In Reply: Dr Mulkey raises 2 concerns about the validity of comparing clinical center to QC diagnoses: (1) that QC diagnoses were rendered "in an idealized setting, with no apparent time restraints on review" which is different from clinical practice and (2) that the QC diagnoses were used for academic and not for patient care purposes. In fact, the workload of both the clinical centers and the QC pathologist in this large trial was extremely demanding and precluded the luxury of leisurely review. Moreover, an important purpose of the QC review was to serve as a safety net and to ensure all involved that the patients could be followed up throughout the trial without undue risk. While clinical management depended primarily on the clinical center diagnoses, QC group interpretations also affected patient care.
Stoler MH, Schiffman M. Interobserver Agreement About Cervical Cytologic and Histologic Diagnosis—Reply. JAMA. 2001;285(22):2855–2856. doi:10.1001/jama.285.22.2855
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