title: Accuracy and reproducibility of telecytology diagnosis of cervical smears. A tool for quality assurance programs.
abstract: We randomly selected 50 cervical smears (benign, 14; atypical squamous cells of undetermined significance [ASCUS], 5; low-grade squamous intraepithelial lesion [LSIL], 10; high-grade squamous intraepithelial lesion (HSIL), 12; squamous cell carcinoma, 6; adenocarcinoma, 3) and captured 1,181 digital images (518 MB) at a maximum resolution of 1,600 x 1,200 pixels and transmitted them by e-mail. Diagnosis of glass slides and digital images was done independently in a double-blind manner by 3 pathologists and 3 cytotechnologists, commencing with the diagnosis of digital images followed by diagnosis of glass slides 3 months later. The procedure was repeated after 3 months. Diagnoses were recorded as benign, ASCUS or atypical glandular cells of undetermined significance, LSIL, HSIL, squamous cell carcinoma or adenocarcinoma, and "inadequate for diagnosis." Diagnostic accuracy and interobserver reproducibility were analyzed using an intraclass correlation coefficient (ICC), which revealed good interobserver agreement for the first (0.72) and second (0.64) glass slide diagnoses and the first (0.72) and second (0.60) digital image diagnoses. The kappa values for intraobserver variation between first and second glass slide diagnoses and first and second digital image diagnoses showed moderate to excellent agreement. Digital images are suitable substitutes for glass slides; telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.
authors.affiliation: Division of Anatomical Pathology, Hunter Area Pathology Service and Discipline of Anatomical Pathology, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Eung Seok
authors.initials: ES
authors.lastname: Lee
authors.forename: In Sun
authors.initials: IS
authors.lastname: Kim
authors.forename: Jong Sang
authors.initials: JS
authors.lastname: Choi
authors.forename: Bom Woo
authors.initials: BW
authors.lastname: Yeom
authors.forename: Han Kyeom
authors.initials: HK
authors.lastname: Kim
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Mi Sook
authors.initials: MS
authors.lastname: Lee
authors.forename: Anthony S Y
authors.initials: AS
authors.lastname: Leong
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D032921:Consensus; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015588:Observer Variation; D011785:Quality Assurance, Health Care; D011897:Random Allocation; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D019113:Telepathology / Q000379:methods*; D013997:Time Factors; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D014626:Vaginal Smears / Q000379:methods*