title: The efficacy of telecolposcopy compared with traditional colposcopy.
abstract: OBJECTIVE
  Rural women have increased rates of cervical neoplasia, but colposcopic services are limited in rural clinics. The purpose of this study was to estimate the efficacy of telecolposcopy for women in rural health care sites.
  
  
  METHODS
  Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics. Images of the colposcopic examination were transmitted to a tertiary care center for interpretation by an expert colposcopist. Another colposcopist (site expert) in attendance at the rural site also examined the same subjects, but did not share findings with the other colposcopists. Colposcopists independently determined the adequacy of the examination, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed by using percent agreement, Cohen's kappa statistic, and McNemar's test with Bonferroni's adjustment.
  
  
  RESULTS
  Teleconsultation was required for 36.2% of colposcopic examinations. A significantly lower percentage of satisfactory colposcopic examinations was noted by the distant colposcopists (60.0%) compared with the other colposcopists (P <.001). Colposcopic impression agreement with histology varied minimally, 59.7% (kappa = 0.31) for local colposcopists, 52.7% (kappa = 0.22) for site experts, 55.7% (kappa = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (kappa = 0.16) for distant experts who viewed the examination on videotape at a later time.
  
  
  CONCLUSIONS
  Teleconsultation was used for a substantial number of examinations. Diagnostic accuracy was maintained, but determination of colposcopic examination adequacy may be impaired by telecolposcopy. Telecolposcopy may help reduce barriers to medical access for women in rural areas.
authors.affiliation: Gynecologic Cancer Prevention Center, Medical College of Georgia, Augusta, Georgia 30912, USA. dferris@mail.mcg.edu
authors.forename: Daron G
authors.initials: DG
authors.lastname: Ferris
authors.forename: Michael S
authors.initials: MS
authors.lastname: Macfee
authors.forename: Jill A
authors.initials: JA
authors.lastname: Miller
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litaker
authors.forename: Debra
authors.initials: D
authors.lastname: Crawley
authors.forename: Diane
authors.initials: D
authors.lastname: Watson
mesh_terms: D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D003127:Colposcopy / Q000379:methods* / Q000592:standards*; D005260:Female; D005845:Georgia; D006801:Humans; D008507:Medically Underserved Area; D011237:Predictive Value of Tests; D019114:Remote Consultation / Q000592:standards*; D012423:Rural Health; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D016387:Women's Health; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology