Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy

an online interregional agreement study

Paola Garutti, Paolo Cristiani, Gian P. Fantin, Francesco Sopracordevole, Silvano Costa, Patrizia Schincaglia, Alessandra Ravaioli, Priscilla Sassoli de Bianchi, Carlo Naldoni, Stefano Ferretti, Lauro Bucchi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists’ training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. Study design Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. Results There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01. Conclusions The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.

Original languageEnglish
Pages (from-to)64-69
Number of pages6
JournalEuropean Journal of Obstetrics, Gynecology and Reproductive Biology
Volume206
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Colposcopy
Italy
Biopsy
Population
Confidence Intervals

Keywords

  • Cervical cancer screening
  • Colposcopy
  • Internet
  • Interobserver agreement
  • Quality assurance

ASJC Scopus subject areas

  • Medicine(all)
  • Reproductive Medicine
  • Obstetrics and Gynaecology

Cite this

Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy : an online interregional agreement study. / Garutti, Paola; Cristiani, Paolo; Fantin, Gian P.; Sopracordevole, Francesco; Costa, Silvano; Schincaglia, Patrizia; Ravaioli, Alessandra; Sassoli de Bianchi, Priscilla; Naldoni, Carlo; Ferretti, Stefano; Bucchi, Lauro.

In: European Journal of Obstetrics, Gynecology and Reproductive Biology, Vol. 206, 01.11.2016, p. 64-69.

Research output: Contribution to journalArticle

Garutti, Paola ; Cristiani, Paolo ; Fantin, Gian P. ; Sopracordevole, Francesco ; Costa, Silvano ; Schincaglia, Patrizia ; Ravaioli, Alessandra ; Sassoli de Bianchi, Priscilla ; Naldoni, Carlo ; Ferretti, Stefano ; Bucchi, Lauro. / Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy : an online interregional agreement study. In: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2016 ; Vol. 206. pp. 64-69.
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abstract = "Objective An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists’ training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. Study design Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. Results There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95{\%} confidence intervals around the above kappa values was ≤0.01. Conclusions The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.",
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T1 - Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy

T2 - an online interregional agreement study

AU - Garutti, Paola

AU - Cristiani, Paolo

AU - Fantin, Gian P.

AU - Sopracordevole, Francesco

AU - Costa, Silvano

AU - Schincaglia, Patrizia

AU - Ravaioli, Alessandra

AU - Sassoli de Bianchi, Priscilla

AU - Naldoni, Carlo

AU - Ferretti, Stefano

AU - Bucchi, Lauro

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N2 - Objective An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists’ training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. Study design Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. Results There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01. Conclusions The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.

AB - Objective An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists’ training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. Study design Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. Results There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01. Conclusions The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.

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KW - Colposcopy

KW - Internet

KW - Interobserver agreement

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