Origoni Massimo, Cantatore Francesco, Sopracordevole Francesco, Clemente Nicolò, Spinillo Arsenio, Gardella Barbara, De Vincenzo Rosa, Ricci Caterina, Landoni Fabio, Di Meo Maria Letizia, Ciavattini Andrea, Di Giuseppe Jacopo, Preti Eleonora, Iacobone Anna Daniela, Carriero Carmine, Dellino Miriam, Capodanno Massimo, Perino Antonino, Miglioli Cesare, Insolia Luca, Barbero Maggiorino, Candiani Massimo
Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy.
Gynecological Oncology Unit, IRCCS Oncological Referral Center (CRO), National Cancer Institute, 33081 Aviano, Italy.
Diagnostics (Basel). 2023 May 29;13(11):1906. doi: 10.3390/diagnostics13111906.
Quality Control (QC) and Quality Assurance (QA) principles are essential for effective cervical cancer prevention. Being a crucial diagnostic step, colposcopy's sensitivity and specificity improvements are strongly advocated worldwide since inter- and intra-observer differences are the main limiting factors. The objective of the present study was the evaluation of colposcopy accuracy through the results of a QC/QA assessment from a survey in Italian tertiary-level academic and teaching hospitals. A web-based, user-friendly platform based on 100 colposcopic digital images was forwarded to colposcopists with different levels of experience. Seventy-three participants were asked to identify colposcopic patterns, provide personal impressions, and indicate the correct clinical practice. The data were correlated with a panel of experts' evaluation and with the clinical/pathological data of the cases. Overall sensitivity and specificity with the threshold of CIN2+ accounted for 73.7% and 87.7%, respectively, with minor differences between senior and junior candidates. Identification and interpretation of colposcopic patterns showed full agreement with the experts' panel, ranging from 50% to 82%, in some instances with better results from junior colposcopists. Colposcopic impressions correlated with a 20% underestimation of CIN2+ lesions, with no differences linked to level of experience. Our results demonstrate the good diagnostic performance of colposcopy and the need for improving accuracy through QC assessments and adhesion to standard requirements and recommendations.
质量控制（QC）和质量保证（QA）原则对于有效的宫颈癌预防至关重要。作为关键的诊断步骤，由于观察者间和观察者内差异是主要限制因素，阴道镜检查的敏感性和特异性的提高在全球范围内得到大力倡导。本研究的目的是通过对意大利三级学术和教学医院的一项调查的质量控制/质量保证评估结果来评估阴道镜检查的准确性。一个基于网络的、用户友好的平台，包含100张阴道镜数字图像，被转发给了不同经验水平的阴道镜检查医师。73名参与者被要求识别阴道镜检查模式，提供个人印象，并指出正确的临床实践。数据与专家评估小组以及病例的临床/病理数据相关联。以CIN2+为阈值时，总体敏感性和特异性分别为73.7%和87.7%，高级和初级参与者之间差异不大。阴道镜检查模式的识别和解释与专家小组完全一致，范围从50%到82%，在某些情况下初级阴道镜检查医师的结果更好。阴道镜检查印象与CIN2+病变被低估20%相关，与经验水平无关。我们的结果证明了阴道镜检查良好的诊断性能，以及通过质量控制评估和遵守标准要求及建议来提高准确性的必要性。
