Results of multiple-slide, blinded review of papanicolaou slides in the context of litigation - Determining what can be detected regularly and reliably
Results of multiple-slide, blinded review of papanicolaou slides in the context of litigation - Determining what can be detected regularly and reliably
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DOI：
10.1002/cncr.21319
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发表时间：
2005-10-25
影响因子：
3.4
通讯作者：
Geils, KB
中科院分区：
文献类型：
--
作者：
Renshaw, AA;Holladay, EB;Geils, KB
背景多个细胞学和病理学组织已认可多玻片盲法审查是在诉讼背景下审查宫颈阴道标本的最合适方法。该过程包括由多名独立细胞学技术人员以盲态方式审查诉讼载玻片，并将这些结果与确认病例的结果进行比较，确认病例由活检随访提示的已知异常组成。据作者所知，这种方法的结果以前没有被证实。回顾了南卡罗来纳州医科大学细胞病理学和分子研究中心1998-2004年的盲法审查项目结果。共审查了135张诉讼幻灯片和122张确认幻灯片。对这些病例的解释有显著性差异（P < 0.001）。诉讼病例更可能被解释为上皮内病变（NIL）或非典型鳞状细胞/非典型腺细胞（ASC/AGC）阴性（P < 0.001）。结果似乎与所涉及的单个细胞技术人员无关。大约10%的诉讼案件被所有观察员至少称为ASC/AGC，4%被所有观察员解释为NIL。对于诉讼案件，ASC/AGC被发现是一样的高度鳞状上皮内病变的可重复性。结果表明，只有10%的诉讼案件是定期和可靠地确定为异常，而一个单一的审查，由专家细胞学家可以预期分类为异常的情况下，56%。该计划表明，大多数诉讼案件没有定期和可靠地确定为异常，一次审查通常会高估定期和可靠地确定的案件的百分比。
BACKGROUND. Multiple-slide, blinded review has been endorsed by several cytology and pathology organizations as the most appropriate method for the review of cervicovaginal specimens in the context of litigation. This process involves review of litigation slides in a blinded manner by multiple independent cytotechnologists and the comparison of those results with those of validation cases that are comprised of known abnormalities with biopsy follow-tip. To the authors' knowledge, the results of this method have not been previously published.METHODS. The results of the blinded review program at the Center for Cytopathology and Molecular Research at the Medical University of South Carolina for the years 1998-2004 were reviewed.RESULTS. A total of 135 litigation slides and 122 validation slides were reviewed. The interpretations of these cases were found to be significantly different (P < 0.001). Litigation cases were significantly more likely to be interpreted as either negative for intraepithelial lesion (NIL) or atypical squamous cells/atypical glandular cells (ASC/AGC) (P < 0.001). The results appeared to be independent of the individual cytotechnologists involved. Approximately 10% of litigation cases were called at least ASC/AGC by all observers and 4% were interpreted as NIL by all observers. For litigation cases, ASC/AGC was found to be just as reproducible as high-grade squamous intraepithelial lesion. The results demonstrated that only 10% of litigation cases are regularly and reliably identified as abnormal, whereas a single review as performed by an expert cytologist can be expected to classify 56% of cases as abnormal.CONCLUSIONS. This program suggests that a majority of litigation cases are not regularly and reliably identified as abnormal, and a single review will routinely overestimate the percentage of cases that are identified regularly and reliably.