Schmidt Jared L, Henriksen Jonathan C, McKeon Dan M, Savik Kay, Gulbahce H Evin, Pambuccian Stefan E
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Cancer. 2008 Oct 25;114(5):287-93. doi: 10.1002/cncr.23798.
Apart from several subjective criteria, ASCUS and LSIL are defined by nuclear enlargement of 2.5x to 3x and > or = 3x the area of a normal intermediate squamous cell nucleus, respectively. The aim of this study was to assess the ability of observers with various degrees of experience to estimate nuclear area ratios.
Forty-five participants (5 anatomic pathologists, 5 cytopathologists, 2 cytopathology fellows, 16 pathology residents, 8 cytotechnologists, 6 medical students, and 3 cytopreparatory staff members) judged the area ratios of pairs of squamous cell nuclei imaged at x100 objective magnification. For Test 1 (T1), participants chose between 5 preset area ratios (1.0x to 1.4x, 1.5x to 1.9x, 2.0x to 2.4x, 2.5x to 2.9x, 3.0x to 3.4x) for 15 pairs of cells with ratios falling in the middle of these intervals. One week after T1, an instructional tutorial was given and T1 was repeated in different order of cell pairs as Test 2 (T2).
The kappa values for all participants were 0.30 for T1 and 0.39 for T2. Accurate responses were given in 50.5% in T1 and 53.5% in T2. Both T1 and T2 responses failed to differentiate between area ratios corresponding to ASCUS and LSIL. There were no differences in accuracy according to sex, experience, or expertise in cytopathology.
The overall accuracy of participants in estimating nuclear area ratios was low, especially for ratios in the range of ASCUS versus LSIL, with only minimal improvement after an instructional tutorial. Nuclear area ratio estimation may, therefore, contribute to the well-known substantial variability in ASCUS rates and ASC/squamous intraepithelial lesion ratios.
除了一些主观标准外，非典型鳞状细胞意义不明确（ASCUS）和低度鳞状上皮内病变（LSIL）分别定义为细胞核增大至正常中层鳞状细胞核面积的2.5倍至3倍以及大于或等于3倍。本研究的目的是评估不同经验程度的观察者估计核面积比的能力。
45名参与者（5名解剖病理学家、5名细胞病理学家、2名细胞病理学住院医师、16名病理住院医师、8名细胞技术人员、6名医学生和3名细胞制备工作人员）判断在100倍物镜放大倍数下成像的成对鳞状细胞核的面积比。对于测试1（T1），参与者从5个预设面积比（1.0倍至1.4倍、1.5倍至1.9倍、2.0倍至2.4倍、2.5倍至2.9倍、3.0倍至3.4倍）中为15对细胞对进行选择，这些细胞对的比例落在这些区间的中间。在T1一周后，进行了一次指导性教程，并以不同的细胞对顺序重复T1作为测试2（T2）。
所有参与者在T1时的kappa值为0.30，在T2时为0.39。T1中50.5%的回答准确，T2中53.5%的回答准确。T1和T2的回答均未能区分与ASCUS和LSIL相对应的面积比。根据性别、经验或细胞病理学专业知识，准确性没有差异。
参与者估计核面积比的总体准确性较低，尤其是对于ASCUS与LSIL范围内的比例，在指导性教程后仅有微小改善。因此，核面积比估计可能是导致ASCUS率和ASC/鳞状上皮内病变比率中众所周知的显著变异性的原因之一。
