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A Study of Variability in the Interpretation of Sputum Cytology Slides

^[1] Department of Chronic Diseases, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland
^[2] Department of Pathology, Hahnemann Medical College, Philadelphia, Pennsylvania
^[3] Department of Pathology, Harper Hospital, Detroit, Michigan
^[4] Department of Pathology, University of Michigan, Ann Arbor, Michigan
^[5] Papanicolaou Cancr Research, Miami, Florida
^[6] St. Joseph Hospital, Lancaster, Pennsylvania

The study reported here was designed to investigate the nature and extent of variability in the malignancy classification of sputum cytologic specimens. The study was conducted in 2 phases. The 1st phase was specifically intended to measure the variability of screeners and cytology centers from multiple reports on the same material. It was shown that screeners differ in their degree of concordance with one another and that the magnitude of this difference is, on the average, somewhat greater for screeners in different centers than for screeners in the same center. The data suggests, however, that a screener will tend to have a greater degree of concordance with his own prior report than with that of another screener.

Cytology center results were assessed by assigning a panel opinion value to each slide based on the data collected and comparing the performance of each cytology center to this standard value. The results indicated generally good agreement on standard negative and standard positive slides, with somewhat less consistent agreement on the intermediate classifications of nonnegative slides.

Evidence was adduced to demonstrate different "levels of suspicion" (in terms of the probabilities of classifying slides) among the 4 participating centers, the most marked instance being a pronounced tendency to underread on the part of the screeners from 1 center, relative to the consensus.

The 2nd phase of the study was an attempt to assess the concordance of the opinions of cytologists without the disturbing influence of screener variability. Because of practical consideration, the data are limited to 5 readings of the slides by 3 cytologists. Overall consistency for non-negative slides was, as expected, better than Phase I results.

The results of this phase suggest another approach to the analysis of ordered categoric classification data when a degree of subjective judgment is involved.

A simple mathematic model of the screening process, together with some numeric illustrations, are given.

Although the data presented here are limited and must be interpreted in the light of a number of reservations, it is hoped that the detailed reporting of the results of this study will stimulate other investigators to examine some of the questions raised.

¹ Deceased; formerly Director, Papanicolaou Cancer Research, Miami, Florida.

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