Interobserver Reproducibility of Cervical Cytologic and Histologic Interpretations<SUBTITLE>Realistic Estimates From the ASCUS-LSIL Triage Study</SUBTITLE>

Abstract

Interpretive variability is substantial for all types of cervical specimens. Histopathology of cervical biopsies is not more reproducible than monolayer cytology, and even the interpretation of LEEP results is variable. Given the degree of irreproducibility that exists among well-trained pathologists, realistic performance expectations should guide use of their interpretations.

Use of human papillomavirus DNA testing to compare equivocal cervical cytologic interpretations in the United States, Scandinavia, and the United Kingdom

“…In the U.S., sensitivity is paramount because of the emphasis on individual safety as opposed to public health and the concern over litigation if a precancerous lesion is missed and/or a woman is lost to follow-up. 26 The apparent emphasis on specificity in Scandinavia suggests strongly that use of HPV DNA testing for triaging mildly abnormal tests would be less costeffective there because the specificity of diagnosis is already high (like LSIL in the U.S. 27 ). This further suggests that introduction of secondary HPV screening will require estimation of cost efficiency for each country and setting, using relevant cytologic collections.…”

p16INK4a Expression Correlates with Degree of Cervical Neoplasia: A Comparison with Ki-67 Expression and Detection of High-Risk HPV Types

“…The screening of women by Pap smear has led to a remarkable decline in the mortality from cervical cancer; however, secondary to subjective criteria, interpretation of Pap smears is subject to marked inter-and intraobserver variability as well as having a relatively low sensitivity for cervical neoplasia on a single sample (as low as 66% sensitivity for biopsy-proven high-grade squamous intraepithelial lesions [HSIL]) (1,2). Recently, histology, which is thought of as the gold standard for the diagnosis of cervical neoplasia, has also been found to suffer from marked intra-and interobserver variability, and testing for high-risk human papillomavirus (HPV) by Hybrid Capture 2, which has been shown to be very sensitive in the detection of cervical neoplasia and useful in the triaging of ASCUS smears, has a low specificity for cervical neoplasia (1,3).…”

“…Recently, histology, which is thought of as the gold standard for the diagnosis of cervical neoplasia, has also been found to suffer from marked intra-and interobserver variability, and testing for high-risk human papillomavirus (HPV) by Hybrid Capture 2, which has been shown to be very sensitive in the detection of cervical neoplasia and useful in the triaging of ASCUS smears, has a low specificity for cervical neoplasia (1,3). Thus, new biomarkers that are more sensitive and specific in the detection of cervical neoplasia and more reproducible than cervical cytology are needed.…”

Clinical Experience with the Cervista HPV HR Assay

“…Despite standardized morphologic criteria, the ASC-US category exhibits substantial variability in practice. 26 To reduce bias introduced by differences in ASC-US cytologic interpretation, the percentage of reportable cases from each test population that had both an ASC-US cytological interpretation and a positive HR-HPV test result was calculated. This calculation should have reduced any bias that may have occurred if there were a consistently lower or higher threshold for ASC-US interpretation during the test intervals.…”