Agreement among Colposcopists on the Identification of Three Digital Images More Frequently Seen in Glandular Cervical Precursor Neoplasias

Abstract

Background: Global strategies to eliminate cervical cancer will probably be followed by a drop in prevalence of precursor cervical neoplasias, leading to the need of improving colposcopic diagnostic performance that may negatively be affected. The aim of this study was to assess agreement among five colposcopists regarding the presence of three isolated colposcopic images, and different degrees of colposcopic findings. Methods: In this retrospective study, two original colposcopists examined colposcopic images of patients treated between 2005 and 2018, classified them following the International Federation for Cervical Pathology and Colposcopy terminology, and evaluated them for the presence of obstructed dilated grouped glands, aceto-white villi with invaginated borders fused or not, and atypical vessels in cylindrical epithelium area. Posteriorly, three independent colposcopists also classified those colposcopic findings. The degree of agreement between the findings of the three independent, and the two original colposcopists was assessed using the Kappa (κ) coefficient. Results: Among the 822 included patients, 67.4% had a diagnosis of cervical intraepithelial neoplasia (CIN) grades 2 or 3, 6.8% of adenocarcinoma in situ, and 11.8% of CIN 1. The agreement for each image ranged from κ 0.14 to 0.37 (p < 0.001). The highest agreements occurred for aceto-white villi with invaginated borders (κ 0.15–0.37), major (κ 0.29–0.46), and minor (κ 0.14–0.36) colposcopic findings (p ≤ 0.001). Conclusions: The agreement among the three independent, and the two original colposcopists was statistically significant, ranging from weak to regular for the identification of three isolated colposcopic images, and from weak to moderate for the identification of major and minor colposcopic findings.