Turkish Journal of Pathology

Türk Patoloji Dergisi

Turkish Journal of Pathology

Turkish Journal of Pathology

2017, Vol 33, Num, 3     (Pages: 177-191)

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

Arzu SAĞLAM 1, Alp USUBÜTÜN 1, Anıl DOLGUN 2, George L. MUTTER 3, M. Coşkun SALMAN 4, Olcay KURTULAN 1, Aytekin AKYOL 1, Eylem AKAR ÖZKAN 5, Sema BAYKARA 6, Dilek BÜLBÜL 7, Zerrin CALAY 8, Funda EREN 9, Derya GÜMÜRDÜLÜ 10, Nihan HABERAL 5, Şennur İLVAN 8, Şeyda KARAVELİ 11, Meral KOYUNCUOĞLU 12, Bahar MÜEZZİNOĞLU 13, Kamil Hakan MÜFTÜOĞLU 14, Özlem ÖZEN 5, Necmettin ÖZDEMİR 15, Elif PEŞTERELİ 11, Çağnur ULUKUŞ 12, Osman ZEKİOĞLU 15

1 Department of Pathology, Hacettepe University, Medical Faculty, ANKARA, TURKEY
2 Department ofBiostatistics, Hacettepe University, Medical Faculty, ANKARA, TURKEY
3 Department of Pathology, Brigham and Women&
4 Department of Obstetrics & Gynecology, Hacettepe University, Medical Faculty, Ankara, Turkey
5 Department of Pathology, Baskent University, Medical Faculty, ANKARA, TURKEY
6 Uludag University, Medical Faculty, BURSA, TURKEY
7 Etlik Zubeyde Hanim Women&
8 Istanbul University Cerrahpasa, Medical Faculty, ISTANBUL, TURKEY
9 Marmara University, Medical Faculty, ISTANBU L, TURKEY
10 Cukurova University, Medical Faculty, Ada na, Turkey, 11Akdeniz University, Medical Faculty, ANTALYA, TURKEY
12 Dokuz Eylül University, Medical Faculty, IZMİR, TURKEY
13 Kocaeli University, Medical Faculty, KOCAELİ, TURKEY
14 Zekai Tahir Women&
15 Ege University, Medical Faculty, IZMİR, TURKEY

DOI: 10.5146/tjpath.2017.01400
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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.

Keywords : Interobserver reproducibility, SIL, CIN, Diagnosis, Gynecologist