Measuring cervical ectopy: Direct visual assessment versus computerized planimetry


      OBJECTIVE: Cervical ectopy has been identified as a possible risk factor for heterosexual transmission of human immunodeficiency virus. To accurately assess the importance of cervical ectopy, methods for measuring ectopy with precision need to be developed. The objective of this study was to evaluate the reliability of two methods of measuring cervical ectopy: direct visual assessment and computerized planimetry. STUDY DESIGN: Cervical photographs of 85 women without cervical disease were assessed for cervical ectopy by three raters using direct visual assessment 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 coefficients, where 1.0 represents perfect agreement and 0 represents no agreement except by chance. RESULTS: The intraclass correlation coefficient among the three raters (interrater agreement) was 0.58 for direct visual 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 coefficient among measurements by each rater over time (intrarater agreement) was 0.66 for direct visual assessment without acetic acid compared with 0.77 for direct visual assessment and 0.83 for computerized planimetry 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 provide 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 to provide comparable estimates. (Am J Obstet Gynecol 1997;176:108-11.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. United Nations Development Program. Young women: silence, susceptibility and the HIV epidemic. United Nations, New York1993 (HIV and Development Program Paper)
        • Moss GB
        • Clementson D
        • D'Costa L
        • Plummer FA
        Association of cervical ectopy with heterosexual transmission of HIV: results of a study in couples in Nairobi, Kenya.
        J Infect Dis. 1991; 164: 588-591
        • Plourde PJ
        • Pepin J
        • Agoki E
        • et al.
        Human immunodeficiency virus type 1 seroconversion in women with genital ulcers.
        J Infect Dis. 1994; 170: 313-317
        • Fleiss JL
        The design and analysis of clinical experiments.
        Wiley, New York1986
        • Shrout PE
        • Fleiss JL
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Wright TC
        • Frenczy AF
        Anatomy and histology of the cervix.
        in: Blaustein's pathology of the genital tract. Springer-Verlag, New York1994: 185-201
        • Coppleson M
        • Pixley E
        • Reid B
        Natural history of squamous metaplasia and the transformation zone.
        in: 2nd ed. Colposcopy—a scientific and practical approach to the cervix and vagina in health and disease. Charles C Thomas, Springfield (IL)1978: 76-119
        • Kelsey JL
        • Thompson WD
        • Evans AS
        Methods in observational epidemiology.
        Oxford University Press, New York1986
        • Moscicki AB
        • Winkler B
        • Irwin CE
        • Schachter J
        Differences in biological maturation, sexual behavior and sexually transmitted disease between adolescents with and without cervical intraepithelial neoplasia.
        J Pediatr. 1989; 115: 487-493