Introduction After the transition toward the HPV-based screening protocol, which has led to an increase in sensitivity, and in order to bring back the specificity to acceptable values, cytology underwent a change of approach becoming a triage test. For these reasons, in the Tuscany region (after the recommendations of the GISCi document), it was decided to reduce, as much as possible, the use of ASC-US category in cytology triage, classifying these morphological cases as NILM or LSIL, basing on the grade of nuclear atypia. So, in Italy, in a cytology triage context (HPV primary screening), a modified Bethesda system (TBS) is currently used. Aims of this study were to evaluate the performances of the review activity of 384 cytology triage cases and of the cervical cancer screening indicators (sensitivity and specificity for CIN2+ lesions) using the TBS 2014 or the modified TBS. Materials and Methods 384 HPV positive cases at one-year recall (192 with a cytology result of NILM both at baseline and at one-year recall; 192 with a cytology result of NILM at baseline, but abnormal at one-year recall), all with a histological confirmed result (128 CIN2+, 256 ≤ CIN1), were selected and their baseline pap tests were reviewed in blind mode by 5 expert cytologists. Results The cytological results of NILM were confirmed for 92.5% and 83.8% of cases using TBS 2014 or modified TBS respectively. 20/128 CIN2+ cases could have been reported at the baseline cytology triage, causing an anticipatory effect and an improvement in sensitivity of the screening protocol at baseline (+15.6%). Using TBS 2014, the number of false positives more than tripled respect to the modified TBS 2014, with a significative increase of unnecessary colposcopies (+11.4%). Discussion/Conclusion This work demonstrated that a greater expertise of cytologists, acquired during the following three years of experience with cytological triage, and a strong IQC system could lead to the identification of a significant number of lesions reported to baseline rather than at one-year recall (diagnostic anticipation).

中文翻译：

---

基于 HPV 的初级筛查环境中细胞学分类的准确性和可重复性：384 项巴氏试验的修订。

简介 在转向基于 HPV 的筛查方案后，敏感性有所提高，并且为了将特异性恢复到可接受的值，细胞学方法发生了变化，成为分类测试。由于这些原因，在托斯卡纳地区（根据 GISCi 文件的建议），决定尽可能减少在细胞学分类中使用 ASC-US 类别，将这些形态学病例分类为 NILM 或 LSIL，根据关于核异型性的等级。因此，在意大利，在细胞学分类（HPV 初级筛查）中，目前使用的是改良的 Bethesda 系统 (TBS)。本研究的目的是使用 TBS 2014 或改良版 TBS 评估 384 例细胞学分诊病例的审查活​​动以及宫颈癌筛查指标（CIN2+ 病变的敏感性和特异性）的表现。材料和方法 384 例一年回忆时 HPV 阳性病例（192 例基线时和一年回忆时细胞学结果均为 NILM；192 例基线时细胞学结果为 NILM，但一年回忆时异常），全部选择具有组织学确认结果（128 CIN2+，256 ≤ CIN1）的患者，并由 5 名细胞学家专家以盲法模式审查其基线巴氏检查。结果使用TBS 2014或改良TBS分别有92.5%和83.8%的病例证实了NILM的细胞学结果。基线细胞学分类时可能报告了 20/128 CIN2+ 病例，从而产生预期效果并提高基线筛查方案的敏感性 (+15.6%)。使用TBS 2014，误报数量比修改后的TBS 2014增加了两倍多，不必要的阴道镜检查显着增加（+11.4%）。讨论/结论这项工作表明，细胞学家在接下来三年的细胞学分诊经验中获得了更丰富的专业知识，加上强大的 IQC 系统，可以识别出基线报告的大量病变，而不是一年后报告的病变。回忆（诊断预期）。