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    Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results

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    Authors
    Manga, Simon
    Parham, Groesbeck
    Benjamin, Nkoum
    Nulah, Kathleen
    Sheldon, Lisa Kennedy.
    Welty, Edith
    Ogembo, Javier Gordon
    Bradford, Leslie
    Sando, Zacharie
    Shields, Ray
    Welty, Thomas
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    UMass Chan Affiliations
    Department of Obstetrics and Gynecology
    Document Type
    Journal Article
    Publication Date
    2015-10-01
    Keywords
    Female Urogenital Diseases and Pregnancy Complications
    Maternal and Child Health
    Obstetrics and Gynecology
    Women's Health
    
    Metadata
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    Link to Full Text
    https://doi.org/10.1097/LGT.0000000000000133
    Abstract
    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 site
    DOI
    10.1097/LGT.0000000000000133
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42788
    PubMed ID
    26164295
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1097/LGT.0000000000000133
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