Reporting cervical intra‐epithelial neoplasia (CIN): Intra‐ and interpathologist variation and factors associated with disagreement

Abstract

Eight histopathologists, based at different hospitals, who had previously examined 100 consecutive colposcopic cervical biopsies were circulated with the results of the initial study. The slides were then 'reblinded' and re-examined by the pathologists who, as before, assigned them into one of six diagnostic categories. The degree of interpathologist agreement for the seven observers who returned usable responses was characterized by kappa statistics and compared to the corresponding figures for the same observers from the previous study. Although some of the observers showed significant alterations in their diagnostic practices there was persistent poor agreement for CIN 1 and 2, mediocre agreement for CIN 3 and excellent agreement for invasive carcinoma. Intra-observer agreement was consistently better than inter-observer agreement for each of the diagnostic categories. Significant differences were found among observers in the degree of intra-observer variability. The 20 cases in which there was most disagreement were re-examined by one of the authors who compared these with 20 biopsies which caused little disagreement. Disagreement was considered to be associated with florid papilloma-virus changes, basal cell hyperplasia and severe inflammation in varying combinations. On the basis of these findings we suggest changes in the terminology of CIN lesions.

Comparison of human papillomavirus genotypes in high-grade squamous intraepithelial lesions and invasive cervical carcinoma: evidence for differences in biologic potential of precursor lesions

“…In that study, PCR was performed on biopsy digests using a restricted number of probes, while our study uses a cytologic sample and an expanded probe set. Similarly, interobserver variability in interpretation of both cytologic [34][35][36] and histologic changes 37,38 in the cervix is well documented in the literature. The findings of Matsukura and Sugase, 8 using a larger set of HPV types, show a varying pattern of HPV types with category of CIN similar to that described here.…”

HPV DNA Testing of the Residual Sample of Liquid-Based Pap Test: Utility as a Quality Assurance Monitor

“…However, histologic assessment, the so-called gold standard, suffers from similar difficulties as cytologic analysis. Both are subject to sampling variation and subjective interpretation (10,11,14). In addition, cytohistologic correlation is extremely labor intensive, taking place over several months and reflecting only the subset of patients undergoing histologic evaluation in the same laboratory.…”

“…At present, correlation of cytology and histology is performed using those cases coming to biopsy. Although the current approach certainly gathers substantive information, biopsy correlation is laborious and suffers from similar problems of observer variability (10,11) and sampling error (11) as cytologic interpretation. In some cases, colposcopic biopsies can be falsely negative, which significantly complicates the correlation process.…”

The impact of HPV cervical screening on negative large loop excision of the transformation zone (LLETZ): A comparative cohort study

“…However, the small and fragmented samples can lead to inadequacy rate of up to 19% [30][31][32] , the inter-observer agreement is at best moderate (k = 0.58; CI 0.52 -0.63) and diagnosis can therefore be underestimated in 16-45% of squamous cell lesions. [32][33] In this study, double data entry and a complete data set for both cohorts removed bias caused by erroneous and missing data. To minimise residual confounding, variables which could explain the observed association between HPV testing and negative LLETZ, were collected and controlled for.…”