ASSESSMENT OF CERVICOVAGINAL SMEAR ADEQUACY - THE BETHESDA SYSTEM GUIDELINES AND REPRODUCIBILITY

Criteria for assessing adequacy of cervicovaginal smears according to the Bethesda System include cellular composition and quantity, specime n preservation, fixation, and absence of obscuring elements. The repro ducibility of adequacy assessment using these parameters was the focus of this study. Specimens were chosen to include a wide spectrum of cl inical history and adequacy interpretations, but excluded cases with e pithelial abnormalities and those judged ''limited'' because of insuff icient transformation zone component. The 114 specimens were independe ntly evaluated twice by five reviewers, with interceding randomization . Full interobserver concordance was obtained in 50.4% of cases, with consensus reached by three or more observers in 97.4% of cases. Of 228 0 paired interpretations, 74% (1692) concurred. Pairwise kappa values for interobserver agreement ranged from .71 to .54 (very good to fair) , with overall kappa = .61. Interobserver agreement for each category was near excellent for ''satisfactory'' (kappa = .73), good for ''unsa tisfactory'' (kappa = .63), and only fair for ''satisfactory but limit ed'' (kappa = .48). Paired intraobserver reproducibility (agreement fo r two separate readings by the same observer) ranged from 69% to 77% ( average, 74%), with good to fair kappa values (.66-.51). These finding s indicate that the specimen adequacy guidelines of the Bethesda Syste m provide good inter- and intraobserver reproducibility. The ''satisfa ctory but limited'' category appears to show the lowest concordance. P roblem areas include evaluation of adequate minimum cellularity and es timation of number of cells obscured.