NYMC Faculty Publications
Comparison of Accuracy and Reproducibility of Colposcopic Impression Based on a Single Image versus a Two-Minute Time Series of Colposcopic Images
Author Type(s)
Faculty
DOI
10.1016/j.ygyno.2022.08.001
Journal Title
Gynecologic Oncology
First Page
89
Last Page
95
Document Type
Article
Publication Date
10-1-2022
Department
Obstetrics and Gynecology
Abstract
OBJECTIVE: Colposcopy is an important part of cervical screening/management programs. Colposcopic appearance is often classified, for teaching and telemedicine, based on static images that do not reveal the dynamics of acetowhitening. We compared the accuracy and reproducibility of colposcopic impression based on a single image at one minute after application of acetic acid versus a time-series of 17 sequential images over two minutes. METHODS: Approximately 5000 colposcopic examinations conducted with the DYSIS colposcopic system were divided into 10 random sets, each assigned to a separate expert colposcopist. Colposcopists first classified single two-dimensional images at one minute and then a time-series of 17 sequential images as 'normal,' 'indeterminate,' 'high grade,' or 'cancer'. Ratings were compared to histologic diagnoses. Additionally, 5 colposcopists reviewed a subset of 200 single images and 200 time series to estimate intra- and inter-rater reliability. RESULTS: Of 4640 patients with adequate images, only 24.4% were correctly categorized by single image visual assessment (11% of 64 cancers; 31% of 605 CIN3; 22.4% of 558 CIN2; 23.9% of 3412 < CIN2). Individual colposcopist accuracy was low; Youden indices (sensitivity plus specificity minus one) ranged from 0.07 to 0.24. Use of the time-series increased the proportion of images classified as normal, regardless of histology. Intra-rater reliability was substantial (weighted kappa = 0.64); inter-rater reliability was fair ( weighted kappa = 0.26). CONCLUSION: Substantial variation exists in visual assessment of colposcopic images, even when a 17-image time series showing the two-minute process of acetowhitening is presented. We are currently evaluating whether deep-learning image evaluation can assist classification.
Recommended Citation
Perkins, R., Jeronimo, J., Hammer, A., Novetsky, A., Guido, R., Del Pino, M., Louwers, J., Marcus, J., Resende, C., Smith, K., Egemen, D., Befano, B., Smith, D., Antani, S., de Sanjose, S., & Schiffman, M. (2022). Comparison of Accuracy and Reproducibility of Colposcopic Impression Based on a Single Image versus a Two-Minute Time Series of Colposcopic Images. Gynecologic Oncology, 167 (1), 89-95. https://doi.org/10.1016/j.ygyno.2022.08.001