Interrater Variability in Diagnosis of Cervical Biopsies from Women with HIV-1: Results from the Women's Interagency HIV Study

S L Massad; L Kirstein; T Darragh; P Bitterman; M Sidawy; L Muderspach; O Abulafia; E Salzer; H Watts; S Melnick

doi:10.1046/j.1526-0976.2000.44002.x

Interrater Variability in Diagnosis of Cervical Biopsies from Women with HIV-1: Results from the Women's Interagency HIV Study

J Low Genit Tract Dis. 2000 Oct;4(4):190-4. doi: 10.1046/j.1526-0976.2000.44002.x.

Authors

S L Massad¹, L Kirstein, T Darragh, P Bitterman, M Sidawy, L Muderspach, O Abulafia, E Salzer, H Watts, S Melnick

Affiliation

¹ *Division of Gynecologic Oncology, Cook County Hospital, Chicago, IL; †Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD; ‡Department of Pathology, University of California, San Francisco, CA; §Department of Pathology, Rush Medical College, Chicago, IL; ∥Department of Pathology, George Washington University Medical Center, Washington, DC; **Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, CA; ††Department of Obstetrics and Gynecology, SUNY-Downstate Medical Center, Brooklyn, NY; ‡‡Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, NY; §§National Institute for Child Health and Human Development, Bethesda, MD; and ∥∥National Cancer Institute, Bethesda, MD.

PMID: 25951153
DOI: 10.1046/j.1526-0976.2000.44002.x

Abstract

Objectives: To determine interrater variability in classifying cervical biopsies from women with human immunodeficiency virus (HIV).

Materials and methods: Cervical biopsies performed on women participating in the Women's Interagency HIV Study (WIHS) were read at the six participating sites. A 10% random sample was retrieved and reviewed using standardized terminology by pathologists with a special interest in gynecologic pathology. Results were compared with kappa values and Mantel-Haentzel tests.

Results: Biopsies from 288 HIV-seropositive and 24 HIV-seronegative women were reviewed. The weighted kappa value of 0.67 indicated moderate to strong agreement between original and review diagnoses, with a range of 0.54 to 0.84 across sites. No cancers were identified. Significantly more specimens showing cervical intraepithelial neoplasia (CIN) grade 2 or 3 were identified by review pathologists (p = .02). CIN2 or CIN3 was graded less severely by local pathologists in 18 (51%) of 35 cases, all from HIV-seropositive women. Local pathologists' diagnoses of CIN2 or CIN3 were downgraded by reviewers in 4 of 21 cases (19%). Discrepancies were more common among women with lower CD4 lymphocyte counts.

Conclusions: Although discrepancies occur, interrater correlation in the interpretation of cervical biopsies from women with HIV is moderate to strong.