Diagnostic Accuracy and Agreement Between Inter- and Intra-Observers in the Absence of Clinical History for Liquid-Based Preparation of Gynecology Specimens

CONTEXT: The clinical history in cytology is the best source of information to ensure the accuracy of diagnosis, facilitating a slide observer to interpret and relate their findings in screening gynecology slides. AIMS: This study aims to evaluate the performance of slide observers to screen-blinded gynecology slides without providing any information on clinical history. SETTING AND DESIGN: A correlational study design was conducted at the cytology laboratory, Universiti Teknologi MARA Selangor, Puncak Alam Campus. METHODS AND MATERIALS: Fity-seven liquid-based preparation slides from gynecology specimens were screened blindly by five slide observers among Medical Laboratory Technology students who completed the enrollment of the cytology course. STATISTICAL ANALYSIS USED: The inter- and intra-observer reliability testing was measured using the kappa value of Fleiss’ and Cohen's kappa value, respectively, while the diagnostic accuracy without a clinical history was determined by the receiver operating characteristic (ROC) curve. RESULTS: The value of Fleiss’ kappa (κ) was 0.221—this represents a fair strength of agreement between inter-observers. An intra-observer reliability test for each slide observer was analyzed using Cohen's kappa statistic and revealed that the kappa value varied between 0.116 and 0.696, indicating slight-to-substantial agreement between intra-observers. Additionally, the sensitivity value of 94.28%, specificity value of 72.40%, a positive predictive value (PPV) of 37.28%, a negative predictive value (NPV) of 72.40%, a likelihood ratio of 14.43, and the diagnostic accuracy of 75.09% were recorded. CONCLUSIONS: In conclusion, the students (slide observers) from the Centre of Medical Laboratory Technology Studies who took part in this study were able to interpret, classify, and diagnose the LBP gynecologic cytopathological cases into several categories (NILM and ECA) based on the 2001 Bethesda System reporting guideline.