Türk Patoloji Dergisi (Sep 2017)

Diagnostic and Treatment Reproducibility of Cervical Intraepithelial Neoplasia / Squamous Intraepithelial Lesion and Factors Affecting the Diagnosis

  • Arzu SAĞLAM,
  • Alp USUBÜTÜN,
  • Anıl DOLGUN,
  • George L. MUTTER,
  • M. Coşkun SALMAN,
  • Olcay KURTULAN,
  • Aytekin AKYOL,
  • Eylem AKAR ÖZKAN,
  • Sema BAYKARA,
  • Dilek BÜLBÜL,
  • Zerrin CALAY,
  • Funda EREN,
  • Derya GÜMÜRDÜLÜ,
  • Nihan HABERAL,
  • Şennur İLVAN,
  • Şeyda KARAVELİ,
  • Meral KOYUNCUOĞLU,
  • Bahar MÜEZZİNOĞLU,
  • Kamil Hakan MÜFTÜOĞLU,
  • Özlem ÖZEN,
  • Necmettin ÖZDEMİR,
  • Elif PEŞTERELİ,
  • Çağnur ULUKUŞ,
  • Osman ZEKİOĞLU

DOI
https://doi.org/10.5146/tjpath.2017.01400
Journal volume & issue
Vol. 33, no. 3
pp. 177 – 191

Abstract

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Objective: Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of “cervical intraepithelial neoplasia” (CIN) and “squamous intraepithelial lesion” (SIL) diagnoses. Material and Method: 19 pathologists evaluated 66 cases once using H&E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. Results: We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic “styles” and gynecologists had management “styles”. Conclusion: In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.

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