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


Rebecca Perkins, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA. Electronic address: rbperkin@bu.edu.
Jose Jeronimo, National Cancer Institute, Bethesda, MD, USA.
Anne Hammer, Department of Obstetrics and Gynecology, Gødstrup Hospital, NIDO - centre for research and education, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Akiva Novetsky, Westchester Medical Center/New York Medical College, Valhalla, NY, USA.
Richard Guido, University of Pittsburgh, Magee-Womens Hospital, Pittsburgh, PA, USA.
Marta Del Pino, Clínic Institute of Gynecology, Obstetrics, and Neonatology (ICGON), Hospital Clínic Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain; Barcelona University, Medicine Faculty, Barcelona, Spain.
Jaqueline Louwers, Diakonessenhuis, department of Obstetrics and Gynecology, Utrecht, the Netherlands.
Jenna Marcus, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
Ceres Resende, University of Brasilia, Brazil.
Katie Smith, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Didem Egemen, National Cancer Institute, Bethesda, MD, USA.
Brian Befano, Information Management Services Inc, 3901 Calverton Blvd Suite 200, Calverton, MD, USA.
Debi Smith, National Cancer Institute, Bethesda, MD, USA.
Sameer Antani, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
Silvia de Sanjose, National Cancer Institute, Bethesda, MD, USA; ISGlobal, Barcelona, Spain.
Mark Schiffman, National Cancer Institute, Bethesda, MD, USA.

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Obstetrics and Gynecology


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.