A statistical analysis of intra-and inter-observer reproducibility in assessing cytologic findings and diagnosis in endometrial smear

Seven cytologic findings were judged and the final diagnosis was determined by 10 cytotechnologists (CTs) for 10 pairs of specimens (20 specimens) and 40 endometrial smears, and the results were compared to assess intraobserver and inter-observer reproducibility, respectively. Although there was a little variation in intra-observer reproducibility, “papillary structure” and “irregular cellular accumulation” showed less agreement. Kappa statistics revealed that “tumor diathesis”, “enlarged nuclei”, and “anisonucleosis” showed better agreement, but “hyperchromasia” and “papillary structure” showed poor agreement with respect to inter-observer reproducibility. Agreement in grading “suspicious” was generally much worse than for “negative” and “positive”. The importance of the cytologic findings that predicted the final diagnosis varied among the CTs. These results suggest that the criteria for assessing malignancy in endometrial cytology are not consistent and that definite criteria need to be established.