Interobserver Variability and Cytotechnologist Performance in Digital Cervical Cytology: An International European Federation of Cytological Societies Study
ABSTRACT Background Whole‐slide imaging (WSI) is increasingly incorporated into digital cervical cytology workflows; however, interpretive variability in borderline and low‐grade squamous lesions remains a recognized diagnostic challenge. This study evaluated interobserver agreement among cytotechnologists in WSI‐based cervical cytology, focusing on borderline and low‐grade squamous lesions. Methods Sixty‐eight cervical cytology cases (31 ASC‐US, 19 NILM, 18 LSIL) were independently assessed by 19 cytotechnologists across two WSI‐based evaluation rounds. One participant was excluded due to incomplete evaluations in Round 1. Interobserver agreement was evaluated using Fleiss' kappa, Kendall's W , intraclass correlation coefficient, Krippendorff's alpha, Cronbach's alpha and Spearman rank correlation. Conclusions Digital assessment using WSI demonstrated moderate interobserver agreement among cytotechnologists, with the greatest variability observed in ASC‐US cases. Repeated evaluation was associated with high internal consistency. Findings are compatible with interpretive variability; WSI‐specific effects cannot be excluded without a direct comparator. Paired rater medians did not differ significantly (4.38 vs. 4.00 min; p = 0.090).
Authors
- Ľubomír Rusňák
- Ivana Kholová (ORCID: https://orcid.org/0000-0003-4089-0450)
- Danijela Vrdoljak‐Mozetič (ORCID: https://orcid.org/0000-0002-2964-8885)
- Mohammed S. I. Mansour (ORCID: https://orcid.org/0000-0002-0271-3659)
- Martina Krehelova
- Philippe Seurat
- Maria Nasioutziki (ORCID: https://orcid.org/0000-0002-4891-2071)
- Zuzana Urbancikova
- Hervé Debaque
- Arrigo Capitanio (ORCID: https://orcid.org/0000-0002-9086-6814)
- Hatice Elmas (ORCID: https://orcid.org/0000-0002-9796-9197)
- Ambrogio Fassina (ORCID: https://orcid.org/0000-0002-5737-2249)
- Giovanni Negri (ORCID: https://orcid.org/0000-0002-9194-8782)
- Laura Ventura (ORCID: https://orcid.org/0000-0001-7322-998X)
- Vladimir Bašić
- Mária Bačová (ORCID: https://orcid.org/0000-0001-8056-3476)
- Lia J. M. van Zuijlen‐Manders
- Béatrix Cochand‐Priollet
- Corinne Selle
- Sara Bazzon (ORCID: https://orcid.org/0009-0000-1244-255X)
- Stacke K.A. (ORCID: https://orcid.org/0009-0005-1354-2532)
- Mária Lőkösová
- David Backlund (ORCID: https://orcid.org/0009-0001-6822-0857)
- Elena Schulmeister
- Katrína Hakošová
- Daniel Carrasco Bernal (ORCID: https://orcid.org/0009-0007-9961-246X)
- Sandra Bessac
- Lorena Quintana Barrilero
- Nadine Eckert
- Carolina Anton Lorenzo
Institutions
- University of Padua (IT)
- University of Rijeka (HR)
- Universität Hamburg (DE)
- Tampere University (FI)
- University of Eastern Finland (FI)
- Lund University (SE)
- Kristianstad University (SE)
- Université Paris Cité (FR)
- Aristotle University of Thessaloniki (GR)
- Sundsvall Municipality (SE)
- Sahlgrenska University Hospital (SE)
- Radboud University Medical Center (NL)
- Ospedale di Bolzano (IT)
- Hôpital Cochin (FR)
- Centre Léon Bérard (FR)
- University Medical Center Hamburg-Eppendorf (DE)
- Ippokrateio General Hospital of Thessaloniki (GR)
- Klinički Bolnički Centar Rijeka (HR)
- Centre de Recherche en Cancérologie de Lyon (FR)
- German Center for Lung Research (DE)
- Fimlab (Finland) (FI)
- Clinica Universidad de Navarra (ES)
- Max Planck Institute for Molecular Genetics (DE)
- Laboratoire National de Santé (LU)
- Norra Älvsborgs Länssjukhus (SE)
- Linköping University Hospital (SE)
- Hallands sjukhus Halmstad (SE)
- University of Tampere (FI)
- Unilabs (Switzerland) (CH)
- Freie Universität Berlin (DE)
- Universidad de Navarra (ES)
- Jönköping University (SE)
Publication Details
- Journal
- Cytopathology
- Published
- 2026-10-29
- DOI
- https://doi.org/10.1111/cyt.70141
- Primary Topic
- Cervical Cancer and HPV Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00