REPRODUCIBILITY STUDY OF CERVICAL CYTOPATHOLOGY IN MEXICO - A NEED FOR REGULATION AND PROFESSIONAL ACCREDITATION

Due to the high rate of false negative results in diagnosis of cervica l cytopathology, in many countries its practice has been transformed t hrough the application of several interventions aimed at medical regul ation to improve diagnostic accuracy. Diagnostic reproducibility of gy necological cytopathology was evaluated in a series of 20 cytology spe cimens [Papanicolaou (Pap)] and 20 cervical biopsy (CB) studies in dif ferent clinical stages, during 1994. The observation unit consisted of 30 pathologists who observed 2 groups of 20 Pap and 20 CB specimens. The standard was a cytopathologist certified by the Pathological Anato my Council of Mexico. Intraclass reproducibility in gynecological cyto pathology is low in Mexico. In a group analysis, concordance increased as clinical status of the cervical lesion increased, For moderate dys plasia, concordance in Pap was kappa = 0.04, compared to 0.23 in CB. C oncordance of diagnosis of invasive cancer was 0.29 for Pap and 0.64 f or CB. Using weighted kappa at the individual level for all possible d iagnoses, concordance varied from 0.29 to 0.59 for Pap, and 0.42 to 0. 65 for CB. The problem of reproducibility in cervical cytopathology in Mexico emphasizes the need for continuing education, uniform diagnost ic criteria, and the advantages of a single operational classification -possibly, the Bethesda System-since current classification systems ar e obsolete. (C) 1997 Wiley-Liss, Inc.