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Interobserver Variability of Colposcopic Interpretations and Consistency with Final Histologic Results

Sideri, Mario1; Spolti, Noemi1; Spinaci, Laura1; Sanvito, Francesca2; Ribaldone, Raffaella2; Surico, Nicola2; Bucchi, Lauro3

Journal of Lower Genital Tract Disease: July 2004 - Volume 8 - Issue 3 - p 212-216
Original Articles

Objective. To evaluate the interobserver reliability of colposcopy and the prediction of final histologic results.

Materials and Methods. Visibility of the squamocolumnar junction, presence and grading of atypical transformation zone (ATZ), and presence and grading of cervical intraepithelial neoplasia (CIN) were assessed by nine expert colposcopists in 100 cervigrams. Pairwise κ, group κ, and class-specific κ values were computed. Frequency and degree of interobserver disagreement on CIN and ATZ grading and correlation with histologic results were studied.

Results. The median pairwise κ and the group κ values were excellent for ATZ detection, acceptable for the squamocolumnar junction, and poor for the other variables; the presence of ATZ had a sensitivity for CIN of 90.2% and a specificity of 48.6%; the colposcopic impression of high-grade CIN had a sensitivity of 54.4% and a specificity of 88%.

Conclusions. Some colposcopic predictions are reproducible between observers, predictive of the histologic results, and can be integrated in the algorithm for the management of patients with abnormal Pap smear results.

The study shows that cervical colposcopic pattern is representative of disease grade and is correlated to final histology.

1European Institute of Oncology, Milano, Italy; 2Clinic of Obstetric and Gynecology, University of Novara, Novara, Italy; and the 3Romagna Cancer Registry, Forli', Italy

Reprint requests to: Mario Sideri, via Ripamonti 435, 20141 Milano, Italy. E-mail:

©2004The American Society for Colposcopy and Cervical Pathology