ORIGINAL ARTICLE Bethesda Interobserver Reproducibility Study-2 (BIRST-2): Bethesda System 2014 Daniel F. I. Kurtycz, MD a, *, Paul N. Staats, MD b , Deborah J. Chute, MD c , Donna Russell, SCT (ASCP) d , Derek Pavelec, PhD a , Sara E. Monaco, MD e , Maria A. Friedlander, MPA, CT (ASCP) f , David C. Wilbur, MD g , Ritu Nayar, MD h a Department of Pathology and Laboratory Medicine and the Wisconsin State Laboratory of Hygiene, University of Wisconsin-Madison, Madison, Wisconsin b Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland c Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio d Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York e Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania f Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York g Harvard University and Massachusetts General Hospital, Boston, Massachusetts h Department of Pathology, Northwestern University, Chicago, Illinois Received 8 March 2017; accepted 27 March 2017 KEYWORDS Bethesda system; Cervical cytology; Web survey; Reproducibility study; Cervical screening Introduction In concert with the 2014 update to the Bethesda System for Reporting Cervical Cytology, a Web-based image interobserver study was performed to evaluate concordance with the “expert panel” inter- pretation, as was done during the Bethesda 2001 update. The aim was to identify cytomorphologic features and Bethesda reporting categories that represent sources of poor interobserver agreement and see how the trends compared to the first Bethesda Interobserver Reproducibility Study (BIRST). Materials and methods Participants were recruited online through national and international cytopathology professional societies. Study participants evaluated 84 previously unpublished web images chosen from the third Bethesda Atlas image set, prior to the release of the atlas. These images spanned all reporting categories and included typical and borderline cytomorphology. Demographic information was collected on level of training, practice patterns, and experience of the participants. Participation was restricted to those correctly answering 2 basic cytopathology questions, ensuring minimal knowledge of gynecologic cytopathology. Results A total of 1290 unique individuals attempted access to this Web-based study and 833 correctly answered the two qualifying questions. Of these, 518 respondents completed the survey. Participant origin *Corresponding author: Daniel F.I. Kurtycz, MD; Department of Pathology and Laboratory Medicine, University of Wisconsin, School of Medicine and Public Health, Wisconsin State Laboratory of Hygiene, 465 Henry Mall, Madison, WI 53792; Tel.: 608-262-9461; Fax: 608-265-6294. E-mail address: dkurtycz@wisc.edu (D.F.I. Kurtycz). 2213-2945/$36 Ó 2017 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jasc.2017.03.003 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.jascyto.org/ Journal of the American Society of Cytopathology (2017) 6, 131e144