IMPROVING CONSISTENCY IN CERVICAL CYTOLOGY REPORTING

Background: During the 1970s, the Papanicolaou method of classifying c ervical cytology specimens and reporting diagnoses was replaced by mor e descriptive reporting systems. The plethora of reporting terms cause d much confusion and a lack of standardization. To improve this situat ion, ''The Bethesda System for Reporting Cervical/Vaginal Cytologic Di agnoses'' was approved at a National Cancer Institute Workshop in 1988 . In Australia, the Victorian Cervical Cytology Registry (VCCR) was es tablished in 1989. Because of the absence of a standard format for rep orting cervical cytology in that country, a coding schedule was develo ped by local cytopathologists. While the pattern of reporting smear di agnoses was found to be reasonably consistent within individual labora tories, substantial variation in reporting abnormal cervical smear dia gnoses by 29 laboratories in Victoria, Australia, was observed. In 199 2, a working party of the National Health and Medical Research Council of Australia proposed that a modified Bethesda System be adopted by A ustralian laboratories. Purpose: The aim of this study was to promote more uniform reporting of cervical/vaginal cytologic diagnoses by cyto pathology laboratories in Victoria, Australia. Methods: From the compu ter database, VCCR staff identified 80 slides that had been registered during the first half of 1991 and that covered the range of low-grade reports and negative reports. Each slide was identified by research n umber only. Two sets of 40 slides were compiled. Of the 29 laboratorie s that had worked with the VCCR during 1991, 22 agreed to participate in this study in 1992. One slide set was sent to each laboratory. An e valuation of the intralaboratory and interlaboratory consistency in re porting a set of 40 slides was undertaken. Analysis of the results com pared the degree of consistency using current descriptive terminology that operates locally in Victoria with that which would pertain if the proposed Australian modification to the Bethesda System were adopted. Results: Intra-laboratory agreement with previously reported slides w as low on the squamous descriptor (49% agreement with original report) but higher on the human papillomavirus descriptor (76% agreement with original report) when the results were analyzed using the current ter minology. Wide variation in reporting was apparent between laboratorie s; only 5% of the slides had agreement by all laboratories. Both intra laboratory and interlaboratory agreement improved substantially when r esults were grouped into the categories of the proposed Australian mod ification of the Bethesda Reporting System. Conclusion and Implication : Substantial improvement in the consistency of reporting cervical cyt ology specimens would be likely if terminology incorporating the broad categories of the Bethesda System were adopted.