title: Cervical cancer screening by visual inspection with acetic acid - interobserver variability between nurse and physician.
abstract: OBJECTIVE
  The objective of the study was to evaluate and compare the test performance of visual inspection with acetic acid (VIA) by a physician and nurse so as to evaluate the feasibility and efficacy of training nurses in interpreting VIA.
  
  
  METHODS
  This cross sectional study was conducted in the colposcopy clinic at the University teaching hospital. A total of 406 women who fulfilled the selection criteria underwent VIA done by both physician and nurse and the findings were interpreted independently. This was followed by colposcopy carried out by a gynecologist blinded to the results of VIA and a directed biopsy was taken if indicated. The diagnostic efficacy was calculated separately for physician and nurse using threshold of cervical intraepithelial neoplasia (CIN) 2 and above and concordance of results between the physician and nurse was determined by kappa statistics.
  
  
  RESULTS
  VIA by physician had a higher sensitivity (88.9% versus 80.0%) and a higher specificity (69.8% versus 54.9%) with a disease threshold of CIN 2 and above. The concordance of results showed moderate agreement (kappa=0.366).
  
  
  CONCLUSIONS
  Trained nurses can be an effective alternative human resource for cervical cancer screening using VIA as a preliminary screening method. Intensive training and periodic reinforcement sessions are needed so as to reduce false positive results.
authors.affiliation: Department of Obstetrics and Gynecology, J. N. Medical College, Nehru Nagar, Belgaum, Karnataka, India. bhavanayatin@rediffmail.com
authors.forename: Bhavana
authors.initials: B
authors.lastname: Sherigar
authors.forename: Anita
authors.initials: A
authors.lastname: Dalal
authors.forename: Geeta
authors.initials: G
authors.lastname: Durdi
authors.forename: Yeshita
authors.initials: Y
authors.lastname: Pujar
authors.forename: Hema
authors.initials: H
authors.lastname: Dhumale
mesh_terms: D019342:Acetic Acid; D000328:Adult; D004396:Coloring Agents; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008403:Mass Screening; D009726:Nurses; D015588:Observer Variation; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000517:prevention & control*
chemical_list: D004396:Coloring Agents; D019342:Acetic Acid