Interobserver Variability and Cytotechnologist Performance in Digital Cervical Cytology: An International European Federation of Cytological Societies Study

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).