Discordance Between Cytologist and Cytopathologist Diagnosis in Glandular Lesions on Cervical Cytology: A 13 Month Study at a Large Academic Referral Center

Summary: Introduction: Cervical cytology (CC) requires sophisticated infrastructure of screening by cytologists (CS) with confirmation of selected cases by cytopathologists (CP) and is optimized for squamous, while glandular neoplasia has proven more difficult to detect. Herein, we correlate atypical glandular diagnosis on CC by CS and CP. Materials and Methods: All CC specimens with any atypical glandular diagnosis by CS over a 13-month period were included. Concordance between CS and CP was assessed using one-sided one sample proportion test. Major discrepancy was defined such that patient management would be altered. A generalized linear mixed effect model with a logit link was applied to assess a possible link with years of CS experience. Results were presented by odds ratios for significant score discrepancies associated with years of experience with 95% confidence intervals. Manual review was performed on all slides with major discrepancies. Results: Of the total 296 cases, 121 (41%) showed major discrepancy. The most common pattern was an atypical CS diagnosis followed by a negative CP diagnosis, including: ""Atypical glandular cells, endocervical type (AGC EC)"" (68/138; 49%), ""Atypical glandular cells, not otherwise specified (AGC)"" (31/70; 44%), and ""Atypical glandular cells, endometrial type (AGC EM)"" (19/53; 36%). A statistically significant discrepancy between the CS and CP for AGC (0.17; p-value< 0.001), AGC EC (0.2; p-value< 0.001), and AGC EM (0.37; p-value< 0.034) was noted (Table 1). Generalized linear mixed effect model did not find an association between CS and CP and the years of CP experience across different cohort groups. Manual review showed agreement among three authors (NB, YS, GA) in 99% (294/296) with the CP diagnosis. Conclusions: There was significant discrepancy between the CS and CP for AGC, AGC EC, and AGC EM. Years CS experience did not affect this finding. This study highlights possible differences in thresholds for CS and CP, which warrants further investigation.