Ziol M, Vacher-Lavenu M C, Heudes D, Ferrand J, Mayelo V, Molinié V, Slama S, Marsan C
Department of Pathology, Hôpital Jean Verdier, Bondy, France.
Anal Quant Cytol Histol. 1999 Feb;21(1):35-41.
To evaluate the diagnostic accuracy of videomicroscopy image selection for expert consultation in cervical cytology.
One hundred diagnostically difficult cervical cytologic smears were selected and rescreened by a general pathologist who chose, from each slide, four or five fields featuring abnormal cells. Video images were digitized and stored on a 512 x 512-pixel matrix using an image acquisition and transmission system. Five experts each reviewed 20 of the 100 cases, and a sixth reviewed all 100 cases. Diagnoses based on selected digitized images were compared to those based on conventional examination of whole slides.
Intraobserver agreement was fair to excellent for all six experts (kappa value: 0.47-0.81); it was complete or acceptable in 68.4-85% of cases. Compared to the reference diagnosis, interobserver agreement was not significantly different whether cases were examined by screening the entire slide or by videomicroscopy of selected fields. The marked discordance in four cases concerned very small cells the significance of which was misinterpreted on videomicroscopy because of poor image quality due to lack of focus setting.
This exploratory study showed that selection of videomicroscopy images seems as reliable as conventional examination of slides for expert consultation on diagnostically difficult cervical cytologic smear cases.
评估用于宫颈细胞学专家会诊的视频显微镜图像选择的诊断准确性。
选择100例诊断困难的宫颈细胞学涂片，由一名普通病理学家重新筛查，该病理学家从每张载玻片中选择四五个有异常细胞的视野。使用图像采集和传输系统将视频图像数字化并存储在512×512像素矩阵上。五位专家每人审查了100例病例中的20例，第六位专家审查了所有100例病例。将基于所选数字化图像的诊断与基于全玻片常规检查的诊断进行比较。
所有六位专家的观察者内一致性为中等至优秀（kappa值：0.47 - 0.81）；在68.4% - 85%的病例中完全或可接受。与参考诊断相比，无论通过筛查整张玻片还是通过所选视野的视频显微镜检查病例，观察者间一致性均无显著差异。四例明显不一致的情况涉及非常小的细胞，由于聚焦设置不佳导致图像质量差，在视频显微镜检查中对其意义的解读有误。
这项探索性研究表明，对于诊断困难的宫颈细胞学涂片病例的专家会诊，视频显微镜图像选择似乎与玻片的常规检查一样可靠。
