title: An online quality assurance program for colposcopy in a population-based cervical screening setting in Italy: results on colposcopic impression.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.
authors.affiliation: 1Cervical Cancer Screening Unit, Bologna Health Care District, Bologna; 2Department of Obstetrics and Gynaecology, St. Orsola Hospital, Bologna; 3Cancer Prevention Center, Ravenna Health Care District, Ravenna; 4Department of Obstetrics and Gynaecology, University Hospital, Ferrara; 5Department of Health, Regione Emilia-Romagna, Bologna; 6Preventive Gynaecology Unit, European Institute of Oncology, Milan; and 7Romagna Cancer Registry, Romagna Cancer Institute (IRST), Meldola, Forlì, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cristiani
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schincaglia
authors.forename: Paola
authors.initials: P
authors.lastname: Garutti
authors.forename: Priscilla Sassoli
authors.initials: PS
authors.lastname: de Bianchi
authors.forename: Carlo
authors.initials: C
authors.lastname: Naldoni
authors.forename: Mario
authors.initials: M
authors.lastname: Sideri
authors.forename: Lauro
authors.initials: L
authors.lastname: Bucchi
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000379:methods* / Q000592:standards*; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D020407:Internet; D007558:Italy; D008875:Middle Aged; D011361:Professional Competence / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult