title: The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+).
  
  
  METHODS
  To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments.
  
  
  RESULTS
  Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN 2+ had at least 1 acetowhite lesion. However, 74% of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39%. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility.
  
  
  CONCLUSIONS
  Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.
authors: Division of Gynecologic Oncology, Washington University School of Medicine, St Louis, MO 63110, USA. massadl@wudosis.wustl.edu
authors: L Stewart
authors: LS
authors: Massad
authors: Jose
authors: J
authors: Jeronimo
authors: Hormuzd A
authors: HA
authors: Katki
authors: Mark
authors: M
authors: Schiffman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000145:classification*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*