Expert consultation for cervical carcinoma smears - Reliability of selected-field videomicroscopy

OBJECTIVE: To evaluate the diagnostic accuracy of videomicroscopy image sel ection for expert consultation in cervical cytology. STUDY DESIGN: One hundred diagnostically difficult cervical cytologic smear s were selected and rescreened by a general pathologist who chose, from eac h slide, four or five fields featuring abnormal cells. Video images were di gitized and stored on a 512 x 512-pixel matrix using an image acquisition a nd transmission system. Five experts each reviewed 20 of the 100 cases, and a sixth reviewed all 100 cases. Diagnoses based on selected digitized imag es were compared to those based on conventional examination of whole slides . RESULTS: Intraobserver agreement was fair to excellent for all six experts (kappa value: 0.47-0.81); it was complete or acceptable in 68.4-85% of case s. Compared to the reference diagnosis, interobserver agreement was not sig nificantly different whether cases were examined by screening the entire sl ide or by videomicroscopy of selected fields. The marked discordance in fou r cases concerned very small cells the significance of which was misinterpr eted on videomicroscopy because of poor image quality due to lack of focus setting. CONCLUSION: This exploratory study showed that selection of videomicroscopy images seems as reliable as conventional examination of slides for expert construction on diagnostically difficult cervical cytologic smear cases.