Inter- and intraobserver agreement in whole-slide digital ThinPrep samples of low-grade squamous lesions of the cervix uteri with known high-risk HPV status: A multicentric international study

Ivana Kholová*, Giovanni Negri, Maria Nasioutziki, Laura Ventura, Arrigo Capitanio, Massimo Bongiovanni, Paul A. Cross, Claire Bourgain, Henrik Edvardsson, Rosario Granados, Artur Lipiński, Ellen Christina Obermann, Maurizio Pinamonti, Henrieta Sidlova, Margareta Strojan Fležar, Folkert J. van Kemenade, Danijela Vrdoljak-Mozetic, Ambrogio Fassina, Beatrix Cochand-Priollet

*Corresponding author for this work

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Abstract

Background: High-risk human papilloma virus (HR HPV) testing and liquid-based cytology are used for primary cervical screening. Digital cytology, based on whole-slide scanned samples, is a promising technique for teaching and diagnostic purposes. The aim of our study was to evaluate the interobserver and intraobserver variation in low-grade squamous lesions, HR HPV status bias, and the use of whole-slide scanned digital cervical cytology slides. Methods: Fifteen expert cytopathologists evaluated 71 digitalized ThinPrep slides (31 atypical squamous cells of undetermined significance [ASC-US], 21 negative for intraepithelial lesion or malignancy, and 19 low-grade squamous intraepithelial lesion cases). HR HPV data were accessible only in the second round. Results: In interobserver analysis, Kendall’s coefficient of concordance was 0.52 in the first round and 0.58 in the second round. Fleiss’ kappa values were 0.29 in the first round and 0.31 in the second round. In the ASC-US category, Fleiss kappa increased from 0.19 to 0.22 in the second round and the increase was even higher expressed by Kendall’s coefficient: from 0.42 to 0.52. In intraobserver analysis, personal scores were higher in the second round. Conclusions: The interobserver and intraobserver variability in low-grade squamous lesions was within fair agreement values in the present study, in line with previous works. The comparison of two rounds showed that expert cytopathologists are generally unbiased by the knowledge of HR HPV data, but that being informed of the HR HPV status leads to a better agreement. Stain quality and back discomfort were highlighted as factors affecting digital cytopathology use.

Original languageEnglish
Pages (from-to)939-948
Number of pages10
JournalCancer cytopathology
Volume130
Issue number12
DOIs
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
The study was initiated, organized, financed (sample shipping), and endorsed by European Federation of Cytology Societies.

Publisher Copyright:
© 2022 The Authors. Cancer Cytopathology published by Wiley Periodicals LLC on behalf of American Cancer Society.

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