Colposcopy quality control by remote review of digitized colposcopic images.
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.
Ferris
Daron G
DG
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
Litaker
Mark S
MS
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