title: A prospective randomized study on limits of colposcopy and histology: the skill of colposcopist and colposcopy-guided biopsy in diagnosis of cervical intraepithelial lesions.
abstract: BACKGROUND
  The main objective of our study was to evaluate the colposcopist ability to correctly identify the worst area of a cervical lesion where biopsy should be performed; the secondary objective was to investigate the influence of the colposcopist skill in grading cervical preneoplastic lesions.
  
  
  METHODS
  296 patients referred for colposcopy were enrolled in a prospective study. All patients were randomized in two groups: in the first group, "senior group", the colposcopy was performed by an experienced colposcopist; in the second group, "junior group", the colposcopy was performed by a less experienced colposcopist. A detailed colposcopic description, including a grading of the lesion, was completed for each case. During the colposcopic exam patients underwent two direct biopsies; each biopsy was labeled with letter A (suspicious area with most severe grade) or B (suspicious area with less severe grade) according to the judgment of the colposcopist. An experienced pathologist reanalyzed the histological slides, after routine diagnosis.
  
  
  RESULTS
  The senior group identify the worst area of the cervical lesion in statistical significant higher rates than junior group. Specimen A resulted representative of the higher-grade lesion (A > B) in 73.7 % (N = 28) in senior group and in 48.4 % (N = 15) in junior group; while in 26.3 % (N = 10) the higher-grade lesion corresponded to specimen B (A < B) in senior group and in 51.6 % (N = 16) in junior group (p < .05).
  
  
  CONCLUSIONS
  The ability of a colposcopist in grading cervical lesion depends on his experience.
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bifulco
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: De Rosa
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Giada
authors.initials: G
authors.lastname: Lavitola
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Piccoli
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bertrando
authors.affiliation: Department of Advanced Biomedical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Natella
authors.affiliation: Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Di Carlo
authors.affiliation: Department of Advanced Biomedical Science, University of Naples "Federico II", Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Insabato
authors.affiliation: Department of Sanità pubblica, University of Naples "Federico II", Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
keywords: Cervical intraepithelial lesions; Colposcopic accuracy; Colposcopic grade; Multiple biopsies