Pajtler Marija, Audy-Jurković Silvana, Milicić-Juhas Valerija, Staklenac Blazenka, Pauzar Biljana
Department of Clinical Cytology, University Hospital Osijek, Osijek, Croatia.
Coll Antropol. 2006 Mar;30(1):137-42.
The aim of the study was to compare interobserver variability for The Bethesda System (TBS) and World Health Organization (WHO) classification of cervical squamous intraepithelial lesions. A total of 1,000 conventional Papanicolaou smears (156 positive and 884 negative) were examined "blindly" by three cytologists and one cytotechnician. The degree of observer agreement was expressed by kappa statistics using a program for the calculation of interobserver variation and association "Agree" (Svanholm and Jergensen, 1989). Kappa (kappa) was determined for each cytologic diagnosis within a particular classification and total for either classification. The association with and separation from other diagnoses was determined for each cytologic diagnosis in the form of conditional probability (P(j)). In WHO classification, the diagnoses of dysplasia media and dysplasia gravis showed poor reproducibility (kappa = 0.114 and kappa = 0.259, respectively), the diagnosis of dysplasia levis good reproducibility (kappa = 0.639), and the diagnosis of carcinoma in situ excellent reproducibility (kappa = 0.762). WHO classification yielded pool kappa of 0.741. In TBS classification, the diagnosis of LSIL showed good, and HSIL excellent reproducibility (kappa = 0.542 and kappa = 0.763, respectively). TBS classification yielded pool kappa of 0.699. Dysplasia media (P(j) = 0.121) and dysplasia gravis (P(j) = 0.274) were found to be morphologically poorly defined, and carcinoma in situ (P(j) = 0.777) and dysplasia levis (P(j) = 0.651) well defined diagnoses. LSIL was morphologically moderately defined (P(j) = 0.587) and HSIL well defined (P(j) = 0.789) diagnosis. Accordingly, TBS does not substantially improve diagnostic reproducibility of the cytologic diagnoses of squamous intraepithelial lesions, while providing considerably less information to the clinician than the four-grade dysplasia/CIS terminology, thus eliminating the opportunity of choosing a different procedure for the diagnosis of dysplasia media, which is of utmost importance in the population of young nulliparae.
本研究的目的是比较观察者间对宫颈鳞状上皮内病变的贝塞斯达系统（TBS）分类和世界卫生组织（WHO）分类的变异性。共有1000份传统巴氏涂片（156份阳性和884份阴性）由三名细胞学家和一名细胞技术员进行“盲法”检查。观察者间的一致程度用kappa统计量表示，使用一个计算观察者间变异和关联的程序“Agree”（Svanholm和Jergensen，1989）。针对特定分类内的每种细胞学诊断以及任一分类的总体情况确定kappa值。以条件概率（P(j)）的形式确定每种细胞学诊断与其他诊断的关联及区分。在WHO分类中，中度发育异常和重度发育异常的诊断显示出较差的可重复性（kappa分别为0.114和0.259），轻度发育异常的诊断具有良好的可重复性（kappa = 0.639），原位癌的诊断具有优异的可重复性（kappa = 0.762）。WHO分类得出的合并kappa值为0.741。在TBS分类中，低度鳞状上皮内病变（LSIL）的诊断具有良好的可重复性，高度鳞状上皮内病变（HSIL）具有优异的可重复性（kappa分别为0.
