Observer variation and quality control of cytodiagnosis

Abstract

SYNOPSISThe aim of quality control of a laboratory investigation is to ensure that similar results are obtained on the same material at different centres. To investigate its practicability in cytodiagnosis, the same cytological material was examined independently at six centres. Each centre supplied material from 20 cases, providing a total of 120 cases, ie, 100 cases excluding the donor centre's own material. The degree of agreement between the centres was studied using (a) the standard National Health Service cytology report terminology, (b) the centre's own terminology, and (c) the recommended recall time. The results revealed close agreement between five out of six centres in the reports obtained in relation to dysplasia and malignancy, namely, less than 3 % false negative results and not more than 1-7 % false positive results. The recommended recall time provided a similar order of agreement after discrepancies due to the management of inflammatory conditions had been eliminated. There was marked disagreement in the diagnosis of both presence and type of infection. The results indicate that improvement in the quality of cytological material would increase the consistency of cytodiagnosis. Cytodiagnosis itself, being an expression of opinion, does not appear to be an appropriate field for quality control.The aim of quality control of a laboratory investigation is to ensure that similar results are obtained on the same material at different centres. To investigate its practicability in cytodiagnosis the same cytological material was examined independently at six centres. The present investigation differs from a previous study in this field (Evans and Sanerkin, 1970) in that the material studied was provided in equal proportion by each of the centres concerned instead of being supplied by only one centre. This was in order to diminishbiasarising out of the nature of the material, eg, due to staining characteristics which might be more acceptable to one centre than to others. Materials and MethodsThe six centres participating in the study were 945Each centre provided 20 slides and was requested to select the material from the routine intake to the cytology department, removing from this a sufficient number of normal slides to provide a relatively high proportion of abnormal slides. The material supplied was from cervical scrapes with the exception of that from centre D where approximately half the slides were from vaginal aspirates. Every centre was asked to examine the slides in essentially the same way that they would adopt when examining the material from their own clinics. Accompanying each slide was the usual clinical information provided on the National Health Service (NHS) cytology form and the report was made using the NHS coding. In addition each centre gave a written report using its own terminology and also gave a recommended recall time andareport on the presence and type of inflammation.The centre providing the cytological material was deemed the reference centre for that case and had access to ...

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