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An Online Quality Assurance Program for Colposcopy in a Population-Based Cervical Screening Setting in Italy

2014; Lippincott Williams & Wilkins; Volume: 18; Issue: 4 Linguagem: Inglês

10.1097/lgt.0000000000000017

1526-0976

Paolo Cristiani, Silvano Costa, Patrizia Schincaglia, Paola Garutti, Priscilla Sassoli de Bianchi, Carlo Naldoni, Mario Sideri, Lauro Bucchi,

Colorectal Cancer Screening and Detection

To report the results of an Internet-based colposcopy quality assurance program from a population-based cervical screening service in a large region of northern Italy.In 2010 to 2011, a Web application was made accessible on the Web site of the regional administration. Fifty-nine colposcopists of the registered 65 participated. They logged-in, viewed a posted set of 50 high-quality digital colpophotographs selected by an expert committee, and rated them for colposcopic impression using a 4-tier classification (Negative; abnormal, grade 1 [G1]; abnormal, grade 2 [G2]; suspected invasive cancer [Cancer]) derived from the International Federation for Cervical Pathology and Colposcopy 2002 classification. kappa (κ) coefficients for intercolposcopist agreement and colposcopist-committee agreement were calculated.Colposcopist-committee agreement was greater than intercolposcopist agreement (overall κ 0.69 vs 0.60, p<.001). The κ values for colposcopist-committee agreement were 0.83 on Negative, 0.53 on G1, 0.66 on G2, and 0.80 on Cancer (all p values for pairwise comparisons<.001, except for Negative vs Cancer [p=.078]). There was no systematic tendency for colposcopists to underestimate or overestimate the colposcopic findings (2-tailed sign test, p=.13). Overall colposcopist-committee agreement was greater among patients 35 years or older (p<.001) and for colposcopists with previous quality assurance experiences (p<.01). Only 0.2% of Negative impressions were formulated for a cervical intraepithelial neoplasia grade 2 or worse. As a parallel finding, the impression of Cancer predicted cervical intraepithelial neoplasia grade 2 or less in 0.5% of cases. The histologic substrates of G1 were dispersed over a large spectrum.The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.