Scholefield J H, Johnson J, Hitchcock A, Kocjan G, Smith J H, Smith P A, Ferryman S, Byass P
Department of Surgery, University Hospital, UK.
Cytopathology. 1998 Feb;9(1):15-22. doi: 10.1046/j.1365-2303.1998.00134.x.
Anal intraepithelial neoplasia is a difficult diagnostic and management problem, particularly when it occurs in women with synchronous or metachronous genital intraepithelial neoplasia. Diagnosis and follow up by colposcopy is too specialized for widespread use, and although anal cytology has been used before it has been thought of as too inconsistent for practical application. This study standardized collection of specimens and investigated interobserver variation. The aim of the study was to determine whether observers could reliably distinguish high grade anal intraepithelial neoplasia from other conditions. Standardized collection of anal preparations was achieved in the host centre. A meeting of experienced cytopathologists was convened to agree guidelines for anal cytology. These guidelines were sent to the panel of six observers who were subsequently circulated with 30 cytopathological preparations in random order and asked to report them all. The results were collected and processed centrally. Four individuals were in complete agreement about those preparations which were inadequate for reporting, but two others had a lower threshold for rejecting preparations as inadequate. There was agreement between the observers in over 95% of cases in distinguishing high grade intraepithelial neoplasia from other cytological conditions. Kappa values range from 0.66 to 1.00. This study demonstrates that the provision of guidelines for the interpretation of anal cytopathological preparations can result in a high degree of interobserver agreement about the clinically important distinction between high grade anal intraepithelial neoplasia and other conditions. Anal cytology is a more useful technique for diagnosis and follow up of 'at risk' individuals than has previously been suggested, and should be utilized more widely in this group of patients.
肛管上皮内瘤变是一个诊断和处理难题，尤其是当它发生在患有同步或异时性生殖道上皮内瘤变的女性中时。通过阴道镜进行诊断和随访过于专业，无法广泛应用，并且尽管之前已使用过肛管细胞学检查，但一直被认为其结果过于不一致，不适合实际应用。本研究规范了标本采集，并调查了观察者间的差异。该研究的目的是确定观察者能否可靠地将高级别肛管上皮内瘤变与其他情况区分开来。在主办中心实现了肛管标本的规范采集。召集了一次经验丰富的细胞病理学家会议，以商定肛管细胞学的指导方针。这些指导方针被发送给六名观察者小组，随后他们被随机分发30份细胞病理学标本，并要求对所有标本进行报告。结果集中收集和处理。对于那些不适合报告的标本，有四个人完全一致，但另外两个人将标本判定为不适合的阈值较低。在区分高级别上皮内瘤变与其他细胞学情况方面，观察者之间在超过95%的病例中达成了一致。Kappa值范围为0.66至1.00。本研究表明，提供肛管细胞病理学标本解读的指导方针可导致观察者在高级别肛管上皮内瘤变与其他情况之间的临床重要区分上达成高度一致。肛管细胞学对于“高危”个体的诊断和随访是一种比之前认为的更有用的技术，并且应该在这组患者中更广泛地应用。
