Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results
Authors
Manga, SimonParham, Groesbeck
Benjamin, Nkoum
Nulah, Kathleen
Sheldon, Lisa Kennedy.
Welty, Edith
Ogembo, Javier Gordon
Bradford, Leslie
Sando, Zacharie
Shields, Ray
Welty, Thomas
UMass Chan Affiliations
Department of Obstetrics and GynecologyDocument Type
Journal ArticlePublication Date
2015-10-01Keywords
Female Urogenital Diseases and Pregnancy ComplicationsMaternal and Child Health
Obstetrics and Gynecology
Women's Health
Metadata
Show full item recordAbstract
OBJECTIVE: The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods. METHOD: Three observers, blinded to each other's interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas. RESULTS: For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47-0.61], A/C, fair (K, 0.37; 95% CI, 0.29-0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37-0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28-0.56); A/C, fair (K, 0.33; 95% CI, 0.20-0.46); B/C, fair (K, 0.54; 95% CI, 0.40-0.67); A/D, moderate (K, 0.59; 95% CI, 0.45-0.74); B/D, moderate (K, 0.58; 95% CI, 0.46-0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63). CONCLUSIONS: Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.Source
J Low Genit Tract Dis. 2015 Oct;19(4):288-94. doi: 10.1097/LGT.0000000000000133. Link to article on publisher's siteDOI
10.1097/LGT.0000000000000133Permanent Link to this Item
http://hdl.handle.net/20.500.14038/42788PubMed ID
26164295Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1097/LGT.0000000000000133