巴氏涂片上的腺细胞异型性：细胞起源诊断和预测中的观察者间差异

Glandular cell atypia on Papanicolaou smears: interobserver variability in the diagnosis and prediction of cell of origin.

作者信息

Simsir Aylin, Hwang Sonya, Cangiarella Joan, Elgert Paul, Levine Pascale, Sheffield Matthew V, Roberson Janie, Talley Lynya, Chhieng David C

机构信息

Division of Cytopathology, Department of Pathology, New York University Medical Center, New York, New York 10016, USA.

出版信息

Cancer. 2003 Dec 25;99(6):323-30. doi: 10.1002/cncr.11826.

DOI:10.1002/cncr.11826

PMID:14681938

Abstract

BACKGROUND

The 2001 Bethesda System recommended qualification of atypical glandular cells (AGC) to indicate the site of origin and separated endocervical adenocarcinoma in situ (AIS) from "AGC favor neoplastic" as a specific diagnostic category. To the authors' knowledge, the literature evaluating the reproducibility of Papanicolaou (Pap) smear diagnosis of glandular cell abnormalities with emphasis on the cell of origin is limited. The aim of the current study was to investigate whether a variety of benign to neoplastic glandular lesions can be reliably classified on Pap smear with regard to diagnosis and cell of origin.

METHODS

Twenty-three conventional Pap smears (CPS) with glandular cellular changes varying from benign to adenocarcinoma (ACA) were reviewed by six observers. They were asked to categorize each smear according to cell of origin (endocervical vs. endometrial) and diagnosis (benign, AGC, or ACA). Kappa statistics were used to evaluate interobserver agreement and correlation of interobserver agreement with experience.

RESULTS

There was no consensus among observers for both the origin of the cells and the diagnosis. Interobserver agreement for site was poor (kappa < 0.4) especially in the AGC category. Unanimous agreement for site was reached for 7 of 23 smears (30%). Two of five endocervical AIS were classified as endometrial and another two were classified as benign by four observers. Interobserver agreement was poor in all diagnostic categories (kappa < 0.4) and showed slight correlation with level of experience. Unanimous agreement for diagnosis was reached for only 2 smears (9%). Three of 11 (27%) smears demonstrating preneoplastic/neoplastic processes were diagnosed as benign by 3 observers. Three (25%) benign CPS were diagnosed as ACA by 2 observers. Accurate prediction of the final histologic diagnosis by observers varied from 30% to 87% and did not correlate closely with experience.

CONCLUSIONS

Cytologic diagnosis of glandular lesions by CPS was problematic and suffered from significant interobserver subjectivity.

摘要

背景

2001年贝塞斯达系统建议对非典型腺细胞（AGC）进行分类以表明其起源部位，并将宫颈管原位腺癌（AIS）与“倾向肿瘤性AGC”区分开来作为一个特定的诊断类别。据作者所知，评估巴氏涂片诊断腺细胞异常的可重复性且着重于起源细胞的文献有限。本研究的目的是调查各种从良性到肿瘤性的腺性病变在巴氏涂片上能否在诊断及起源细胞方面得到可靠分类。

方法

六名观察者对23份具有从良性到腺癌（ACA）不等的腺细胞改变的传统巴氏涂片（CPS）进行了复查。要求他们根据起源细胞（宫颈管与子宫内膜）及诊断（良性、AGC或ACA）对每份涂片进行分类。kappa统计用于评估观察者间的一致性以及观察者间一致性与经验的相关性。

结果

观察者之间对于细胞起源及诊断均未达成共识。观察者间在部位方面的一致性较差（kappa<0.4），尤其是在AGC类别中。23份涂片中仅有7份（30%）在部位上达成了一致意见。5份宫颈管AIS中有2份被四名观察者分类为子宫内膜来源，另外两份被分类为良性。所有诊断类别中观察者间一致性均较差（kappa<0.4），且与经验水平仅有轻微相关性。仅2份涂片（9%）在诊断上达成了一致意见。11份显示肿瘤前/肿瘤性病变过程的涂片中，有3份（27%）被三名观察者诊断为良性。2份观察者将3份（25%）良性CPS诊断为ACA。观察者对最终组织学诊断的准确预测率从30%到87%不等，且与经验并无密切相关性。