title: Interobserver variability of the International Federation of Gynecology and Obstetrics staging in cervical cancer.
abstract: OBJECTIVE
  The objective of this study was to assess the interobserver variability of pelvic examination under anesthesia (EUA) in cervical cancer.
  
  
  METHODS
  Subsequent patients undergoing a staging procedure under anesthesia for primary cervical cancer were enrolled in the study. All clinicians assessed "blinded" tumor size, and the involvement of vagina, parametria, sacrouterine ligaments, pelvic sidewalls, bladder, and/or rectum. Items were scored varying from 1 ("certainly no involvement"), 2 ("not sure about involvement"), to 3 ("involvement"). Each individual decided on the International Federation of Gynecology and Obstetrics (FIGO) stage; also, the urge for imaging and treatment proposal were accounted for. Final FIGO staging was obtained by consensus of the team. Investigators were classified as experienced after more than 50 EUAs. All others were classified less experienced. The free-marginal κ values between experienced and less experienced investigators were calculated for all previously mentioned items.
  
  
  RESULTS
  Between February 2009 and December 2010, a total of 86 patients were enrolled. Among experienced investigators, a moderate interobserver agreement was found with regard to FIGO stage (free-marginal κ value of 0.49) and an excellent interobserver agreement on their proposed therapy (free-marginal κ value of 0.84). A lower level of agreement was found when comparing experienced with less experienced investigators: only a slight level of agreement on FIGO stage and a substantial agreement on their therapy proposal (free-marginal κ values of 0.03 and 0.66).
  
  
  CONCLUSIONS
  We describe only a moderate interobserver agreement on clinical staging of patients with cervical cancer. The interobserver agreement increases in the group of experienced doctors, indicating that EUA can be learned.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands. philippe.tummers@ugent.be
authors: Philippe
authors: P
authors: Tummers
authors: Kees
authors: K
authors: Gerestein
authors: Jan Willem
authors: JW
authors: Mens
authors: Hans
authors: H
authors: Verstraelen
authors: Helena
authors: H
authors: van Doorn
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006176:Gynecology; D006801:Humans; D007390:International Agencies; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D015588:Observer Variation; D009774:Obstetrics; D017773:Pelvic Floor / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery