title: Interobserver variability of cervical cytology in HIV-infected women.
abstract: OBJECTIVE
  Our objectives were to determine the reproducibility of cytological specimen interpretation between two pathologists in human immunodeficiency virus (HIV)-infected women (from the VIHGY, ANRS CO17 study of human papillomavirus genital pathology among HIV-positive women) and to analyse the improvement, if any, between conventional and liquid-based cytology (LBC) interpretations.
  
  
  METHODS
  A sample of all abnormal and 40% of randomly selected normal Papanicolaou (Pap) tests was randomly ordered and read blindly by a second pathologist using the revised Bethesda terminology 2001. For both conventional and liquid-based preparations, unweighted and Cicchetti-Allison-weighted kappa and their 95% confidence intervals (CIs) were calculated. Kappa values were then compared using the Altman rule to classify the reproducibility of cytological specimen interpretation.
  
  
  RESULTS
  Two hundred and seventy-seven conventional Pap tests were reviewed, including 79 abnormal and 10 unsatisfactory results. Overall agreement between the two observers was 78%, with an estimated Cicchetti-Allison-weighted kappa of 0.69 (95%CI, 0.61-0.77). The corresponding values for the 268 LBCs, including 123 abnormal and two unsatisfactory results, were 84% and 0.82 (95%CI, 0.76-0.87), respectively. The reproducibility of LBC interpretations was significantly higher than that of conventional preparations (P = 0.009) and, for both laboratories, the percentages of unsatisfactory results were significantly lower for LBC.
  
  
  CONCLUSIONS
  In HIV-infected women in the combination antiretroviral therapy era, the strength of agreement was better for LBCs than for conventional preparations, with a lower percentage of unsatisfactory results. When available, LBC should be preferred because of its higher reproducibility.
authors.affiliation: Centre National de Référence des papillomavirus humains, Institut Pasteur, Paris, France.|Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Heard
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Paris, France.|INSERM, UMR_S 1136, Paris, France.|INSERM TRANSFERT, Cergy Pontoise, France.
authors.forename: V
authors.initials: V
authors.lastname: Potard
authors.affiliation: Laboratoire Cerba, Cergy Pontoise, France.
authors.forename: C
authors.initials: C
authors.lastname: Bergeron
authors.affiliation: Laboratoire Cartier, Paris, France.
authors.forename: I
authors.initials: I
authors.lastname: Cartier
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Paris, France.|INSERM, UMR_S 1136, Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Costagliola
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000473:pathology*; D006801:Humans; D015337:Multicenter Studies as Topic; D015588:Observer Variation; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*
keywords: cervical cancer screening; conventional cytology; human immunodeficiency virus; interobserver variation; liquid-based cytology; reproducibility