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Observer variability among colposcopists from the West Midlands region
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Etherington, I. J., Luesley, D. M., Shafi, M. I., Dunn, Janet A., Hiller, Louise and Jordan, J. A. (1997) Observer variability among colposcopists from the West Midlands region. BJOG: An International Journal of Obstetrics and Gynaecology, 104 (12). pp. 1380-1384. doi:10.1111/j.1471-0528.1997.tb11007.x
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Official URL: https://doi.org/10.1111/j.1471-0528.1997.tb11007.x
Abstract
Objective To assess variation in diagnoses and management decisions among colposcopists when
presented with cervical images; to see the impact of the referral cytology report on diagnostic
accuracy.
Design A two-part video questionnaire study.
Participants Colposcopists from West Midlands Region
Methods Twenty cervical images displaying a range of transformation zones from normal through
varying abnormalities up to cervical intraepithelial neoplasia (CIN) grade 3 were shown on video
tape together with basic patient information. Two sets of videos were made, the second being
identical to the first other than including the referral cytology. Participants recorded their diagnoses
and management decisions on prepared questionnaires. The two sets of videos were viewed several
weeks apart.
Results Completed questionnaires to both videos were received from 30 colposcopists. Diagnostic
accuracy improved with knowledge of the cervical cytology result in cases of CIN 213 (x2 = 19.45,
P < 0.0001) but not where the histology was CIN 1 or less (x2 = 2.64, P = 0.10). Overall interobserver
agreement improved slightly from K = 0.1 69 to K = 0.21 2 when the cytology was revealed.
While only 2.6% of cases of CIN 213 would have been under-managed after the second
questionnaire, 37.5% cases where the abnormality did not amount to CIN would have been overtreated.
Conclusion There is considerable inter-observer variability and variation in diagnostic accuracy in
scoring cervical images particularly at the lower end of the spectrum of abnormality which has the
potential to lead to over-treatment. We rely considerably on the cervical cytology result in forming a
diagnosis. We recommend that a see-and-treat approach be abandoned when the referral smear
shows minor abnormalities. The study has implications for both training and audit in colposcopy
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RG Gynecology and obstetrics | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | BJOG: An International Journal of Obstetrics and Gynaecology | ||||||
| Publisher: | Blackwell Publishing | ||||||
| ISSN: | 1470-0328 | ||||||
| Official Date: | December 1997 | ||||||
| Dates: |
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| Volume: | 104 | ||||||
| Number: | 12 | ||||||
| Page Range: | pp. 1380-1384 | ||||||
| DOI: | 10.1111/j.1471-0528.1997.tb11007.x | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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