Raab S S, Geisinger K R, Silverman J F, Thomas P A, Stanley M W
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Am J Clin Pathol. 1998 Nov;110(5):653-9. doi: 10.1093/ajcp/110.5.653.
The interobserver variability of a Papanicolaou smear diagnosis of atypical glandular cells of undetermined significance (AGUS) has not been measured. Four expert cytopathologists retrospectively reclassified 100 smears originally diagnosed as AGUS; on follow-up examination, 54 had a clinically significant lesion and 46 had a benign lesion. The mean sensitivity and specificity of reclassification were 86% and 21%, respectively. The kappa statistic for pairwise cytopathologist comparison varied from 0.16 to 0.27. In 45% of cases the cytopathologists all used different Bethesda System diagnoses, and in no case did all the cytopathologists use the same diagnosis. There was little agreement on which cytologic criteria were important in separating clinically significant and benign lesions. We conclude the following: interobserver agreement in reclassifying AGUS lesions is very poor; the AGUS category is poorly understood, and there is no agreement on diagnostic cytologic criteria; and when reclassifying slides, cytopathologists make a number of false-negative diagnoses.
巴氏涂片诊断意义不明确的非典型腺细胞（AGUS）的观察者间变异性尚未得到测定。四位专家级细胞病理学家对最初诊断为AGUS的100份涂片进行了回顾性重新分类；在随访检查中，54例有临床意义的病变，46例有良性病变。重新分类的平均敏感性和特异性分别为86%和21%。细胞病理学家两两比较的kappa统计量在0.16至0.27之间。在45%的病例中，细胞病理学家均采用了不同的贝塞斯达系统诊断，无一例所有细胞病理学家都采用相同的诊断。在区分具有临床意义和良性病变的重要细胞学标准方面几乎没有一致性。我们得出以下结论：在重新分类AGUS病变方面观察者间的一致性非常差；对AGUS类别了解不足，在诊断细胞学标准上没有一致性；并且在重新分类玻片时，细胞病理学家会做出一些假阴性诊断。
