title: Telecytology: intraobserver and interobserver reproducibility in the diagnosis of cervical-vaginal smears.
abstract: Telecytologic diagnosis of cervical-vaginal smears is potentially useful because it could allow more efficient use of cytopathologist resources and expertise. A pathologist in one location could, in principle, review cytotechnologists' findings using a video display hundreds or thousands of miles away. Currently, bandwidth restrictions limit practical implementation of such a system to review of fields that had been selected for review by the cytotechnologist. The purpose of our investigation was to evaluate how well this type of review correlates with a review in which the entire slide is available for examination by the pathologist. We prospectively selected 100 consecutive cervical-vaginal smears over an 11-day period in August 1999. For each smear, 4 to 12 fields containing abnormal cells from each slide were digitally imaged. Each of 3 pathologists reviewed all digitized images and all glass slides. Diagnoses based on selected digitized images were compared with those based on conventional pathologist review. The kappa statistic, a measure of chance-corrected agreement (reproducibility), was calculated in each setting. Overall, intraobserver and interobserver reproducibility of cervical-vaginal smear diagnoses is fair to excellent. The use of remote digital images for pathologist review did not introduce large (2-step) diagnostic disagreements. The disagreement between a pathologist's glass slide and digital diagnoses is less than that for different pathologists reviewing glass slides, although interobserver differences were even greater in the interpretation of digital images.
authors.affiliation: Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Alli
authors.forename: C W
authors.initials: CW
authors.lastname: Ollayos
authors.forename: L D
authors.initials: LD
authors.lastname: Thompson
authors.forename: I
authors.initials: I
authors.lastname: Kapadia
authors.forename: D R
authors.initials: DR
authors.lastname: Butler
authors.forename: B H
authors.initials: BH
authors.lastname: Williams
authors.forename: D L
authors.initials: DL
authors.lastname: Rosenthal
authors.forename: T J
authors.initials: TJ
authors.lastname: O'leary
mesh_terms: D003581:Cytodiagnosis / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D006652:Histological Techniques / Q000379:methods; D006801:Humans; D015588:Observer Variation; D011446:Prospective Studies; D019114:Remote Consultation; D015203:Reproducibility of Results; D019113:Telepathology / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000379:methods*