Vet Dermatol 2012 DOI: 10.1111/j.1365-3164.2012.01075.

Reproducibility of a semiquantitative method to assess

cutaneous cytology
Svenja C. Budach and Ralf S. Mueller
Small Animal Medicine Clinic, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University, Veterinaerstraße 13, 80539 Munich,
Germany
Correspondence: Ralf S. Mueller, Small Animal Medicine Clinic, Centre for Clinical Veterinary Medicine Ludwig Maximilian University,
Veterinaerstraße 13, 80539 Munich, Germany. E-mail: ralf.mueller@med.vetmed.uni-muenchen.de

Background – Cutaneous cytology is used in veterinary dermatology to assess bacteria and yeast on the skin
surface and in the ears for diagnostic purposes and to monitor treatment success. A number of methods were
used in reported studies to quantify micro-organisms on cytology, but evaluation of the intra- and interobserver
reliability of the methods is rare.
Objective – The aim of this study was to evaluate the intra- and interobserver reliability of a semiquantitative
cytology assessment method frequently used in practice.
Methods – A total of 60 experienced and inexperienced veterinarians and veterinary students were asked to
evaluate 10 glass slides and 18 photographs of cutaneous cytology twice. Cocci, rods, yeast, neutrophilic and
eosinophilic granulocytes and macrophages were graded from 0 to 4+.
Results – The intra-observer reproducibility for evaluating the slides in the experienced group was 84.3%; in the
inexperienced group it was 82.6%. For the photographs, the intra-observer reproducibility was 92.1% in both
groups. The interobserver reproducibility for evaluating the slides was 81.6 and 81.0% in the experienced and
inexperienced group, respectively; corresponding values for the photographs were 91.0 and 90.0%. There was
no significant difference between different participants or between the first and second evaluation by each partic-
ipant for any of the parameters graded.
Conclusion and clinical importance – Based on these results, this semiquantitative method of grading can be
recommended for evaluating and monitoring of antimicrobial therapy in daily practice.

ogy is also often used in practice to monitor treatment of

Introduction
Skin and ear diseases are common presenting complaints
in small animal practice and are often associated with
microbial infections that need to be diagnosed with appro-
priate tests.1,2 The most time-efficient and most practical
way to evaluate micro-organisms and cells on the skin
surface is to perform cutaneous cytology.1 Cytology can
rapidly provide information regarding the presence and
type of infectious agents and ⁄ or inflammatory cells. Spec-
imens can be obtained easily and inexpensively from the
ear or skin. The most common micro-organisms involved
in skin and ear diseases are Staphylococcus spp., i.e.
S. (pseud)intermedius in dogs and S. aureus and
S. pseudintermedius in cats,3,4 Pseudomonas aerugin-
osa3,4 and Malassezia pachydermatis.5,6 Rod-shaped bac-
teria on cutaneous cytology may indicate Gram-negative
bacteria that may be resistant to many antibiotics
commonly used in veterinary dermatology, thus a bacte-
rial culture and susceptibility may be indicated.7,8 Cytol-
Accepted 11 May 2012
This study was published as an abstract of the North American
Veterinary Dermatology Forum, Vet Dermatol 2011; 22: 301.
Sources of Funding: This study was self funded.
Conflict of Interest: No conflicts of interest have been declared.
cutaneous microbial infections. When clinical signs have
resolved and organisms are absent from cytology, ther-
apy is considered successful in the authors’ experience.
The use of cytology is widespread and there are different
methods of quantification used to document clinical
improvement,9,10 but to the authors’ knowledge there are
no studies evaluating their inter- and intra-observer repro-
ducibility.
The aim of this study was to evaluate a commonly used
semiquantitative assessment of cutaneous cytology for
its intra- and interobserver reproducibility.
Materials and methods
Examiners
A total of 60 examiners participated in the study. They were divided
into two groups. The experienced group (n = 29) evaluated >10
slides per week and the inexperienced group (n = 31) evaluated <10
samples weekly. In the inexperienced group, the academic status
ranged from students of veterinary medicine to practitioners. In the
experienced group, there were Diplomates of the European College
of Veterinary Dermatology (n = 6) and Veterinary Oncology (n = 1),
doctoral students (n = 12) and residents (n = 5) of those Diplomates
and practitioners with substantial experice of veterinary dermatology
over several years (n = 5). Some of them conducted the evaluations
at the VeterinaryTeaching Hospital, while others participated during
a 2 day conference where the photographs, slides and two

ª 2012 The Authors. Veterinary Dermatology

ª 2012 ESVD and ACVD, Veterinary Dermatology 1
Budach and Mueller
microscopes were available for assessment of the specimens at a
stand in the exhibition hall.
Specimen collection and processing
Impression smears and swabs were taken from the skin and ear
canals, respectively, of dogs and cats presented to the dermatology
service. A glass slide (Assistent Elka Objektträger; Glaswarenfabrik
Karl Hecht, GmbH & Co. KG, Sondheim, Germany) was gently
pressed onto the affected skin, immediately removed and labelled. In
animals with otitis externa, a swab (Glaswarenfabrik Karl Hecht.
GmbH & Co. KG) was inserted in the ear canal, rotated through
360 degrees several times and removed. The material obtained was
rolled onto a glass microscope slide. The samples were air dried, heat
fixed and stained by one of the authors (S.C.B.) with a modified
Wright’s stain (Diff Quik; Medion Diagnostics AG, Düdingen, Switzer-
land). All samples were analysed by the same investigator using a
translucent upright microscope (BX51; Olympus Imaging Europa,
Hamburg, Germany) with a ·100 nonoil lens, a digital camera (Color-
View IIIu; Olympus Imaging Europa GmbH) and additional imaging
software (AnalySIS docu; Olympus Imaging Europa GmbH). A total
of 50 slides were analysed and 260 photographs taken. Of these, 10
suitable glass slides and 18 photographs were selected for the
assessment trial. Three drops of mounting medium (EUKITT Mount-
ing Medium; EMS, Hatfield, PA, USA) were applied to each glass
microscope slide, and a coverslip was placed on top, avoiding air bub-
bles. The photographs were printed out and laminated to protect
them during the examination (Creative Laminator A4; Northbrook, IL,
USA). Each slide or photograph was labelled with two different ran-
domly chosen numbers between 1 and 100, one number for each
examination cycle.
Specimen evaluation
The examiners were asked to evaluate six different categories using
a semiquantitative scale ranging from 0 to 4+. The criteria of the
scale ranging from 0 to 4+ are shown in Table 1 and were provided
to each examiner prior to evaluation of the slides and photographs.
Examiners evaluated cocci, rods, yeast, neutrophilic and eosinophilic
granulocytes and macrophages separately. Each examiner was
asked to evaluate a total of 10 slides and 18 photographs twice, at
least 6 h apart. Additionally, examiners were asked to state whether
bacteria (if present) were intracellular or not. The order and number-
ing of the slides and photographs were changed for the second eval-
uation. Experienced examiners were asked to evaluate the slides
without any further guidelines other than Table 1. Less experienced
participants were advised to scan the slides using a lower magnifica-
tion for areas with material present and subsequently evaluate areas
of interest with a higher magnification in more detail.The available
microscopes had ocular lenses of ·10 magnification and objectives
with ·4, ·10, ·40 and ·100 magnifications, resulting in a final
magnification of ·40, ·100, ·400 and ·1000. Each examiner com-
pleted an examination sheet documenting examiner data, date, time
and the results of the evaluation.
Table 1. Classification of the semiquantitative scale
Classification Description
0 No bacteria ⁄ yeast ⁄ inflammatory cells
1+ Occasional bacteria ⁄ yeast ⁄ inflammatory cells
present, but slide must be scanned carefully for
detection
2+ Bacteria ⁄ yeast ⁄ inflammatory cells present in low
numbers, but detectable rapidly without difficulties
3+ Bacteria ⁄ yeast ⁄ inflammatory cells present in larger
numbers and detectable rapidly without any
difficulties
4+ Massive amounts of bacteria ⁄ yeast ⁄ inflammatory
cells present and detectable rapidly without
difficulties
2 ª 2012 ESVD and ACVD, Veterinary Dermatology
Assessment of reproducibility
For intra-observer reproducibility, the results of both evaluations of
each slide ⁄ photo were compared. The percentage agreement was
calculated. Evaluations were considered in agreement if they differed
by no more than one grade. If, however, one of the grades was 0,
then agreement was considered present only if the second grade
was 0 as well. For statistical evaluation of the comparison, the data
pairs of single examiners were analysed using a Wilcoxon signed-
ranks test.
For interobserver reproducibility, the results of the first examina-
tion of each slide ⁄ photo from each of the examiners were compared
with the mean value of all examinations. An evaluation was consid-
ered correct when the grade was less than one grade different from
the mean of all evaluations for that slide. Statistically, the results of
the first evaluation of each examiner were compared with a Fried-
mann test and Dunn’s post hoc test. The results of experienced and
nonexperienced clinicians were compared in a similar manner. A
P-value of <0.05 was considered significant. A percentage agree-
ment of >80% was considered clinically acceptable.
The qualitative agreement of the assessment of intracellular bacte-
ria was determined using a j-test. A j-value from 1 to 0.8 repre-
sented an almost perfect agreement, 0.79–0.6 a substantial
agreement, 0.59–0.4 a moderate agreement, 0.39–0.2 a fair agree-
ment, 0.19–0.0 a poor agreement and below 0 no agreement.11
Results
Examiners
A total of 29 of 60 examiners (48.3%) were classified as
experienced and 31 (51.7%) as inexperienced. Four of
the experienced group were male and 25 female; in the
inexperienced group, there were four males and 27
females. The academic status ranged from students of
veterinary medicine to Diplomates of the European Col-
lege of Veterinary Dermatology.
Specimen evaluation
Slides were evaluated by 26 experienced clinicians in
the first examination cycle. Twenty-one evaluated all 10
specimens; five did not evaluate all slides. Twenty-five
people evaluated the slides a second time; 21 of them
evaluated all 10 specimens. A total of 1439 of 1452 in
the first and 1428 of 1428 evaluations in the second
examination cycle were included for analysis. Data
sheets without complete documentation were excluded
from analysis.
In the inexperienced group, the slides were evalu-
ated by 27 participants in the first examination cycle;
21 of them evaluated all specimens. Eighteen of 21
participants evaluated the slides a second time. A total
of 1476 of 1488 in the first and 1032 of 1032 evalua-
tions in the second examination cycle were included in
the analysis.
The evaluation of the photographs was performed by
all participants in the experienced group in the first exami-
nation cycle. In the second examination cycle, the photo-
graphs were evaluated by 25 investigators. The number
of evaluations analysed were 3097 of 3108 for the first
and 2694 of 2700 for the second cycle.
In the less experienced group, 28 people evaluated the
photographs in the first examination cycle. The
photographs were evaluated the second time by 25
investigators. In total, 2949 of 3018 examinations from
the first and 1944 of 1944 from the second cycle were
included in the final analysis.
ª 2012 The Authors. Veterinary Dermatology
 Semiquantitative cytology

Assessment of intra-observer reproducibility Table 3. Intra-observer reproducibility for each category in the expe-
The intra-observer reproducibility describes the agree- rienced group evaluating photographs
ment between two evaluations of the same investigator Mean ± SD Confidence
of the same cytology slide or photograph. The mean per- Category agreement (%) Median ± SD interval P-value
centage agreement of all investigators and categories Cocci 85.5 ± 7.5 1.0 ± 1.6 1.5–1.7 0.3212
taken together and their standard deviation in the experi- Rods 90.9 ± 2.5 0.0 ± 1.1 0.4–0.6 0.1362
enced (inexperienced) group for cytology slides was Yeast 94.2 ± 2.5 0.0 ± 1.0 0.4–0.6 0.2269
84.3 ± 6.2% (82.6 ± 6.9%). For photographs, the agree- Neutrophilic 92.3 ± 5.0 2.0 ± 1.4 1.5–1.8 0.4887
granulocytes
ment was 92.1 ± 4.7% (92.1 ± 4.4%). The mean per-
Eosinophilic 96.6 ± 5.0 0.0 ± 0.4 0.1–0.2 0.7007
centage agreement, the median values, standard granulocytes
deviations and confidence intervals of each category, as Macrophages 94.0 ± 2.5 0.0 ± 0.7 0.2–0.3 0.3319
well as the significance levels of the comparison of the
first and second evaluations of experienced examiners
are presented in Tables 2 and 3; values for the nonexperi-
Table 4. Interobserver reproducibility for each category in the expe-
enced examiners were very similar. There was no signifi- rienced group evaluating microscope slides
cant difference between the two evaluations for any
Mean ± SD Confidence
category, with the exception of the evaluation of macro-
Category agreement (%) Median ± SD interval
phages on microscopic slides and cocci and neutrophils
on photographs by the group of inexperienced clinicians. Cocci 64.6 ± 20.0 1.5 ± 1.3 0.8–2.6
Rods 89.4 ± 10.0 1.5 ± 1.3 0.6–2.5
Yeast 86.4 ± 12.5 0.0 ± 1.1 0.0–1.5
Assessment of interobserver reproducibility Neutrophilic 71.5 ± 20.0 1.4 ± 1.7 0.4–2.8
The interobserver reproducibility was assessed by calcu- granulocytes
lating the agreement of the results of the first examina- Eosinophilic 93.9 ± 5.0 0.0 ± 0.2 0.0–0.2
tion cycle from different investigators. The mean granulocytes
percentage agreement ± SD in evaluating the micro- Macrophages 83.8 ± 12.5 0.0 ± 0.8 0.0–1.0
scopic samples in the experienced (inexperienced) group
was 81.6 ± 14% (81 ± 14%). The evaluation of the pho-
tographs achieved an interobserver reproducibility of Table 5. Interobserver reproducibility for each category in the expe-
90.9 ± 9.4% (90 ± 9.7%). The percentage agreement, rienced group evaluating photographs
median value and confidence interval of each category for Mean ± SD Confidence
experienced examiners are presented in Tables 4 and 5; Category agreement (%) Median ± SD interval
the values for inexperienced examiners were almost iden- Cocci 82.3 ± 15.0 1.1 ± 1.4 0.7–2.3
tical. There was no significant difference between investi- Rods 90.9 ± 10.0 0.0 ± 1.1 0.0–1.1
gators for any of the categories. Yeast 92.3 ± 10.0 0.0 ± 1.0 0.0–1.0
Neutrophilic 90.2 ± 12.5 1.4 ± 1.4 0.9–2.3
Intracellular bacteria granulocytes
Eosinophilic 96.6 ± 5.0 0.0 ± 0.4 0.0–0.3
The qualitative agreement of the assessment of intracel-
granulocytes
lular bacteria was determined using a j-test. The j-values Macrophages 93.4 ± 5.0 0.0 ± 0.6 0.0–0.6
of cocci are shown in Table 6.

Discussion Table 6. Average j-values of the assessment of intracellular cocci

Intra- Intra-
In this study, a semiquantitative method for assessing
observer observer Interobserver Interobserver
cutaneous cytology has shown a clinically acceptable experienced inexperienced experienced inexperienced
intra- and interobserver reproducibility, with no significant
Photographs 0.6 0.6 0.4 0.3
difference between either two subsequent evaluations of
Slides 0.7 0.3 0.4 0.2
a single observer or between the assessments of differ-
ent experienced and less experienced clinicians.
Both groups had similar size and gender distribution. In
both groups, females were over-represented. This distri-
Table 2. Intra-observer reproducibility for each category in the expe- bution correlates with the gender distribution of veteri-
rienced group evaluating cytology slides nary students in Germany. Many of the investigators
Mean ± SD Confidence
evaluated the specimens during a 2 day conference. This
Category agreement (%) Median ± SD interval P-value was the reason why a high number of inexperienced
examiners did not complete the second examination. The
Cocci 80.1 ± 12.5 1.0 ± 1.3 1.4–1.7 0.9058
Rods 87.2 ± 2.5 0.0 ± 1.4 0.6–0.9 0.3231
environment at the conference, with time pressure and
Yeast 86.2 ± 5.0 0.0 ± 1.1 0.6–0.8 0.1511 distractions for participants, was not ideal at all times and
Neutrophilic 82.3 ± 10.0 1.0 ± 1.6 1.4–1.8 0.4054 may have influenced the concentration of the examiners.
granulocytes The higher completion rate in the experienced group may
Eosinophilic 93.2 ± 0.3 0.0 ± 0.3 0.03–0.1 0.5138 be due to the ability to evaluate slides and photographs
granulocytes more rapidly using a proposed semiquantitative scale.
Macrophages 80.4 ± 7.5 0.0 ± 0.9 0.4–0.6 0.6274
Another limiting factor may have been the decreasing
ª 2012 The Authors. Veterinary Dermatology
ª 2012 ESVD and ACVD, Veterinary Dermatology 3
Budach and Mueller
quality of the specimens. Three of the 10 glass micro-
scope slides broke during the conference, and not all par-
ticipants were able to evaluate all specimens. The initial
participants were students and staff working at the veteri-
nary teaching hospital, and therefore there were no time
constraints to complete both evaluations. Results were
considered reproducible, confirming that this method is
suited for daily practice.
A semiquantitative rather than a quantitative scale was
applied for two reasons. Firstly, this simple scale is often
used in daily practice as a rapid and practical way to diag-
nose microbial skin infections and assess treatment out-
come. Secondly, a previous study evaluated different
quantitative methods and did not achieve satisfactory
results.12 Pappalardo et al.10 used a similar semiquantita-
tive classification to examine anal sac secretion of healthy
and sick dogs. The grades were defined as 0 (absent), +
(few), ++ (moderate) and +++ (abundant), and 10 ran-
domly selected fields were evaluated.10 Nobre et al.13
used the same scale to classify results of otic cytology
but assigned a range of numbers to each step () = nega-
tive, + = 1–5, ++ = 6–10, and +++ > 10). However, in
these studies reproducibility of the results was not exam-
ined.
In the present study, the results were considered
reproducible when they coincided exactly or when they
did not differ by more than one grade from the mean of all
evaluations. The exception was a negative result. If one
evaluation had a negative result, the second one had to
be negative as well to be considered reproducible. This
approach was selected because clinical consequences
rarely differ if there are many or massive numbers of
microbes present in the ear canal. In contrast, if none or a
few are present, treatment recommendations may differ.
There was no mandatory way of evaluation. Partici-
pants were asked to perform the evaluation as they usu-
ally do in routine practice. If inexperienced examiners
asked, it was suggested to scan the slides initially using a
lower magnification for areas with material present and
subsequently evaluate the areas of interest with a higher
magnification in more detail. This method corresponds to
what is described to be appropriate for analysing cytologi-
cal samples.1,9,14 This may have led to a more uniform
approach to assessing the slide specimens in the inexpe-
rienced group and thus a higher reproducibility than with
a completely random approach. In practices with several
veterinarians, it may be sensible to agree on the above
assessment method to maximize reproducibility between
individuals.
The experienced group achieved marginally higher
intra-observer reproducibility with microscopic slides than
the inexperienced group (84.3 versus 82.6%). The experi-
enced group had more experience using microscopes,
which could explain the higher agreement. However, the
difference between groups was not statistically signifi-
cant. Thus, experience did not seem to have a prominent
influence on reproducibility, but rather an effect on the
speed of evaluation, although that parameter was not
evaluated in this study. In the evaluation of photographs,
both groups achieved an agreement of 92.1%. For
interobserver reproducibility, both groups achieved simi-
lar agreement.
4 ª 2012 ESVD and ACVD, Veterinary Dermatology
In both groups, agreement was higher with the evalua-
tion of photographs for both inter- and intraobserver
reproducibility compared with the evaluation of glass
slides. On the photographs, each investigator evaluated
the same high-power field in both examination cycles.
This may explain the higher agreement. Regarding the
individual categories, cocci in almost all cases had the
lowest agreement values. Cocci can easily be mistaken
for melanin granules or detritus.1 Changing the focus is
helpful for distinction on glass slides, but this is not possi-
ble with photographs. This may have contributed to the
decreased agreement.
Rods and eosinophilic granulocytes achieved the high-
est values of agreement in both groups. Interobserver
variation tends to be higher at lower counts.9,14 If a per-
son was not comfortable with recognizing all categories
and consequently considered all specimens negative, the
chances of achieving a higher agreement were greater
with cells or micro-organisms that occurred only rarely. In
this study, rods and eosinophilic granulocytes were cer-
tainly the structures least frequently encountered.
Another reason for the high agreement values for eosino-
philic granulocytes could be their unique appearance due
to their pink granules.
An unacceptably low agreement was found with inex-
perienced examiners with respect to determining
whether or not cocci were intracellular or not. The com-
bination of greater experience and confidence in evaluat-
ing cytological samples might have led to a higher
agreement in the experienced group. The results
obtained using the j-test indicate that intracellular bacte-
ria are overlooked in some cases, particularly by inexperi-
enced examiners. The j statistical approach is not
perfect for assessing the reproducibility, especially when
there is a high prevalence of agreement, as was the
case with rods. Rods were least prevalent on the glass
microscope slides and photographs, and therefore a
high level of agreement for the category of ‘intracellular’
was expected, thus only the j-values of cocci were
listed.
The results obtained in this study cannot be compared
with the results of other studies, because a different
scale and classification was used. In addition, criteria for
reproducibility were not mentioned in other studies.9,10,15
To the authors’ knowledge, intra-observer reproducibility
and interobserver reproducibility for evaluation of cytolog-
ical samples of more than two investigators have not
been studied.
Cytology should be used as an adjunctive diagnostic
tool, and results have to be interpreted in light of history
and clinical examination of each individual patient. How-
ever, it was not the goal of this study to provide data on
interpretation of cytology results in dogs or cats with skin
problems, but rather to provide evidence for a satisfactory
inter- and intra-observer reproducibility.
In conclusion, satisfactory results were achieved in
both groups for the evaluation of microscope slides as
well as photographs of cutaneous cytology for both
inter- and intra-observer reproducibility. Based on these
results, this semiquantitative evaluation method can be
recommended for the use in daily practice and for thera-
peutic monitoring.
ª 2012 The Authors. Veterinary Dermatology
 Semiquantitative cytology

Acknowledgements 8. Martin Barrasa JL, Lupiola GP, Lama GZ et al. Antibacterial sus-
ceptibility patterns of Pseudomonas strains isolated from chronic
The authors would like to thank Carola Sauter Louis for canine otitis externa. J Vet Med B Infect Dis Vet Public Health
her statistical help. 2000; 47: 191–196.
9. Ginel PJ, Lucena R, Rodriguez JC et al. A semiquantitative cyto-
logical evaluation of normal and pathological samples from the
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Résumé
Contexte – La cytologie cutanée est utilisée en dermatologie vétérinaire pour évaluer la présence de
bactéries et de levures à la surface de la peau et dans les oreilles à des fins diagnostics ainsi que pour éva-
luer la réussite d’un traitement. Un certain nombre de méthodes a été utilisé dans les études rapportées
pour dénombrer les micro-organismes en cytologie mais la concordance de l’évaluation intra et inter-ob-
servateur de ces méthodes est rare.
Objectif – Le but de cette étude était d’évaluer la concordance intra et inter-observateur d’une cytologie
semi-quantitative, méthode d’évaluation fréquemment utilisée en pratique.
Méthodes – Un total de 60 vétérinaires expérimentés, non expérimentés et d’étudiants vétérinaires ont
évalué 10 lames en verre et 18 photographies de cytologie cutanée à deux reprises. Une note de 0 à 4 + a
été attribuée aux cocci, bâtonnets, levures, granulocytes neutrophiles et éosinophiles.
Résultats – La reproductibilité intra-observateur pour l’évaluation des lames était de 84.3% dans le groupe
expérimenté, et de 82.6% dans le groupe inexpérimenté. Pour les photographies, la reproductibilité était
de 92.1% dans les deux groupes. La reproductibilité inter-observateur pour l’évaluation des lames était re-
spectivement de 81.6 et 81.0% dans les groupes expérimenté et non expérimenté; les valeurs correspon-
dantes pour les photographies étaient de 91.0 et 90.0%. Il n’y avait pas de différence significative entre les
différents participants ou entre la première et la seconde évaluation par chaque participant quelque soit le
paramètre évalué.
Conclusion et importance clinique – Ces résultats suggèrent que la méthode de notation semi-quantita-
tive peut être recommandée pour l’évaluation et le suivi des traitements antimicrobiens en pratique quotidi-
enne.

Resumen
Introducción – la citologı́a cutánea se utiliza en dermatologı́a veterinaria para determinar la presencia de
bacterias y levaduras en la superficie de la piel y en los oı́dos con fines diagnósticos y para revisar el éxito
del tratamiento. Un número diferente de métodos han sido utilizados en estudios publicados para cuantifi-
car los microorganismos en la citologı́a, pero es raro que se evalúen la fiabilidad de las observaciones a ni-
vel de investigador y entre investigadores.
Objetivo – el propósito de este estudio fue evaluar la fiabilidad a nivel de investigador y entre investiga-
dores de un método semicuantitativo de evaluación de la citologı́a usado con frecuencia en la práctica vete-
rinaria.
Métodos – un total de 60 veterinarios experimentados e inexpertos y de estudiantes veterinarios evalua-
ron 10 preparaciones citológicas y 18 fotografı́as de citologı́a cutánea dos veces. El número de cocos, baci-
los, levaduras, y de neutrófilos, eosinófilos y macrófagos fueron calificados entre 0 y 4+.

ª 2012 The Authors. Veterinary Dermatology

ª 2012 ESVD and ACVD, Veterinary Dermatology 5
Budach and Mueller

Resultados – la reproducibilidad del mismo investigador en la evaluación de las muestras citológicas en el

grupo de veterinarios experimentados fue de 84,3%; en el grupo inexperto de 82,6%. Para las fotografı́as,
la reproductibilidad del mismo observador fue de 92,1% en ambos grupos. La reproductibilidad entre inves-
tigadores en la evaluación de las preparaciones citológicas fue de 81,6 y 81,0% en el grupo experimentado
e inexperto, respectivamente; los valores correspondientes para las fotografı́as fueron de 91,0 y 90,0%.
No hubo diferencia significativa entre diversos participantes o entre la primera y segunda evaluación de
cada participante para los parámetros evaluados.
Conclusión e importancia clı́nica – basados en estos resultados, este método semicuantitativo de evalu-
ación se puede recomendar para examinar y controlar el tratamiento antimicrobiano en la práctica diaria.

Zusammenfassung
Hintergrund – Die Zytologie der Haut wird in der Veterinärdermatologie verwendet, um Bakterien und He-
fepilze auf der Hautoberfläche und in den Ohren zu diagnostischen Zwecken zu beurteilen und um einen
Behandlungserfolg zu überwachen. In veröffentlichten Studien wurde eine Vielzahl von Methoden besch-
rieben, die Mikroorganismen zytologisch quantifizieren, wobei allerdings eine Evaluierung der Ver-
lässlichkeit im Bezug auf Intra-Beobachter und Inter-Beobachter dieser Methoden selten stattgefunden
hat.
Ziel – Das Ziel dieser Studie war eine Evaluierung der Intra-Beobachter und Inter-Beobachter Ver-
lässlichkeit einer semiquantitativen zytologischen Methode, die in der Praxis häufig angewendet wird.
Methoden – Insgesamt wurden 60 erfahrene und unerfahrene TierärztInnen und Veterinärmedizinstuden-
tInnen gebeten 10 Objektträger und 18 Fotos cutaner Zytologie zweimal durchzusehen. Kokken, Stäbchen,
Hefepilze, neutrophile und eosinophile Granulozyten und Makrophagen wurden von 0 bis 4+ beurteilt.
Ergebnisse – Die Intra-Beobachter Reproduzierbarkeit bei der Evaluierung der Objektträger in der erfahre-
nen Gruppe betrug 84,3%; in der unerfahrenen Gruppe 82,6%. Bei den Fotos lag die Intra-Beobachter Rep-
roduzierbarkeit in beiden Gruppen bei 92,1%. Die Inter-Beobachter Reproduzierbarkeit bei der Evaluierung
der Objektträger betrug 81,6% bzw 81,0% in der erfahrenen bzw der unerfahrenen Gruppe; die entspre-
chenden Werte für die Auswertung der Fotos lagen bei 91,0 und 90,0%. Es bestand kein signifikanter Un-
terschied für die beurteilten Parameter zwischen den verschiedenen TeilnehmerInnen oder zwischen der
ersten und zweiten Evaluierung der einzelnen TeilnehmerInnen.
Schlussfolgerung und klinische Bedeutung – Basierend auf diesen Ergebnissen kann diese semiquanti-
tative Beurteilungsmethode für die Evaluierung und die Überwachung der antimikrobiellen Therapie in der
täglichen Praxis empfohlen werden.

ª 2012 The Authors. Veterinary Dermatology

6 ª 2012 ESVD and ACVD, Veterinary Dermatology