意大利基于人群的宫颈癌筛查中阴道镜检查的在线质量保证项目：阴道镜检查印象结果

An online quality assurance program for colposcopy in a population-based cervical screening setting in Italy: results on colposcopic impression.

作者信息

Cristiani Paolo, Costa Silvano, Schincaglia Patrizia, Garutti Paola, de Bianchi Priscilla Sassoli, Naldoni Carlo, Sideri Mario, Bucchi Lauro

机构信息

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.

出版信息

J Low Genit Tract Dis. 2014 Oct;18(4):309-13. doi: 10.1097/LGT.0000000000000017.

DOI:10.1097/LGT.0000000000000017

PMID:24886869

Abstract

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.

摘要

目的

报告意大利北部一个大区域基于人群的宫颈筛查服务中一项基于互联网的阴道镜质量保证项目的结果。

方法

2010年至2011年，一个网络应用程序可在地区行政部门的网站上访问。登记的65名阴道镜检查医师中有59名参与。他们登录，查看由一个专家委员会挑选的一组50张高质量数码阴道镜照片，并使用源自国际宫颈病理与阴道镜联合会2002年分类的4级分类法（阴性；异常，1级[G1]；异常，2级[G2]；疑似浸润癌[癌症]）对阴道镜印象进行评分。计算阴道镜检查医师之间的一致性以及阴道镜检查医师与委员会之间的一致性的kappa（κ）系数。

结果

阴道镜检查医师与委员会之间的一致性大于阴道镜检查医师之间的一致性（总体κ值分别为0.69和0.60，p<0.001）。阴道镜检查医师与委员会之间一致性的κ值在阴性时为0.83，G1时为0.53，G2时为0.66，癌症时为0.80（除阴性与癌症之间的比较[p=0.078]外，所有两两比较的p值均<0.001）。阴道镜检查医师没有低估或高估阴道镜检查结果的系统倾向（双侧符号检验，p=0.13）。在35岁及以上的患者中，阴道镜检查医师与委员会之间的总体一致性更高（p<0.001），并且对于有先前质量保证经验的阴道镜检查医师也是如此（p<0.01）。仅0.2%的阴性印象是针对宫颈上皮内瘤变2级或更严重情况做出的。作为一个平行发现，在0.5%的病例中，癌症的印象预测宫颈上皮内瘤变2级或更低。G1的组织学基础分布广泛。