Gupta D K, Komaromy-Hiller G, Raab S S, Nath M E
Department of Pathology, Shadyside Hospital and University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
Acta Cytol. 2001 Sep-Oct;45(5):697-703. doi: 10.1159/000328290.
Interoberver variability has important implications for patient care, diagnostic error and medical litigation. In the management of any cervical epithelial abnormality, its biologic significance as well as diagnostic reproducibility is very important. Interobserver variability has not been measured adequately for metaplastic squamous lesions. We analyzed interobserver and intraobserver variability and diagnostic accuracy in the diagnosis of dysplastic metaplastic cells.
Sixty Pap smears from patients with abnormalities of metaplastic squamous cells of varying severity were selected from the files of Lankenau Hospital, Wynnewood, Pennsylvania, U.S.A., diagnosed between 1990 and 1996. These were reviewed by four observers with different levels of cytology experience. Each of the observers blindly and independently reviewed all Pap smears. Tabulated results were analyzed to determine interobserver and intraobserver variability and diagnostic accuracy.
Statistically significant interobserver reproducibility was found between both inexperienced observers as well as between observers 1 (experienced) and 3 (inexperienced) and between observers 2 (experienced) and 4 (inexperienced). The observed degree of agreement between both experienced observers (1 and 2) reflected random rating rather than reproducibility. There was no difference in interobserver reproducibility in low vs. high grade lesions. Intraobserver reproducibility had no significant correlation with experience of the observer. The sensitivity ranged from 0.69 to 0.97 (mean, 0.79), while the specificity ranged from 0.09 to 0.46 (mean, 0.30). Mean diagnostic accuracy was better in benign and low grade squamous intraepithelial lesions in comparison to high grade squamous intraepithelial lesions.
There was good interobserver agreement in classifying squamous metaplastic lesions. The agreement did not correlate with grade of dysplasia or experience of the cytopathologists. These findings should be considered in making treatment, quality assurance and legal decisions. A larger study is indicated to study interobserver and intraobserver variability and define cytologic criteria for lesions of metaplastic squamous cells.
观察者间的变异性对患者护理、诊断错误及医疗诉讼具有重要影响。在任何宫颈上皮异常的管理中，其生物学意义以及诊断的可重复性都非常重要。对于化生鳞状病变，观察者间的变异性尚未得到充分测量。我们分析了观察者间和观察者内的变异性以及发育异常化生细胞诊断的准确性。
从美国宾夕法尼亚州 Wynnewood 的兰肯瑙医院 1990 年至 1996 年间诊断的病例档案中，选取了 60 份来自不同严重程度化生鳞状细胞异常患者的巴氏涂片。由四名具有不同细胞学经验水平的观察者进行复查。每位观察者对所有巴氏涂片进行盲法且独立的复查。对列表结果进行分析，以确定观察者间和观察者内的变异性以及诊断准确性。
在经验不足的观察者之间、观察者 1（经验丰富）与观察者 3（经验不足）之间以及观察者 2（经验丰富）与观察者 4（经验不足）之间均发现了具有统计学意义的观察者间可重复性。两位经验丰富的观察者（1 和 2）之间观察到的一致程度反映的是随机评级而非可重复性。低级别与高级别病变的观察者间可重复性没有差异。观察者内可重复性与观察者的经验没有显著相关性。敏感性范围为 0.69 至 0.97（平均 0.79），而特异性范围为 0.09 至 0.46（平均 0.30）。与高级别鳞状上皮内病变相比；良性和低级别鳞状上皮内病变的平均诊断准确性更好。
在鳞状化生病变的分类方面存在良好的观察者间一致性。这种一致性与发育异常的级别或细胞病理学家的经验无关。在制定治疗、质量保证和法律决策时应考虑这些发现。需要进行更大规模的研究来研究观察者间和观察者内的变异性，并确定化生鳞状细胞病变的细胞学标准。
