(s):  
Power Analysis ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
A Priori ◽  
Colorectal Adenomas ◽  
Canadian Study ◽  
National Guidelines ◽  
A Priori Power Analysis ◽  
Whole Slide Images

AimsFollowing the introduction of colorectal cancer screening programmes throughout Canada, it became necessary to standardise the diagnosis of colorectal adenomas. Canadian guidelines for standardised reporting of adenomas were developed in 2011. The aims of the present study were (a) to assess interobserver variability in the classification of dysplasia and architecture in adenomas and (b) to determine if interobserver variability could be improved by the adoption of criteria specified in the national guidelines.MethodsAn a priori power analysis was used to determine an adequate number of cases and participants. Twelve pathologists independently classified 40 whole-slide images of adenomas according to architecture and dysplasia grade. Following a wash-out period, participants were provided with the national guidelines and asked to reclassify the study set.ResultsAt baseline, there was moderate interobserver agreement for architecture (K=0.4700; 95% CI 0.4427 to 0.4972) and dysplasia grade (K=0.5680; 95% CI 0.5299 to 0.6062). Following distribution of the guidelines, there was improved interobserver agreement in assessing architecture (K=0.5403; 95% CI 0.5133 to 0.5674)). For dysplasia grade, overall interobserver agreement remained moderate but decreased significantly (K=0.4833; 95% CI 0.4452 to 0.5215). Half of the cases contained high-grade dysplasia (HGD). Two pathologists diagnosed HGD in ≥75% of cases.ConclusionsThe improvement in interobserver agreement in classifying adenoma architecture suggests that national guidelines can be useful in disseminating knowledge, however, the variability in the diagnosis of HGD, even following guideline review suggests the need for ongoing knowledge-transfer exercises.

scholarly journals Low reproducibility of equivocal categories of the Bethesda System for Reporting Thyroid Cytology makes the associated risk of malignancy specific to the diagnostic center

Endocrine ◽  
2021 ◽  
Author(s):  
Dorota Słowińska-Klencka ◽  
Mariusz Klencki ◽  
Joanna Duda-Szymańska ◽  
Jarosław Szwalski ◽  
Bożena Popowicz
Keyword(s):  
Interobserver Agreement ◽  
Histopathological Examination ◽  
Published Data ◽  
Thyroid Cytology ◽  
Diagnostic Center ◽  
Risk Of Malignancy ◽  
Estimated Risk ◽  
Bethesda System ◽  
The Bethesda System

Abstract Purpose Equivocal categories (III, IV, V) of the Bethesda System for Reporting Thyroid Cytology (BSRTC) are characterized by high variability of the estimated risk of malignancy. The aim of the study was to analyze the reproducibility of classification of nodules into an equivocal category and the frequency of malignancy (FoM) observed in such categories. Methods Five experienced cytopathologists from three centers (A, B, C) independently performed reclassification of smears obtained from 213 thyroid nodules with equivocal routine cytology and known results of the postoperative histopathological examination. Results The interobserver agreement among all cytopathologists was poor, with a Krippendorff’s alpha coefficient equaling 0.34. The intra-center agreement was higher than the inter-center (fair vs poor). Pathologists of the center A classified smears into categories II and III significantly less often and categories IV and V more often than pathologists of centers B and C. The joint FoM of nodules classified into any of categories IV–VI (regarded as an indication for surgery) was different among centers (A: 40.0%, B: 66.7%, C: 80.6%). The FoM of category III nodules with features of nuclear atypia (AUS) in center B and C was two times higher than that of other nodules of category III (FLUS), while in center A the FoM was similar. Conclusions The use of published data on the risk of malignancy in nodules of particular BSRTC categories without concern for the uniqueness of the diagnostic center may lead to erroneous conclusions.

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