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Colposcopy Quality Control: Establishing Colposcopy Criterion Standards for the National Cancer Institute ALTS Trial

D G Ferris1, J T Cox, L Burke

  • 1*The Department of Family Medicine and §Office of Biostatistics, Medical College of Georgia, Augusta, GA; †The Student Health Service, University of California at Santa Barbara, Santa Barbara, CA; ‡Department of Obstetrics and Gynecology, Beth Israel Deaconess Hospital, Boston, MA; ¶Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH; #Women's Cancer Center, Royal Hospital for Women, Sydney, Australia; ** Omnia, Inc., Philadelphia, PA; and ††The National Cancer Institute, Rockville, MD.

Journal of Lower Genital Tract Disease
|May 8, 2015
PubMed
Summary

Colposcopy quality control monitors showed fair to excellent agreement in assessing cervical images and biopsy site placement. This study evaluated observer agreement in colposcopy quality control for cervical cancer screening.

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Area of Science:

  • Gynecology
  • Pathology
  • Medical Imaging

Background:

  • The Atypical Squamous Cells of Undetermined Significance-Low-Grade Squamous Intraepithelial Lesions (ASCUS/LSIL) Triage Study (ALTS) established a quality control (QC) group for colposcopy.
  • QC monitors assessed colposcopists through direct observation and analysis of digitized colposcopic images.

Purpose of the Study:

  • To evaluate the agreement among colposcopy QC monitors regarding colposcopic impressions.
  • To assess the accuracy of biopsy site placement based on photographic images.

Main Methods:

  • 100 Cervigram slides representing CIN1, CIN2/3, normal, and cancer were independently interpreted by QC monitors and certified evaluators.
  • Agreement was measured for intraobserver, interobserver, and observer-vs-histology diagnoses.
  • Biopsy site accuracy was determined by measuring distances between annotated sites.

Main Results:

  • Observer agreement with histology ranged from 47.4% to 75.3% (first evaluation) and 50.5% to 71.1% (second evaluation).
  • Interobserver agreement varied from 57% to 71% (first) and 12% to 76% (second).
  • Intraobserver agreement ranged from 68.0% to 86.0%, with mean biopsy site annotation distances under 2 mm.

Conclusions:

  • Colposcopy QC monitors demonstrated poor to good agreement with histology, fair to excellent interobserver agreement, and good to excellent intraobserver agreement.
  • These agreement levels are comparable to those reported for cervical cytology and histology interpretations by pathologists.
  • Monitors achieved precise biopsy site placement with minimal variation (< 2 mm).