title: Reproducibility of cervical intraepithelial neoplasia diagnosis on histological review of cervical punch biopsies from a visual inspection with acetic acid and HPV detection-based screening program.
abstract: OBJECTIVE
  To assess the reproducibility of cervical intraepithelial neoplasia (CIN) diagnosis in a visual inspection with acetic acid (VIA) and HPV detection-based screening program, and to correlate CIN diagnosis with oncogenic HPV status.
  
  
  METHODS
  A total of 9630 women were screened by VIA and high-risk HPV detection at community outreach clinics in India between June 2011 and June 2012. Biopsies obtained from women who were positive on either test were reviewed by two pathologists blinded to the histological diagnoses originally made by pathologists working at the Chittaranjan National Cancer Institute.
  
  
  RESULTS
  The interobserver agreement between the pathologists' diagnoses and the diagnoses made by the expert reviewers on 424 slides was fair (kappa = 0.26). There was a distinct difference in agreement in detecting CIN 2 (kappa = 0.21) and detecting CIN 3 (kappa = 0.74). The overall agreement in diagnosis improved when the slides obtained from the HPV-positive women were considered (kappa = 0.5). Almost half of the discordant CIN 2 cases were high-risk HPV negative.
  
  
  CONCLUSIONS
  Diagnosis of CIN 2 is poorly reproducible. The natural history of CIN 2 lesions is more similar to CIN 1 than CIN 3; it is therefore necessary to re-evaluate whether to consider CIN 2 lesions as high-grade squamous intraepithelial lesions with CIN 3, as in the Bethesda system of classification.
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Srabani
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Ishita
authors.initials: I
authors.lastname: Ghosh
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Dipanwita
authors.initials: D
authors.lastname: Banerjee
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Surgical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
authors.affiliation: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Raje
authors.initials: R
authors.lastname: Nijhawan
authors.affiliation: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Radhika
authors.initials: R
authors.lastname: Srinivasan
authors.affiliation: Department of Pathology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Chinmayi
authors.initials: C
authors.lastname: Ray
authors.affiliation: Department of Gynecologic Oncology, Chittaranjan National Cancer Institute, Kolkata, India. Electronic address: basupartha@hotmail.com.
authors.forename: Partha
authors.initials: P
authors.lastname: Basu
mesh_terms: D019342:Acetic Acid; D000328:Adult; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007194:India; D008403:Mass Screening; D008875:Middle Aged; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000473:pathology; D015203:Reproducibility of Results; D019035:Rural Health Services; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology
chemical_list: D019342:Acetic Acid
keywords: Cervical cancer screening; Cervical intraepithelial neoplasia; HPV test; Histology; Hybrid Capture 2; Reproducibility; Visual inspection with acetic acid