title: Receiver operating characteristic curves for analysis of the results of cervicovaginal smears. A useful quality improvement tool.
abstract: OBJECTIVE
  To assess the value of receiver operating characteristic curves (ROCs) as a tool for improvement in the evaluation of cervicovaginal smear results.
  
  
  METHODS
  We reviewed the results of cervicovaginal smear interpretation for 1 year by 10 different cytopathologists working in the same laboratory (total number of cases, 45,356) and compared them with results of histologic evaluation of corresponding biopsies (n = 2090, 4.6%), the latter taken to be the gold standard. Receiver operating characteristic curves were generated for the laboratory as a whole and for individual cytopathologists.
  
  
  RESULTS
  Analysis of these receiver operating characteristic curves was surprisingly informative. They showed that cytopathologists with different diagnostic thresholds could be distinguished from each other. A difference in diagnostic threshold could be distinguished from a difference in diagnostic accuracy.
  
  
  CONCLUSIONS
  We conclude that while receiver operating characteristic curves for cervicovaginal smear interpretation have limitations, the results can be used for quality improvement.
authors.affiliation: Department of Pathology, Brigham & Women's Hospital, Boston, Mass 02115, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: B R
authors.initials: BR
authors.lastname: Dean
authors.forename: E S
authors.initials: ES
authors.lastname: Cibas
mesh_terms: D005260:Female; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D015588:Observer Variation; D011786:Quality Control; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D014626:Vaginal Smears / Q000592:standards*