2017 Volume 66 Issue 5 Pages 486-492
The Bethesda System (TBS) and the guideline based on TBS clearly indicate the clinical management of cases with atypical “indefinite for dysplastic or malignant” cells by defining the categories of “atypical squamous cells (ASC)” and “atypical glandular cells (AGC)”. However, there still remain some cases with atypical metaplastic cells that are difficult to categorize on the basis of TBS. In this study, we tried to find the discrepancies in the diagnoses of atypical metaplastic cells between diagnosticians, and discussed the problems. Four pathologists and twenty cytotechnologists (CT) in five hospitals independently diagnosed different photo slides of eighteen atypical metaplastic cells on the basis of TBS, and the results of the diagnoses were statistically analyzed. Correlations between the diagnoses of each pathologist and CT were quite low. The kappa coefficients ranged from −0.17 to 0.39, and poor or fair agreement did not correlate with experience or specialty. In this study, the correlation of the present TBS-based diagnoses of atypical metaplastic cells was quite poor between diagnosticians. Recent reports indicate high-risk human papillomavirus (HPV) infection in atypical immature metaplasia of the uterine cervix; thus, it seems important to discuss the diagnostic criteria and clinical management of these atypical metaplastic cells.
