MEASURING CERVICAL ECTOPY - DIRECT VISUAL ASSESSMENT VERSUS COMPUTERIZED PLANIMETRY

OBJECTIVE: Cervical ectopy has been identified as a possible risk fact or for heterosexual transmission of human immunodeficiency virus. To a ccurately assess the importance of cervical ectopy,;methods for measur ing ectopy with precision need to be developed. The objective of this study was to evaluate the reliability of two methods of measuring cerv ical ectopy: direct visual assessment and computerized planimetry. STU DY DESIGN: Cervical photographs of 85 women without cervical disease w ere assessed for cervical ectopy by three raters using direct visual a ssessment and a computer planimetry method. Agreement between the two methods, among the three raters, and among measurements by each rater over time was calculated with use of intraclass correlation coefficien ts, where 1.0 represents perfect agreement and 0 represents no agreeme nt except by chance. RESULTS: The intraclass correlation coefficient a mong the three raters (interrater agreement) was 0.58 for direct visua l assessment without application of acetic acid to the cervix compared with 0.72 for direct visual assessment with acetic acid and 0.82 for computerized planimetry with acetic acid. The intraclass correlation c oefficient among measurements by each rater over time (intrarater agre ement) was 0.66 for direct visual assessment without acetic acid compa red with 0.77 for direct visual assessment and 0.83 for computerized p lanimetry after application of acetic acid. When acetic acid was used, the intraclass correlation coefficient between the two methods was 0. 69. CONCLUSIONS: Computerized planimetry of cervical photographs may p rovide the most consistent estimate of the percent of ectopy. However, if time and resources make the use of computer planimetry difficult, direct visual assessment after application of 5% acetic acid appears t o provide comparable estimates.