title: Using the ASC:SIL ratio, human papillomavirus, and interobserver variability to assess and monitor cytopathology fellow training performance.
abstract: BACKGROUND
  The goal of this study was to assess objective measurements of cytopathology fellow performance during their training.
  
  
  METHODS
  The authors examined cytopathology performance characteristics (the ratio of atypical squamous cells to squamous intraepithelial lesions [ASC:SIL], interobserver variability [IOV], high-risk human papillomavirus [hr-HPV]-positive atypical squamous cells of undetermined significance [ASC-US]) of cytopathology fellows and assessed whether they could be used as tools to further their education.
  
  
  RESULTS
  The ASC:SIL ratio, the proportion of hr-HPV-positive ASC-US, and IOV were calculated for 5 consecutive cytopathology fellows. The average ASC:SIL ratio for the fellows was 1.15. The overall average Cohen κ-coefficient (κ-value) between fellow and cytopathologist interpretation was 0.75 (substantial agreement). The conditional κ-value for ASC-US only was higher for cases the fellows called ASC-US (0.70) than for cases the cytopathologist called ASC-US (0.60). Of the cases that were diagnosed as "negative for intraepithelial lesion or malignancy" (NILM) by the fellow and ASC-US by the pathologist, 33.2% were positive for hr-HPV. This was higher than the expected frequency of hr-HPV-positive results in the NILM population, suggesting that the fellows were over-interpreting NILM in hr-HPV-positive cases that had cytologic features sufficient for an ASC-US interpretation.
  
  
  CONCLUSIONS
  In this study, agreement was compared between trainee and cytopathologist to determine where a fellow's interpretation differed. With the use of IOV, the ASC:SIL ratio, and the percentage of hr-HPV-positive results in the NILM, ASC-US, and low-grade SIL categories, the authors attempted to outline objective assessments and areas of improvement for fellows before they enter independent practice.
authors.affiliation: Division of Cytopathology, James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ivan
authors.initials: I
authors.lastname: Chebib
authors.forename: Rema A
authors.initials: RA
authors.lastname: Rao
authors.forename: David C
authors.initials: DC
authors.lastname: Wilbur
authors.forename: Rosemary H
authors.initials: RH
authors.lastname: Tambouret
mesh_terms: D002278:Carcinoma in Situ / Q000473:pathology* / Q000821:virology; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000821:virology; D002983:Clinical Competence; D006784:Hospitals, Teaching; D006801:Humans; D008404:Massachusetts; D015588:Observer Variation; D027383:Papillomaviridae; D010338:Pathology, Clinical / Q000193:education* / Q000592:standards
keywords: Papanicolaou test; cytopathology; fellow; human papillomavirus; interobserver variability