Accuracy of cervical cytology: comparison of diagnoses of 100 Pap smears read by four pathologists at three hospitals in Norway.
Accuracy of cervical cytology: comparison of diagnoses of 100 Pap smears read by four pathologists at three hospitals in Norway.
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宫颈细胞学的准确性：在挪威三家医院中四名病理学家阅读的100张子宫颈抹片检查的诊断比较。
DOI：
10.1186/s12907-017-0058-8
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发表时间：
2017
影响因子：
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通讯作者：
Al-Shibli K
中科院分区：
文献类型：
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作者：
Sørbye SW;Suhrke P;Revå BW;Berland J;Maurseth RJ;Al-Shibli K
宫颈癌可以通过对癌前病变的早期发现和治疗来预防。自1995年以来，挪威一直有一项全国性的宫颈癌筛查计划，建议25-69岁的妇女每三年进行一次巴氏涂片检查。有17个细胞学实验室，覆盖500万人口。不同实验室宫颈异常的发现率不同。我们想调查挪威三家不同医院的四位不同病理学家的细胞学诊断的准确性。挪威三家医院的四名病理学家对2015年在联合国大学筛查的100份巴氏涂片(20份正常，20份ASC-US，20份LSIL，20份ASC-H和20份HSIL)进行了评估。所有患者都得到了随访，一直持续到2016年12月。组织学证实的高度不典型增生(CIN2+)被认为是研究终点。四位病理学家评估为异常(ASC-US+)的巴氏涂片的数量从61到85不等。高级别细胞学(ASC-H+)的数量从26个到50个不等。观察员之间有中等程度的一致(加权kappa 0.45-0.58)。32例高级别组织学(CIN2+)患者，其中CIN2 19例，CIN3 12例，鳞状细胞癌1例。以高级别细胞学(ASC-H+)为界值，CIN2+的敏感性为68.8%~93.8%(平均77.4%)，特异性为70.6%~95.6%(平均81.3%)。CIN2+敏感性最高的病理学家假阳性率最高，特异性最低(p<；0.05)。CIn2+的准确率为74.1%~83.8%(平均79.4%)。宫颈癌患者的巴氏涂片被四位病理学家中的一位诊断为高级别(ASC-H+)。基于细胞学的宫颈癌筛查的准确性有限。这项研究揭示了观察者之间的适度一致，以及敏感性和特异性之间的权衡。提示宫颈细胞学检测阳性率高的医院对CIN2+的敏感性较高，但特异性较低。本文的在线版本(10.1186/s12907-0170058-8)包含补充材料，可供授权用户使用。
Cervical cancer can be prevented by early detection and treatment for precancerous lesions. Since 1995, there has been a national cervical cancer screening program in Norway, where women aged 25–69 years are recommended to take Pap smears every three years. There are 17 cytology laboratories covering a population of 5 million people. The detection rate of cervical abnormalities varies from laboratory to laboratory. We wanted to investigate the accuracy of cytology diagnoses by four different pathologists at three different hospitals in Norway. One hundred Pap smears (20 Normal, 20 ASC-US, 20 LSIL, 20 ASC-H and 20 HSIL) screened at UNN in 2015 were evaluated by four pathologists at three hospitals in Norway. All patients were followed up through December 2016. Histologically confirmed high-grade dysplasia (CIN2+) was considered as study endpoint. The number of Pap smears evaluated as abnormal (ASC-US+) by the four pathologists varied from 61 to 85. The number of high-grade cytology (ASC-H+) varied from 26 to 50. There was moderate agreement (weighted kappa 0.45–0.58) between the observers. There were 32 women with high-grade histology (CIN2+) in the follow-up, including 19 CIN2, 12 CIN3 and one squamous cell carcinoma (SCC). Using high-grade cytology (ASC-H+) as cut-off, the sensitivity for CIN2+ varied from 68.8% to 93.8% (mean 77.4%) and specificity from 70.6% to 95.6% (mean 81.3%). The pathologist with the highest sensitivity for CIN2+ had the highest false positive rate and the lowest specificity (p<0.05). The accuracy for CIN2+ varied from 74.1% to 83.8% (mean 79.4%). The Pap smear from the woman with cervical cancer was diagnosed as high-grade (ASC-H+) by one of the four pathologists. Cervical cancer screening based on cytology has limited accuracy. The study revealed a moderate agreement between the observers, along with a trade-off between sensitivity and specificity. This might indicate that hospitals with high detection rates of cervical cytology have higher sensitivity for CIN2+ but lower specificity. The online version of this article (10.1186/s12907-017-0058-8) contains supplementary material, which is available to authorized users.