INTEROBSERVER VARIATION IN THE DIAGNOSIS AND GRADING OF DYSKARYOSIS IN CERVICAL SMEARS - SPECIALIST CYTOPATHOLOGISTS COMPARED WITH NONSPECIALISTS

Aims-To compare the assessment of dyskaryosis in cervical smears made by specialist consultant cytopathologists and consultant general histo pathologists. Methods-One hundred and ten cervical smears were circula ted to 10 observers from five district general hospital histopathology departments and five major departments of cytopathology. Their respon ses were analysed by five consultant general histopathologists and fiv e consultant specialist cytopathologists. In 54 of the 110 cases, the histology of a corresponding cervical biopsy specimen was compared wit h the smear assessments. Results-Specialist cytopathologists were more consistent than non-specialists when diagnosing and grading dyskaryos is. They chose the higher grades of dyskaryosis more frequently than t he non-specialists. The cytopathologists recommended referral for colp oscopy more frequently, but if they asked for a repeat smear, they wan ted it done within three months more frequently than the histopatholog ists. The specialists were more frequently in agreement with the biops y grade of intra-epithelial neoplasia than the nonspecialists, whose s mear diagnoses tended to underestimate the severity of the histopathol ogical abnormality.Conclusions-This study has shown major differences between specialist and non-specialist cytopathologists in the diagnosi s and grading of cervical smears and in the recommended management of patients with abnormal smears. These differences may result in uneven clinical management of women with smear abnormalities. It is therefore important to explore possible strategies for standardising the report ing of cervical smears, such as centralisation of screening services, accreditation in cytopathology for non-specialist consultants, and the value of participation in external quality assessment schemes.