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An Online Quality Assurance Program for Colposcopy in a Population-Based Cervical Screening Setting in Italy: Results on Colposcopic Impression

Cristiani, Paolo MD1; Costa, Silvano MD2; Schincaglia, Patrizia MD3; Garutti, Paola MD4; de Bianchi, Priscilla Sassoli BBiol5; Naldoni, Carlo MD5; Sideri, Mario MD6; Bucchi, Lauro MD7

Journal of Lower Genital Tract Disease: October 2014 - Volume 18 - Issue 4 - p 309–313
doi: 10.1097/LGT.0000000000000017
Original Articles

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.

A large interobserver agreement study involving trained colposcopists showed the high reproducibility of a 4-tier classification of colposcopic impression derived from the IFCPC 2002 classification.

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

Reprint requests to: Lauro Bucchi, MD, Romagna Cancer Registry, IRCCS IRST, 47014 Meldola, Forlì, Italy. E-mail:

The authors declare that they have no conflicts of interest.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology