Atypical Glandular Cells: Interobserver Variability according to Clinical Management.

OBJECTIVE: The 2014 Bethesda System diagnostic criteria for atypical glandular cells (AGC) aids in classification of atypical cells in cervical cytology. There is limited literature regarding reproducibility and interobserver variability in the application of the 2014 AGC criteria. Our aim is to assess the interobserver variability of AGC with a focus on how diagnostic categories link with guideline-driven management. STUDY DESIGN: Three observers re-reviewed 51 previously diagnosed AGC Papanicolaou tests. The diagnoses were categorized as follows: (1) according to guideline-specified management, and (2) as glandular vs. squamous lesions. The κ statistic was used to evaluate interobserver agreement. RESULTS: The interobserver variability per guideline management by weighted 2-observer κ ranged from 0.009 to 0.530, with half of the interobserver pairings meeting the threshold for at least fair-moderate agreement. For categorization as glandular, squamous, or both, unweighted κ yielded at best fair interobserver agreement (κ = 0.250) in 1 pairing, with low κ scores in the remainder of reviewer pairs (range 0.015-0.152). CONCLUSIONS: There is significant interobserver variability in the diagnosis of AGC. The AGC cases when divided by clinical management had fair-moderate interobserver agreement, suggesting that diagnostic variability likely has a real effect on patient care. This diagnostic uncertainty should be understood by cytologists and clinicians.

Evaluating the Age Cutoff Criterion for Reporting Benign-Appearing Endometrial Cells in Routine Pap Tests: An 8-Year Retrospective Review.

OBJECTIVE: The 2014 Bethesda System recommends that benign-appearing endometrial cells (BECs) in routine Pap tests should be reported in patients aged ≥45 years. This is a change from previous guidelines to report BECs in women ≥40 years of age. BECs are reported to have 1% chance of endometrial lesion on follow-up. This study tests whether the new threshold may increase the specificity of the test for the detection of clinically significant endometrial lesions. STUDY DESIGN: After institutional review board approval, 1,177 BECs, reported during an 8-year study period in patients aged ≥40 years, were retrieved from 672,000 routine ThinPrep Pap tests. The results of subsequent workup were collected by chart review, and the Fisher exact test was used to compare results in patients aged <50 and ≥50 years. RESULTS: No endometrial carcinoma and only 2 cases of endometrial hyperplasia were detected in women aged <50 years, whereas 5.5% of women aged ≥50 years with BECs had carcinoma and/or endometrial hyperplasia (p = 0.000169). CONCLUSION: Investigation of BECs on routine Pap test are useful in patients aged ≥50 years as 5.5% of cases were confirmed to have significant endometrial disease. Our data as well as other studies support raising the BEC-reporting age threshold from ≥45 to ≥50 years, as the new threshold may improve the specificity of the test.

ASC:SIL ratio following implementation of the 2001 Bethesda System.

The 2001 Bethesda system (TBS 2001) eliminated the "satisfactory but limited by" category, benign cellular changes (BCC), and the designations "favor benign" (ASC-B) and "favor low grade" (ASC-L) for atypical squamous cells. We compared the unsatisfactory rate and atypical squamous cells:squamous intraepithelial lesions (ASC:SIL) ratio pre- and postimplementation of TBS 2001 to see if there was an increase in unsatisfactory specimens, ASC rate, and altered ASC:SIL ratio. Pap Tests (569,726) reviewed at the Cytopathology Laboratory of Women and Infants Hospital from 1998-2002 were included. TBS 1991 terminology was used through December 31, 2001. Conversion to TBS 2001 took place on January 1, 2002. The average ASC:SIL ratios pre- and postimplementation of TBS 2001 were 1.52:1 and 1.42:1, respectively. The rates of unsatisfactory specimens and ASC remained unchanged. Conversion to TBS 2001 did not adversely affect the ASC:SIL ratio or the detection rates of abnormalities of Pap tests.