Document Detail

Bethesda classification of cervicovaginal smears: reproducibility and viral correlates.
MedLine Citation:
PMID:  8666368     Owner:  NLM     Status:  MEDLINE    
Fifty-five cervicovaginal smears from women with squamous intraepithelial lesions (SILs) were independently evaluated on two separate occasions by four cytopathologists using a binary classification system (the Bethesda system). Smears were categorized as low-grade (LSIL) or high-grade (HSIL) using previously published criteria. All women had subsequent cervical biopsies containing human papillomavirus (HPV) DNA amplified with the polymerase chain reaction and typed by restriction fragment polymorphism analysis. Three or more observers agreed on classification in 49 of 55 cases (87%); unanimous diagnoses were rendered in 31 cases (56%). Interobserver and intraobserver reproducibility ranged from fair to near-excellent (kappa values 0.40 to 0.63; 0.63 to 0.74, respectively). HPV types included HPV 16 (27%), 18 (7%), 31 (9%), 35 (4%), 39 (4%), 6 (10%), 11 (2%), novel types (30%), and multiple types (4%). High-risk HPV types (16, 18, 31, 35, and 39) were significantly associated (P = .03) with consensus HSIL diagnoses (agreement of three or more observers). This was primarily because of the strong association of HPV 16 with HSIL (P = .001). After excluding HPV 16, the other high-risk HPV types (18, 31, 35, and 39) were no longer significantly associated with consensus HSIL diagnoses (P > .5). Conversely, LSIL diagnoses were significantly associated with non-high-risk HPV types (all HPV types except 16, 18, 31, 35, and 39; P = .006). Binary cytological classification of cervicovaginal SILs is reproducible among cytopathologists. Such classification correlates well with most low-risk HPV types and with the prototypic high-risk HPV 16 but not with other high-risk HPV types.
N E Joste; L Rushing; R Granados; J C Zitz; D R Genest; C P Crum; E S Cibas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Human pathology     Volume:  27     ISSN:  0046-8177     ISO Abbreviation:  Hum. Pathol.     Publication Date:  1996 Jun 
Date Detail:
Created Date:  1996-08-05     Completed Date:  1996-08-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9421547     Medline TA:  Hum Pathol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  581-5     Citation Subset:  IM    
Department of Pathology, Division of Cytology, Brigham and Women's Hospital, Boston, MA, USA.
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MeSH Terms
Cervical Intraepithelial Neoplasia / epidemiology,  pathology,  virology
Observer Variation
Papillomaviridae / classification*,  isolation & purification
Papillomavirus Infections / epidemiology,  pathology
Reproducibility of Results
Tumor Virus Infections / epidemiology,  pathology
Uterine Cervical Dysplasia / epidemiology,  pathology,  virology
Uterine Cervical Neoplasms / epidemiology,  pathology,  virology
Vaginal Smears / classification*,  statistics & numerical data

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