OBJECTIVE: To estimate the agreement among multiple expert colposcopists evaluating high-resolution digitized cervigrams taken from patients with a variety of human papillomavirus (HPV) infection states and previous cervigram interpretations. METHODS: Twenty expert colposcopists evaluated 939 digitized images of the uterine cervix obtained after the application of 5% acetic acid during the ASCUS-LSIL Triage Study. Twenty images selected to represent a broad range were graded by all the colposcopists. The remaining 919 pictures were distributed by stratified random sampling, such that each image was evaluated by two colposcopists, and each expert evaluated 112 images with similar distributions of cervigram diagnoses and HPV DNA test results. We evaluated interrater agreement among the pairs of colposcopists and confirmed the conclusions using the 20 images they all graded. RESULTS: Pairs of colposcopists agreed on the diagnosis for only 56.8% of images. Similar agreement was seen regarding number of visible lesions (of low-grade or greater). This variability in ratings remained when the images were stratified by final histologic diagnosis or HPV status. The results were confirmed by the presence of large variability in ratings (ranging in some cases from normal to cancer) for the 20 images graded by all colposcopists. CONCLUSION: Colposcopic diagnosis using static images is poorly reproducible and might reflect similar problems in clinical practice. Researchers should question the use of colposcopic images as a reference standard for teaching and evaluating the presence or severity of disease.
OBJECTIVE: To estimate the agreement among multiple expert colposcopists evaluating high-resolution digitized cervigrams taken from patients with a variety of human papillomavirus (HPV) infection states and previous cervigram interpretations. METHODS: Twenty expert colposcopists evaluated 939 digitized images of the uterine cervix obtained after the application of 5% acetic acid during the ASCUS-LSIL Triage Study. Twenty images selected to represent a broad range were graded by all the colposcopists. The remaining 919 pictures were distributed by stratified random sampling, such that each image was evaluated by two colposcopists, and each expert evaluated 112 images with similar distributions of cervigram diagnoses and HPV DNA test results. We evaluated interrater agreement among the pairs of colposcopists and confirmed the conclusions using the 20 images they all graded. RESULTS: Pairs of colposcopists agreed on the diagnosis for only 56.8% of images. Similar agreement was seen regarding number of visible lesions (of low-grade or greater). This variability in ratings remained when the images were stratified by final histologic diagnosis or HPV status. The results were confirmed by the presence of large variability in ratings (ranging in some cases from normal to cancer) for the 20 images graded by all colposcopists. CONCLUSION: Colposcopic diagnosis using static images is poorly reproducible and might reflect similar problems in clinical practice. Researchers should question the use of colposcopic images as a reference standard for teaching and evaluating the presence or severity of disease.
Authors: Jenna L Mueller; Elizabeth Asma; Christopher T Lam; Marlee S Krieger; Jennifer E Gallagher; Alaattin Erkanli; Roopa Hariprasad; J S Malliga; Lisa C Muasher; Bariki Mchome; Olola Oneko; Peyton Taylor; Gino Venegas; Anthony Wanyoro; Ravi Mehrotra; John W Schmitt; Nimmi Ramanujam Journal: J Low Genit Tract Dis Date: 2017-04 Impact factor: 1.925
Authors: Carolina Porras; Nicolas Wentzensen; Ana C Rodríguez; Jorge Morales; Robert D Burk; Mario Alfaro; Martha Hutchinson; Rolando Herrero; Allan Hildesheim; Mark E Sherman; Sholom Wacholder; Diane Solomon; Mark Schiffman Journal: Int J Cancer Date: 2011-08-02 Impact factor: 7.396
Authors: Nicolas Wentzensen; Joan L Walker; Michael A Gold; Katie M Smith; Rosemary E Zuna; Cara Mathews; S Terence Dunn; Roy Zhang; Katherine Moxley; Erin Bishop; Meaghan Tenney; Elizabeth Nugent; Barry I Graubard; Sholom Wacholder; Mark Schiffman Journal: J Clin Oncol Date: 2014-11-24 Impact factor: 44.544
Authors: Nicolas Wentzensen; Rosemary E Zuna; Mark E Sherman; Michael A Gold; Mark Schiffman; S Terence Dunn; Jose Jeronimo; Roy Zhang; Joan Walker; Sophia S Wang Journal: Gynecol Oncol Date: 2009-09-20 Impact factor: 5.482