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


Objectives: The objective of the study was to evaluate and compare the test performance of visual inspectionwith acetic acid (VIA) by a physician and nurse so as to evaluate the feasibility and efficacy of training a nursein interpreting VIA.
Methods: It was a cross sectional study conducted in the colposcopy clinic at the Universityteaching hospital. 406 women who fulfilled the selection criteria underwent VIA done by both physician andnurse and the findings were interpreted independently. This was followed by colposcopy done by a gynecologistblinded to the results of VIA and directed biopsy was taken if indicated. The diagnostic efficacy was calculatedseparately for physician and nurse using threshold of cervical intraepithelial neoplasia (CIN) 2 and above andconcordance of results between the physician and nurse was determined by kappa statistics.
Results: VIA byphysician had a higher sensitivity (88.89% versus 80%) and a higher specificity (69.81% versus 54.85%) withdisease 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 usingVIA as a preliminary screening method. Intensive training and periodic reinforcement sessions are needed soas to reduce the false positive results.