Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Pathology, Fimlab Laboratories, Tampere, Finland.
Cancer Cytopathol. 2022 Dec;130(12):939-948. doi: 10.1002/cncy.22624. Epub 2022 Jul 14.
High-risk human papilloma virus (HR HPV) testing and liquid-based cytology are used for primary cervical screening. Digital cytology, based on whole-slide scanned samples, is a promising technique for teaching and diagnostic purposes. The aim of our study was to evaluate the interobserver and intraobserver variation in low-grade squamous lesions, HR HPV status bias, and the use of whole-slide scanned digital cervical cytology slides.
Fifteen expert cytopathologists evaluated 71 digitalized ThinPrep slides (31 atypical squamous cells of undetermined significance [ASC-US], 21 negative for intraepithelial lesion or malignancy, and 19 low-grade squamous intraepithelial lesion cases). HR HPV data were accessible only in the second round.
In interobserver analysis, Kendall's coefficient of concordance was 0.52 in the first round and 0.58 in the second round. Fleiss' kappa values were 0.29 in the first round and 0.31 in the second round. In the ASC-US category, Fleiss kappa increased from 0.19 to 0.22 in the second round and the increase was even higher expressed by Kendall's coefficient: from 0.42 to 0.52. In intraobserver analysis, personal scores were higher in the second round.
The interobserver and intraobserver variability in low-grade squamous lesions was within fair agreement values in the present study, in line with previous works. The comparison of two rounds showed that expert cytopathologists are generally unbiased by the knowledge of HR HPV data, but that being informed of the HR HPV status leads to a better agreement. Stain quality and back discomfort were highlighted as factors affecting digital cytopathology use.
高危型人乳头瘤病毒（HR HPV）检测和液基细胞学用于宫颈癌的初筛。基于全片扫描样本的数字细胞学是一种有前途的教学和诊断技术。我们的研究目的是评估低级别鳞状上皮内病变的观察者间和观察者内差异、HR HPV 状态偏倚以及全片扫描数字宫颈细胞学幻灯片的应用。
15 位细胞学专家评估了 71 个数字化 ThinPrep 玻片（31 例非典型鳞状细胞意义不明确[ASC-US]，21 例上皮内病变或恶性肿瘤阴性，19 例低级别鳞状上皮内病变）。仅在第二轮评估中提供 HR HPV 数据。
在观察者间分析中，第一轮的 Kendall 一致性系数为 0.52，第二轮为 0.58。第一轮的 Fleiss κ 值为 0.29，第二轮为 0.31。在 ASC-US 类别中，Fleiss κ 值在第二轮从 0.19 增加到 0.22，Kendall 系数的增加甚至更高：从 0.42 增加到 0.52。在观察者内分析中，第二轮的个人评分更高。
本研究中低级别鳞状上皮病变的观察者间和观察者内变异性处于良好的一致性范围内，与以往的研究结果一致。两轮比较表明，细胞学专家一般不受 HR HPV 数据的影响，但了解 HR HPV 状态会导致更好的一致性。染色质量和背部不适被认为是影响数字细胞学应用的因素。
