title: World wide web-based cytological analysis of atypical squamous cells cannot exclude high-grade intraepithelial lesions.
abstract: OBJECTIVE
  It has been reported that the low level of consistency of diagnosis of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions (ASC-H) in uterine cervical cancer screening using the Bethesda System, indicating the necessity of a large-scale survey. We presented cases cytologically judged as ASC-H on our website and invited our members to give their opinions regarding the diagnosis by voting online. The Web voting results were analyzed and ASC-H was cytologically investigated.
  
  
  METHODS
  Virtual slides of atypical cells in cytology preparations of 53 cases were prepared and presented on a website. ASC-H cases were divided into 42 cases sampled by brush scraping and 11 cases sampled by cotton swab scraping. Fifty-three cases cytologically judged as ASC-H were classified into benign and CIN2/3, and their patterns of arrangement of atypical cells and 8 cytological parameters were morphologically investigated.
  
  
  RESULTS
  The frequency of ASC-H diagnosis in the Web votes was low: 29.2% for brush-scraped and 26.2% for cotton swab-scraped cases. Three-dimensionality, coarse chromatin and irregular nuclei were significantly different between high-grade squamous intraepithelial lesions and benign cases.
  
  
  CONCLUSIONS
  Web-based surveys showed the difference of cytological findings between high-grade squamous intraepithelial lesions and benign cases. To increase interobserver consistency, it may be useful to share information online, which avoids geographical and temporal limitations.
authors.affiliation: Department of Pathologic Analysis, Hirosaki University Graduate School of Health Sciences, Hirosaki, Japan. kwashiya@cc.hirosaki-u.ac.jp
authors.forename: Kiyotada
authors.initials: K
authors.lastname: Washiya
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Takamizu
authors.forename: Yukie
authors.initials: Y
authors.lastname: Kumagai
authors.forename: Yukari
authors.initials: Y
authors.lastname: Himeji
authors.forename: Takako
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Muneo
authors.initials: M
authors.lastname: Iwai
authors.forename: Jun
authors.initials: J
authors.lastname: Watanabe
mesh_terms: D002584:Cervix Uteri / Q000473:pathology*; D003581:Cytodiagnosis / Q000379:methods; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D020407:Internet; D015203:Reproducibility of Results; D019113:Telepathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*