Gynocology
Computerized planimetry versus clinical assessment for the measurement of cervical ectopia,☆☆

https://doi.org/10.1067/mob.2001.113125Get rights and content

Abstract

Objective: As part of a study to assess the role of cervical ectopia in the acquisition of cervical infections, we determined the reliability of cervical ectopia measurements made by computer planimetry and by clinical (visual) assessment. Study Design: We conducted pelvic examinations of 1004 women seeking contraceptive services at two health centers in Baltimore. After application of acetic acid, clinicians estimated the relative area of ectopia by visual inspection and took cervical photographs. Two independent raters measured the absolute and relative areas of ectopia from the digitized images by means of an analytic software program. Agreement levels between raters, between multiple readings by the same rater, and between the two measurement methods were quantified by means of the intraclass correlation coefficient and weighted κ. Results: Intrarater agreement was excellent for computer planimetry measurements of the absolute (intraclass correlation coefficient, 0.97) and relative (intraclass correlation coefficient, 0.89) areas of ectopia. Interrater agreement was also high for computer planimetry measurements of the absolute (intraclass correlation coefficient, 0.83) and relative (intraclass correlation coefficient, 0.85) areas of ectopia. Agreement levels were moderate between clinician assessment and computer planimetry measurements of the relative area of ectopia (κ = 0.48), but agreement was better when clinical assessment was limited to observations by a single, experienced clinician. Conclusion: Measurement of cervical ectopia by computer planimetry was highly reliable and appears appropriate for assessment of the role of ectopia in the acquisition of cervical infections. Clinical assessment of cervical ectopia may be used when computer planimetry is not available. (Am J Obstet Gynecol 2001;184:1170-6.)

Section snippets

Material and methods

This research study was approved by the Protection of Human Subjects Committee of Family Health International, Research Triangle Park, NC, and by the Institutional Review Board on Research Involving Human Subjects of the School of Public Health at the University of North Carolina, Chapel Hill. All women provided written informed consent before study participation.

Results

We enrolled women who primarily were single (76%), had graduated from high school (79%), and were nulliparous (75%). About two thirds of the women (65%) were <25 years old, including 14% aged 15 to 17 years. About 54% of the participants were white, and 41% were African American. About half of the participants (49%) had ≥6 lifetime sexual partners, and 75% reported the use of male condoms at some time in the previous 3 months. Almost two thirds (63%) had previously used combined oral

Comment

We found high levels of agreement in measuring cervical ectopia by computer planimetry and by clinician assessment. In particular, the computer planimetry method had excellent levels of both intrarater (0.86-0.97) and interrater (0.68-0.85) agreement for measurements of both the absolute and the relative areas of cervical ectopia. Levels of agreement between computer planimetry and clinician assessment for measurement of the relative area of ectopia were moderate (0.48).

Our results agree with

Acknowledgements

We thank Dr Jay Baker and Ms Kathleen Arbogast of the CONRAD Clinical Research Center at Eastern Virginia Medical School for their help in identifying use of the vinyl dots for calibration of cervical ectopia measurements. We also thank the clinical and administrative staff of Planned Parenthood of Maryland for their contributions to the study.

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  • Cited by (0)

    Supported with funds from the US Agency for International Development and from the National Institute for Child Health and Human Development.

    ☆☆

    Reprint requests: Charles S. Morrison, PhD, Family Health International, PO Box 13950, Research Triangle Park, NC 27709.

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