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Discrepancy in the Interpretation of Cervical Histology by Gynecologic Pathologists

From the Department of Obstetrics and Gynecology and Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii; and Clinical Pathology Associates, Louisville, Kentucky.

Address reprint requests to: Mary F. Parker, MD, 3 English Ivy Court, Rockville, MD 20854; E-mail: parker{at}tatrc.org.

OBJECTIVE: To determine if subspecialty review of cervical histology improves diagnostic consensus of cervical intra-epithelial neoplasia (CIN).

METHODS: After routine histologic assessment within the hospital pathology department, 119 colposcopic cervical biopsies were interpreted by two subspecialty-trained gynecologic pathologists (GYN I and GYN II) blinded to each other’s interpretations and to the interpretations of the hospital general pathologists (GEN). Biopsies were classified as normal (including cervicitis), low grade (LG, including CIN I and human papillomavirus changes), and high grade (HG, including CIN II/III). The interobserver agreement rates between GEN and GYN I, between GEN and GYN II, and between GYN I and GYN II were described using the statistic. The proportions of biopsies assigned to each biopsy class were compared using McNemar test.

RESULTS: Interobserver agreement rates between GEN and GYN I were moderate for normal ( = 0.53) and LG ( = 0.46) and excellent for HG ( = 0.76). There were no significant differences in the classifications between GEN and GYN I. Interobserver agreement rates between GEN and GYN II were moderate for normal ( = 0.50) and LG ( = 0.44) and excellent for HG ( = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P < .001) and less likely to classify biopsies as LG (P < .001). The interobserver agreement rates between GYN I and GYN II were moderate for normal ( = 0.61) and LG ( = 0.41) and excellent for HG ( = 0.84). Also, GYN II was significantly more likely to classify biopsies as normal (P < .001) and less likely to classify biopsies as LG (P = .01).

CONCLUSION: Interobserver agreement between two gynecologic pathologists was no better than that observed between general and gynecologic pathologists. Subspecialty review of cervical histology does not enhance diagnostic consensus of CIN.

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