Lepe Marcos, Eklund Claire M, Quddus M Ruhul, Paquette Cherie
Department of Pathology, Rhode Island Hospital, Providence, Rhode Island, USA.
Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Acta Cytol. 2018;62(5-6):397-404. doi: 10.1159/000489968. Epub 2018 Jul 3.
The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aids in classification of atypical cells in cervical cytology. There is limited literature regarding reproducibility and interobserver variability in the application of the 2014 AGC criteria. Our aim is to assess the interobserver variability of AGC with a focus on how diagnostic categories link with guideline-driven management.
Three observers re-reviewed 51 previously diagnosed AGC Papanicolaou tests. The diagnoses were categorized as follows: (1) according to guideline-specified management, and (2) as glandular vs. squamous lesions. The κ statistic was used to evaluate interobserver agreement.
The interobserver variability per guideline management by weighted 2-observer κ ranged from 0.009 to 0.530, with half of the interobserver pairings meeting the threshold for at least fair-moderate agreement. For categorization as glandular, squamous, or both, unweighted κ yielded at best fair interobserver agreement (κ = 0.250) in 1 pairing, with low κ scores in the remainder of reviewer pairs (range 0.015-0.152).
There is significant interobserver variability in the diagnosis of AGC. The AGC cases when divided by clinical management had fair-moderate interobserver agreement, suggesting that diagnostic variability likely has a real effect on patient care. This diagnostic uncertainty should be understood by cytologists and clinicians.
2014年贝塞斯达系统非典型腺细胞（AGC）诊断标准有助于宫颈细胞学中非典型细胞的分类。关于2014年AGC标准应用中的可重复性和观察者间变异性的文献有限。我们的目的是评估AGC的观察者间变异性，重点关注诊断类别与指南驱动管理的联系。
三名观察者重新审查了51例先前诊断为AGC的巴氏涂片检查。诊断分类如下：（1）根据指南指定的管理，以及（2）腺性病变与鳞状病变。κ统计量用于评估观察者间的一致性。
按加权2观察者κ计算，每个指南管理的观察者间变异性范围为0.009至0.530，一半的观察者配对达到至少中等程度一致的阈值。对于分类为腺性、鳞状或两者，未加权κ在1对配对中产生了充其量中等的观察者间一致性（κ = 0.250），其余审查员配对中的κ得分较低（范围0.015 - 0.152）。
AGC诊断中存在显著的观察者间变异性。按临床管理划分的AGC病例观察者间有中等程度的一致性，表明诊断变异性可能对患者护理产生实际影响。细胞学家和临床医生应了解这种诊断不确定性。
