title: Interrater Variability in Diagnosis of Cervical Biopsies from Women with HIV-1: Results from the Women's Interagency HIV Study.
abstract: OBJECTIVE
  To determine interrater variability in classifying cervical biopsies from women with human immunodeficiency virus (HIV).
  
  
  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.
authors.affiliation: *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.
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authors.lastname: Massad
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authors.lastname: Melnick