title: Accuracy of Colposcopically Directed Biopsy: Results from an Online Quality Assurance Programme for Colposcopy in a Population-Based Cervical Screening Setting in Italy.
abstract: OBJECTIVE
  To report the accuracy of colposcopically directed biopsy in an internet-based colposcopy quality assurance programme in northern Italy.
  
  
  METHODS
  A web application was made accessible on the website of the regional Administration. Fifty-nine colposcopists out of the registered 65 logged in, viewed a posted set of 50 digital colpophotographs, classified them for colposcopic impression and need for biopsy, and indicated the most appropriate site for biopsy with a left-button mouse click on the image.
  
  
  RESULTS
  Total biopsy failure rate, comprising both nonbiopsy and incorrect selection of biopsy site, was 0.20 in CIN1, 0.11 in CIN2, 0.09 in CIN3, and 0.02 in carcinoma. Errors in the selection of biopsy site were stable between 0.08 and 0.09 in the three grades of CIN while decreasing to 0.01 in carcinoma. In multivariate analysis, the risk of incorrect selection of biopsy site was 1.97 for CIN2, 2.52 for CIN3, and 0.29 for carcinoma versus CIN1.
  
  
  CONCLUSIONS
  Although total biopsy failure rate decreased regularly with increasing severity of histological diagnosis, the rate of incorrect selection of biopsy site was stable up to CIN3. In multivariate analysis, CIN2 and CIN3 had an independently increased risk of incorrect selection of biopsy site.
authors.affiliation: Preventive Gynaecology Unit, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141 Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sideri
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Garutti
authors.affiliation: Department of Obstetrics and Gynaecology, St. Orsola Hospital, Via Giuseppe Massarenti 9, 40138 Bologna, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.affiliation: Cervical Cancer Screening Unit, Bologna Health Care District, Via della Repubblica 11, San Lazzaro di Savena, 40068 Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cristiani
authors.affiliation: Cancer Prevention Centre, Ravenna Health Care District, Viale Vincenzo Randi 5, 48121 Ravenna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Schincaglia
authors.affiliation: Department of Health, Regione Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Sassoli de Bianchi
authors.affiliation: Department of Health, Regione Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Naldoni
authors.affiliation: Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Via Piero Maroncelli 40, Meldola, 47014 Forlì, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Bucchi
mesh_terms: D000328:Adult; D000818:Animals; D001706:Biopsy; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020407:Internet; D007558:Italy / Q000453:epidemiology; D051379:Mice; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology*