Cervical Cancer Screening by Visual Inspection with Acetic Acid - Interobserver Variability between Nurse and Physician


Objectives: The objective of the study was to evaluate and compare the test performance of visual inspection with acetic acid (VIA) by a physician and nurse so as to evaluate the feasibility and efficacy of training nurses in interpreting VIA.
Methods: This cross sectional study was conducted in the colposcopy clinic at the University teaching hospital. A total of 406 women who fulfilled the selection criteria underwent VIA done by both physician and nurse and the findings were interpreted independently. This was followed by colposcopy carried out by a gynecologist blinded to the results of VIA and a directed biopsy was taken if indicated. The diagnostic efficacy was calculated separately for physician and nurse using threshold of cervical intraepithelial neoplasia (CIN) 2 and above and concordance of results between the physician and nurse was determined by kappa statistics.
Results: VIA by physician had a higher sensitivity (88.89% versus 80%) and a higher specificity (69.8% versus 54.9%) with disease threshold of CIN 2 and above. The concordance of results showed moderate agreement (kappa=0.366).
Conclusion: Trained nurses can be an effective alternative human resource for cervical cancer screening using VIA as a preliminary screening method. Intensive training and periodic reinforcement sessions are needed so as to reduce false positive results.