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    Low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion? Concordance between the interpretation of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion in Papanicolaou tests: Results from the College of American Pathologists PAP education Program

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    Author
    Crothers, B.A.
    Ghofrani, M.
    Zhao, C.
    Date
    2019
    Journal
    Archives of Pathology and Laboratory Medicine
    Publisher
    College of American Pathologists
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://dx.doi.org/10.5858/arpa.2018-0003-CP
    Abstract
    Context.-Obtaining diagnostic concordance for squamous intraepithelial lesions in cytology can be challenging. Objective.-To determine diagnostic concordance for biopsy-proven low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL) Papanicolaou test slides in the College of American Pathologists PAP Education program. Design.-We analyzed 121 059 responses from 4251 LSIL and HSIL slides for the interval 2004 to 2013 using a nonlinear mixed-model fit for reference diagnosis, preparation type, and participant type. We evaluated interactions between the reference diagnosis and the other 2 factors in addition to a repeated-measures component to adjust for slide-specific performance. Results.-There was a statistically significant difference between misclassification of LSIL (2.4%; 1384 of 57 664) and HSIL (4.4%; 2762 of 63 395). There was no performance difference between pathologists and cytotechnologists for LSIL, but cytotechnologists had a significantly higher HSIL misclassification rate than pathologists (5.5%; 1437 of 27 534 versus 4.0%; 1032 of 25 630; P = .01), and both were more likely to misrepresent HSIL as LSIL (P, .001) than the reverse. ThinPrep LSIL slides were more likely to be misclassified as HSIL (2.4%; 920 of 38 582) than SurePath LSIL slides (1.5%; 198 of 13 196), but conventional slides were the most likely to be misclassified in both categories (4.5%; 266 of 5886 for LSIL, and 6.5%; 573 of 8825 for HSIL). Conclusions.-More participants undercalled HSIL as LSIL (false-negative) than overcalled LSIL as HSIL (false-positive) in the PAP Education program, with conventional slides more likely to be misclassified than ThinPrep or SurePath slides. Pathologists and cytotechnologists classify LSIL equally well, but cytotechnologists are significantly more likely to undercall HSIL as LSIL than are pathologists. Copyright College of American Pathologists. All right reserved. Open access.
    Keyword
    Papanicolaou Test
    Squamous Intraepithelial Lesions of the Cervix
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059702012&doi=10.5858%2farpa.2018-0003-CP&partnerID=40&md5=3ae438cdc2fe89c3ff2ab91b66a53c9a; http://hdl.handle.net/10713/8696
    ae974a485f413a2113503eed53cd6c53
    10.5858/arpa.2018-0003-CP
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