title: Colposcopy quality control by remote review of digitized colposcopic images.
abstract: OBJECTIVE
  This study was undertaken to estimate the accuracy of colposcopy quality control review of subjects' digitized colposcopic images during the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study (ALTS).
  
  
  METHODS
  After colposcopic examination and the acquisition of 2 digitized cervical images, colposcopists recorded colposcopic diagnoses in a standardized computer database. The images were transferred by modem to colposcopy quality control reviewers for a blinded interpretation, including assessment of image quality. Reviewers' and colposcopists' diagnoses were compared with histologic diagnoses using standard contingency table methods.
  
  
  RESULTS
  Colposcopists and reviewers underdiagnosed 16.1% and 25.3% of subjects, and overdiagnosed 44.7% and 19.8% of subjects compared with histology, respectively. The sensitivity and specificity for detecting cervical intraepithelial neoplasia 2 or greater were 35.4% versus 23.2%, P < .0001, and 89.9% versus 95.0%, P < .0001, respectively, for colposcopists and reviewers.
  
  
  CONCLUSIONS
  Colposcopy quality control by review of digitized colposcopic images in clinical trials warrants further evaluation if the accuracy can be improved.
authors.affiliation: Departments of Family Medicine and Obstetrics and Gynecology, 1423 Harper St, HH-100, Medical College of Georgia, Augusta, GA 30912, USA. dferris@mail.mcg.edu
authors.forename: Daron G
authors.initials: DG
authors.lastname: Ferris
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litaker
mesh_terms: D001707:Biopsy, Needle; D002983:Clinical Competence; D015331:Cohort Studies; D020681:Colposcopes; D003127:Colposcopy / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011786:Quality Control; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017749:Total Quality Management; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears; D014741:Video Recording; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery