Snyder Tamela M, Renshaw Andrew A, Styer Patricia E, Mody Dina R, Colgan Terence J
Department of Pathology, The Methodist Hospital, Houston, Tex, USA.
Arch Pathol Lab Med. 2005 Jul;129(7):861-5. doi: 10.5858/2005-129-861-ARORCI.
Previous studies have shown that the diagnosis of reparative changes in conventional smears in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology is one of the least reproducible diagnoses. Indeed, the diagnosis of reparative changes consistently yields the highest false-positive rate of any negative for intraepithelial lesions and malignancy (NILM) cytodiagnostic category. It is unknown whether cytologists recognize reparative changes in ThinPrep specimens as well, or less often, as in conventional smears.
To assess and compare the ability of cytologists to recognize reparative changes in conventional and ThinPrep preparations.
We compiled performance data from the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology from the 2000-2003 program years. More than 400 slides with a reference diagnosis of reparative changes met our study criteria, representing a total of 11 200 individual responses for conventional cases and 1155 individual responses for ThinPrep specimens. We evaluated the results of both individual and laboratory participants using 2 performance criteria: the false-positive discordancy rate and the exact match error rate (any response that does not exactly match the reference diagnosis of 120 [reparative changes]).
Cases with a reference diagnosis of reparative changes made up 1.2% of all ThinPrep slides and 3.7% of all conventional slides in circulation. The false-positive discordancy rate of individual responses on educational slides for conventional smears was significantly higher than the corresponding false-positive discordancy rate for ThinPrep specimens (15.7% for conventional vs 7.1% for ThinPrep specimens, P < .001). Laboratory responses on educational conventional smears and ThinPrep slides showed a similar trend (14.2% for conventional smears vs 2.4% for ThinPrep slides, P = .002). The exact match error rate on educational conventional slides was 41.4% for individual responses, while on educational ThinPrep slides, the overall error rate was 57.5% (P < .001). For laboratory responses, the exact match error rate was 40.5% for educational conventional smears versus 58.9% for educational ThinPrep smears (P < .001). Characteristic features of reparative changes were identified in ThinPrep specimens.
In the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology, ThinPrep slides with a reference diagnosis of reparative changes have a lower false-positive discordancy rate than conventional slides. Responses to ThinPrep cases with a reference diagnosis of reparative change show a higher exact match error rate than conventional smears. Since reparative changes in gynecologic cytology are recognized as indicating an increased risk of significant lesions, the clinical significance of these altered patterns of recognition of reparative changes in ThinPrep specimens warrants further investigation.
以往研究表明，在美国病理学家学会妇科细胞学实验室间比较计划中，传统涂片上修复性改变的诊断是重现性最差的诊断之一。实际上，在所有上皮内病变和恶性肿瘤阴性（NILM）的细胞诊断类别中，修复性改变的诊断始终产生最高的假阳性率。目前尚不清楚细胞学家是否能像在传统涂片中那样，或更少地识别ThinPrep标本中的修复性改变。
评估并比较细胞学家识别传统涂片和ThinPrep制片中修复性改变的能力。
我们收集了美国病理学家学会妇科细胞学实验室间比较计划2000 - 2003年项目年度的表现数据。400多张参考诊断为修复性改变的玻片符合我们的研究标准，代表传统病例共有11200份个体反应，ThinPrep标本有1155份个体反应。我们使用两个表现标准评估个体和实验室参与者的结果：假阳性不一致率和完全匹配错误率（任何与120[修复性改变]的参考诊断不完全匹配的反应）。
参考诊断为修复性改变的病例占所有流通的ThinPrep玻片的1.2%，占所有传统玻片的3.7%。传统涂片教育玻片上个体反应的假阳性不一致率显著高于ThinPrep标本相应的假阳性不一致率（传统涂片为15.7%，ThinPrep标本为7.1%，P <.001）。教育传统涂片和ThinPrep玻片上的实验室反应显示出类似趋势（传统涂片为14.2%，ThinPrep玻片为2.4%，P =.002）。教育传统玻片上个体反应的完全匹配错误率为41.4%，而教育ThinPrep玻片上的总体错误率为57.5%（P <.001）。对于实验室反应，教育传统涂片的完全匹配错误率为40.5%，教育ThinPrep涂片为58.9%（P <.001）。在ThinPrep标本中识别出了修复性改变的特征。
在美国病理学家学会妇科细胞学实验室间比较计划中，参考诊断为修复性改变的ThinPrep玻片的假阳性不一致率低于传统玻片。对参考诊断为修复性改变的ThinPrep病例的反应显示出比传统涂片更高的完全匹配错误率。由于妇科细胞学中的修复性改变被认为表明存在重大病变的风险增加，ThinPrep标本中这些改变的修复性改变识别模式的临床意义值得进一步研究。
