Pulkkinen Johanna, Huhtala Heini, Krogerus Leena Anneli, Hollmén Sinikka, Laurila Marita, Kholová Ivana
Department of Pathology, Fimlab Laboratories, Tampere, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Acta Cytol. 2022;66(3):206-215. doi: 10.1159/000522212. Epub 2022 Feb 28.
Although the cytological diagnostic criteria for cervical squamous and glandular lesions are established by the Bethesda System for Reporting Cervical Cytology, the reproducibility of the diagnosis of these lesions has been shown to be variable in previous studies. At best, occasional good kappa (κ) values were reached both inter- and intra-observerly. Generally, consensus on high-grade lesions has been better compared to milder changes.
Altogether, 167 conventional Pap smears from 50 patients with histologically confirmed endocervical adenocarcinomas (EAC) and adenocarcinomas in situ (AIS) and from 28 patients with histologically proven high-grade intraepithelial lesions were analyzed by four cytopathologists. Twenty of the smears were later re-evaluated by the same cytopathologists. κ-values between cytopathologists in the categories of squamous versus glandular, negative for intraepithelial lesion or malignancy (NILM), atypical, and preneoplastic/neoplastic were calculated. The diagnostic Pap smears of EAC and AIS with best and worst consensus between observers were then morphologically analyzed.
The reproducibility ranged from poor to substantial. The overall κ-values between the four cytopathologists were 0.412, 0.314, 0.272, and 0.082, respectively, in the categories of preneoplastic/neoplastic, squamous versus glandular, NILM, and atypical. Overall intra-observer κ-values were correspondingly 0.491, 0.616, 0.345, and 0.241. In the diagnostic smears of AIS and EAC, the nuclear size >2 times the normal and nuclear pleomorphism were the commonest features associated with good diagnostic consensus and the lack of nuclear enlargement and degenerative changes were associated with poor consensus.
The reproducibility of preneoplasia/neoplasia diagnoses was better than that of atypia and NILM both in the inter- and intra-observer part in this study. In the smears from AIS and EAC patients, general neoplasia-associated features were more common in samples with good agreement by the four cytopathologists of the neoplastic nature and the endocervical origin of the lesion.
尽管宫颈鳞状和腺性病变的细胞学诊断标准由贝塞斯达宫颈细胞学报告系统制定，但在以往研究中，这些病变诊断的可重复性已显示存在差异。观察者间和观察者内偶尔能达到较好的卡帕（κ）值。总体而言，与较轻病变相比，高级别病变的一致性更好。
共有来自50例经组织学确诊为宫颈管腺癌（EAC）和原位腺癌（AIS）的患者以及28例经组织学证实为高级别上皮内病变的患者的167份传统巴氏涂片由4名细胞病理学家进行分析。其中20份涂片后来由相同的细胞病理学家重新评估。计算细胞病理学家在鳞状与腺性、上皮内病变或恶性肿瘤阴性（NILM）、非典型以及癌前/肿瘤类别中的κ值。然后对观察者间一致性最佳和最差的EAC和AIS诊断性巴氏涂片进行形态学分析。
可重复性范围从差到实质性。在癌前/肿瘤、鳞状与腺性、NILM和非典型类别中，4名细胞病理学家之间的总体κ值分别为0.412、0.314、0.272和0.082。观察者内总体κ值相应为0.491、0.616、0.345和0.241。在AIS和EAC的诊断涂片中，核大小>正常的2倍和核多形性是与良好诊断一致性相关的最常见特征，而缺乏核增大和退行性改变与一致性差相关。
在本研究中，观察者间和观察者内癌前病变/肿瘤诊断的可重复性均优于非典型和NILM诊断。在AIS和EAC患者的涂片中，4名细胞病理学家对病变的肿瘤性质和宫颈管起源达成良好一致的样本中，一般与肿瘤相关的特征更为常见。
