Colposcopy quality control by remote review of digitized colposcopic images

Objective This study was undertaken to estimate the accuracy of colposcopy quality control review of subjectsʹ digitized colposcopic images during the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion triage study (ALTS). Study design After colposcopic examination and the acquisition of 2 digitized cervical images, colposcopists recorded colposcopic diagnoses in a standardized computer database. The images were transferred by modem to colposcopy quality control reviewers for a blinded interpretation, including assessment of image quality. Reviewersʹ and colposcopistsʹ diagnoses were compared with histologic diagnoses using standard contingency table methods. Results Colposcopists and reviewers underdiagnosed 16.1% and 25.3% of subjects, and overdiagnosed 44.7% and 19.8% of subjects compared with histology, respectively. The sensitivity and specificity for detecting cervical intraepithelial neoplasia 2 or greater were 35.4% versus 23.2%, P< .0001, and 89.9% versus 95.0%, P< .0001, respectively, for colposcopists and reviewers. Conclusion Colposcopy quality control by review of digitized colposcopic images in clinical trials warrants further evaluation if the accuracy can be improved.