Agreement between cytotechnologists and cytopathologists as a new measure of cytopathologist performance in gynecologic cytology

作者：Quinn Andrew M^*; Minhajuddin Abu T; Hynan Linda S; Reisch Joan S; Cibas Edmund S

来源：Cancer Cytopathology, 2017, 125(7): 576-580.

DOI：10.1002/cncy.21856

• agreement
• cytopathologist
• cytotechnologist
• gynecologic
• outlier
• Papanicolaou test
• performance
• quality
• SQL

BACKGROUNDAlthough objective measures of cytotechnologist (CT) and cytopathologist (CP) performance exist, challenges remain. Two assumptions deserve examination: CPs' interpretations are correct, and CTs and CPs render interpretations independently of each other. This study presents a CT-CP interpretation comparison and provides insight into these assumptions.
METHODSEvery gynecologic cytology specimen examined by both a CT and a CP from December 2004 to March 2015 was extracted from the laboratory information system; glandular interpretations were excluded. Excel and SAS were used for CT-CP pair analysis. CT-CP pairs with fewer than 32 specimens (the lowest quartile) were excluded. For the remaining CT-CP pairs, 30 specimens or 10% of the specimens (whichever was higher) were randomly selected for comparison by a weighted statistic. values greater than 0.6 represented good agreement within CT-CP pairs.
RESULTSThis study evaluated 7116 of 53,241 gynecologic cytology specimens (13.4%) that received CT and CP interpretations. This resulted in 155 pair-specific values from 15 CTs and 16 CPs. In aggregate, the values had a mean of 0.64, a standard deviation of 0.14, a median of 0.65, and a range of 0.27 to 0.91. Nine CTs exhibited good agreement in the majority of their pair-specific values with CPs (high-concordance CTs; 88 pair-specific values). This allowed us to identify outlier CPs who did not demonstrate good agreement with high-concordance CTs (16 of 88 pair-specific values [18.2%]).
CONCLUSIONSLaboratories can use this to determine when CP levels of agreement with CTs depart from those of their peers. Adding this to established metrics can give a more nuanced impression of CP performance. Cancer Cytopathol 2017;125:576-80. (c) 2017 American Cancer Society.
This study presents a cytotechnologist-cytopathologist interpretation comparison that provides insight into the assumptions that cytopathologists' interpretations are correct and that they are rendered independently of cytotechnologists' interpretations. By randomly selecting gynecologic cytology specimens evaluated over a 10-year period for comparison with a weighted statistic, this study has identified outlier cytopathologists who do not demonstrate good agreement with high-concordance cytotechnologists, thus providing a more nuanced impression of cytopathologist performance.

• 出版日期2017-7