Observer agreement with laparoscopic diagnosis of pelvic inflammatory disease using photographs

To test the intraobserver (are observers likely to agree between themselves?) and interobserver (are observers likely to agree with other observers?) reproducibility and the overall diagnostic accuracy of laparoscopic diagnosis of pelvic inflammatory disease (PID).

Three senior consultants and three residents in training in obstetrics and gynecology scored the four laparoscopic images (adnexa, cul-de-sac, and pelvic panoramic view) from each of 40 patients and repeated the process 2 days later after the order of presentation had been randomized. A standardized predesigned scoring form was used. Histopathologically proven PID was used as the gold standard.

The overall accuracy of the laparoscopic diagnosis of PID was 78%, the sensitivity was 27%, and the specificity was 92%. The overall intraobserver reproducibility of the diagnosis of PID was only fair (kappa = 0.58), and it was clearly better among the consultants than among the residents (kappa = 0.76 and 0.39, respectively). The overall interobserver reproducibility was poor to fair (kappa = 0.43), and it was again better among the consultants than among the residents (kappa = 0.48 and 0.38, respectively). When specific diagnostic features (including tubal erythema, edema, adhesions, cul-de-sac fluid) were separately analyzed, the results were no different suggesting only poor-to-fair reproducibility.

Based on photographic images, the observer reproducibility and the overall diagnostic accuracy of the laparoscopic diagnosis of PID are unsatisfactory when histopathologically proven PID is used as the gold standard.