Qualitative analysis of value judgments in interpreting cervicovaginal smears using the Bethesda system.

CONTEXT: We hypothesize that there are unrecognized value judgments that influence cytopathologists in interpreting borderline cervicovaginal smears and that these judgments contribute to the well-documented variation among cytopathologists regarding such diagnoses.

OBJECTIVE

To identify and map these values.

DESIGN

Survey consisting of Kodachromes and histories for 5 borderline smears. Respondents were asked to give their diagnoses, recommendations for treatment, and reasoning.

RESULTS

We demonstrated a wide variation in interpretation of borderline smears similar to previous studies. We then used inductive qualitative analysis to identify the clinical reasoning and value judgments that influenced the responses.

CONCLUSIONS

We mapped those diagnostic value judgments that should be used in evaluation borderline cases. We believe this map can be used to rigorously manage and standardize the use of such judgments.