Qualitative analysis of value judgments in interpreting cervicovaginal smears using the Bethesda System

Context-We hypothesize that there are unrecognized value judgments that inf luence cytopathologists in interpreting borderline cervicovaginal smears an d that these judgments contribute to the well-documented variation among cy topathologists regarding such diagnoses. Objective-To identify and map these values. Design-Survey consisting of Kodachromes and histories for 5 borderline smea rs. Respondents were asked to give their diagnoses, recommendations for tre atment, and reasoning. Results-We demonstrated a wide variation in interpretation of borderline sm ears similar to previous studies. We then used inductive qualitative analys is to identify the clinical reasoning and value judgments that influenced t he responses. Conclusions-We mapped those diagnostic value judgments that should be used in evaluation borderline cases. We believe this map can he used to rigorous ly manage and standardize the use of such judgments.