title: Cervical Cancer Screening in Cameroon: Interobserver Agreement on the Interpretation of Digital Cervicography Results.
abstract: OBJECTIVE
  The World Health Organization recommends visual inspection with acetic acid (VIA) for cervical cancer screening in resource-limited settings. In Cameroon, we use digital cervicography (DC) to capture images of the cervix after VIA. This study evaluated interobserver agreement of DC results, compared DC with histopathologic results, and examined interobserver agreement among screening methods.
  
  
  METHODS
  Three observers, blinded to each other's interpretations, evaluated 540 DC photographs as follows: (1) negative/positive for acetowhite lesions or cancer and (2) assigned a presumptive diagnosis of histopathologic lesion grade in the 91 cases that had a histopathologic diagnosis. Observer A was the actual screening nurse; B, a reproductive health nurse; C, a gynecologic oncologist; and D, the histopathologic diagnosis. We compared inter-rater agreement of DC impressions among observers A, B, and C, and with D, with Cohen kappas.
  
  
  RESULTS
  For interpretations of DC, (negative/positive) strengths of agreement of paired observers were the following: A/B, moderate [K, 0.54; 95% confidence interval (CI), 0.47-0.61], A/C, fair (K, 0.37; 95% CI, 0.29-0.44), and B/C, moderate (K, 0.45; 95% CI, 0.37-0.53). For presumptive pathologic grading, strengths of agreement for weighted Ks were as follows: A/B, moderate (K, 0.42; 95% CI, 0.28-0.56); A/C, fair (K, 0.33; 95% CI, 0.20-0.46); B/C, fair (K, 0.54; 95% CI, 0.40-0.67); A/D, moderate (K, 0.59; 95% CI, 0.45-0.74); B/D, moderate (K, 0.58; 95% CI, 0.46-0.70); and C/D, moderate (K, 0.50; 95% CI, 0.37-0.63).
  
  
  CONCLUSIONS
  Interobserver agreement of DC interpretations was mostly moderate among the 3 observers, between them and histopathology, and comparable to that of other visual-based screening methods, i.e., VIA, cytology, or colposcopy.
authors.affiliation: 1Cameroon Baptist Convention Health Services, Bamenda, Cameroon; 2Catholic University of Central Africa, Yaoundé, Cameroon; 3University of North Carolina, NC, USA; 4University of Massachusetts, Boston, MA, USA; 5University of Massachusetts Medical School, Worcester, MA, USA; 6Yaoundé Gyneco-Obstetric and Pediatric Hospital, Yaoundé, Cameroon; and 7The Hill Group, Bellingham,WA, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Manga
authors.forename: Groesbeck
authors.initials: G
authors.lastname: Parham
authors.forename: Nkoum
authors.initials: N
authors.lastname: Benjamin
authors.forename: Kathleen
authors.initials: K
authors.lastname: Nulah
authors.forename: Lisa Kennedy
authors.initials: LK
authors.lastname: Sheldon
authors.forename: Edith
authors.initials: E
authors.lastname: Welty
authors.forename: Javier Gordon
authors.initials: JG
authors.lastname: Ogembo
authors.forename: Leslie
authors.initials: L
authors.lastname: Bradford
authors.forename: Zacharie
authors.initials: Z
authors.lastname: Sando
authors.forename: Ray
authors.initials: R
authors.lastname: Shields
authors.forename: Thomas
authors.initials: T
authors.lastname: Welty
mesh_terms: D002163:Cameroon; D003127:Colposcopy / Q000379:methods*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D015588:Observer Variation; D010781:Photography; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*