Premium
Using the ASC:SIL ratio, human papillomavirus, and interobserver variability to assess and monitor cytopathology fellow training performance
Author(s) -
Chebib Ivan,
Rao Rema A.,
Wilbur David C.,
Tambouret Rosemary H.
Publication year - 2013
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.29
H-Index - 57
eISSN - 1934-6638
pISSN - 1934-662X
DOI - 10.1002/cncy.21328
Subject(s) - cytopathology , medicine , squamous intraepithelial lesion , human papillomavirus , cytology , malignancy , population , oncology , gynecology , cervical cancer , cervical intraepithelial neoplasia , cancer , pathology , environmental health
BACKGROUND The goal of this study was to assess objective measurements of cytopathology fellow performance during their training. METHODS The authors examined cytopathology performance characteristics (the ratio of atypical squamous cells to squamous intraepithelial lesions [ASC:SIL], interobserver variability [IOV], high‐risk human papillomavirus [hr‐HPV]–positive atypical squamous cells of undetermined significance [ASC‐US]) of cytopathology fellows and assessed whether they could be used as tools to further their education. RESULTS The ASC:SIL ratio, the proportion of hr‐HPV–positive ASC‐US, and IOV were calculated for 5 consecutive cytopathology fellows. The average ASC:SIL ratio for the fellows was 1.15. The overall average Cohen κ‐coefficient (κ‐value) between fellow and cytopathologist interpretation was 0.75 (substantial agreement). The conditional κ‐value for ASC‐US only was higher for cases the fellows called ASC‐US (0.70) than for cases the cytopathologist called ASC‐US (0.60). Of the cases that were diagnosed as “negative for intraepithelial lesion or malignancy” (NILM) by the fellow and ASC‐US by the pathologist, 33.2% were positive for hr‐HPV. This was higher than the expected frequency of hr‐HPV–positive results in the NILM population, suggesting that the fellows were over‐interpreting NILM in hr‐HPV–positive cases that had cytologic features sufficient for an ASC‐US interpretation. CONCLUSIONS In this study, agreement was compared between trainee and cytopathologist to determine where a fellow's interpretation differed. With the use of IOV, the ASC:SIL ratio, and the percentage of hr‐HPV–positive results in the NILM, ASC‐US, and low‐grade SIL categories, the authors attempted to outline objective assessments and areas of improvement for fellows before they enter independent practice. Cancer (Cancer Cytopathol) 2013;121:638–43. © 2013 American Cancer Society.