Interobserver Variability of the International Federation of Gynecology and Obstetrics Staging in Cervical Cancer

Tummers, Philippe MD*†; Gerestein, Kees MD, PhD*; Mens, Jan Willem MD; Verstraelen, Hans MD, PhD; van Doorn, Helena MD, PhD*

International Journal of Gynecological Cancer: June 2013 - Volume 23 - Issue 5 - p 890–894
doi: 10.1097/IGC.0b013e318292da65
Cervical Cancer

Objective: The objective of this study was to assess the interobserver variability of pelvic examination under anesthesia (EUA) in cervical cancer.

Methods: Subsequent patients undergoing a staging procedure under anesthesia for primary cervical cancer were enrolled in the study. All clinicians assessed “blinded” tumor size, and the involvement of vagina, parametria, sacrouterine ligaments, pelvic sidewalls, bladder, and/or rectum. Items were scored varying from 1 (“certainly no involvement”), 2 (“not sure about involvement”), to 3 (”involvement”). Each individual decided on the International Federation of Gynecology and Obstetrics (FIGO) stage; also, the urge for imaging and treatment proposal were accounted for. Final FIGO staging was obtained by consensus of the team. Investigators were classified as experienced after more than 50 EUAs. All others were classified less experienced. The free-marginal κ values between experienced and less experienced investigators were calculated for all previously mentioned items.

Results: Between February 2009 and December 2010, a total of 86 patients were enrolled. Among experienced investigators, a moderate interobserver agreement was found with regard to FIGO stage (free-marginal κ value of 0.49) and an excellent interobserver agreement on their proposed therapy (free-marginal κ value of 0.84). A lower level of agreement was found when comparing experienced with less experienced investigators: only a slight level of agreement on FIGO stage and a substantial agreement on their therapy proposal (free-marginal κ values of 0.03 and 0.66).

Conclusions: We describe only a moderate interobserver agreement on clinical staging of patients with cervical cancer. The interobserver agreement increases in the group of experienced doctors, indicating that EUA can be learned.

*Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands; †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospital Ghent, Ghent, Belgium; and ‡Department of Radiotherapy, Erasmus University Medical Center, Rotterdam, the Netherlands.

Address correspondence and reprint requests to Philippe Tummers, MD, De Pintelaan 185, 9000 Gent, Belgium. E-mail: philippe.tummers@ugent.be.

The research and its publication were entirely funded by the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands.

The authors declare no conflicts of interest.

Received November 12, 2012

Accepted March 17, 2013

Copyright © 2013 by IGCS and ESGO