Clinical perception of disease probability associated with Bethesda systemdiagnoses

The degree to which clinical perceptions of Papanicolaou smear sensitivity contribute to patient mismanagement is uncertain. A voluntary, anonymous qu estionnaire was mailed to 350 obstetricians/gynecologists (OGYNs) and 350 o ther primary care providers (PCPs) located in Pennsylvania or Ohio. The cli nicians estimated the probability of no disease, dysplasia, and invasive ca rcinoma for 1 of 7 Bethesda System diagnoses. Differences in probability es timates between provider types and between the clinicians and medical liter ature data were measured. The response rate was 22.7%. Compared with publis hed values, clinicians estimated similar disease probabilities for many dia gnoses. However; for some diagnoses, the probability estimates differed con siderably from published values (eg, overestimation of dysplasia and invasi ve carcinoma for benign diagnoses and underestimation of dysplasia for some dysplasia diagnoses), and such errors could contribute to patient mismanag ement. OGYNs generally were more accurate in probability estimates than PCP s. Methods to convey more accurately these diagnostic disease probabilities should he examined.