Reproducibility of cervical intraepithelial neoplasia diagnosis on histological review of cervical punch biopsies from a visual inspection with acetic acid and HPV detection-based screening program

Abstract Objective To assess the reproducibility of cervical intraepithelial neoplasia (CIN) diagnosis in a visual inspection with acetic acid (VIA) and HPV detection-based screening program, and to correlate CIN diagnosis with oncogenic HPV status. Methods A total of 9630 women were screened by VIA and high-risk HPV detection at community outreach clinics in India between June 2011 and June 2012. Biopsies obtained from women who were positive on either test were reviewed by two pathologists blinded to the histological diagnoses originally made by pathologists working at the Chittaranjan National Cancer Institute. Results The interobserver agreement between the pathologists’ diagnoses and the diagnoses made by the expert reviewers on 424 slides was fair (kappa = 0.26). There was a distinct difference in agreement in detecting CIN 2 (kappa = 0.21) and detecting CIN 3 (kappa = 0.74). The overall agreement in diagnosis improved when the slides obtained from the HPV-positive women were considered (kappa = 0.5). Almost half of the discordant CIN 2 cases were high-risk HPV negative. Conclusion Diagnosis of CIN 2 is poorly reproducible. The natural history of CIN 2 lesions is more similar to CIN 1 than CIN 3; it is therefore necessary to re-evaluate whether to consider CIN 2 lesions as high-grade squamous intraepithelial lesions with CIN 3, as in the Bethesda system of classification.