Elsevier

Obstetrics & Gynecology

Volume 99, Issue 2, February 2002, Pages 248-254
Obstetrics & Gynecology

The efficacy of telecolposcopy compared with traditional colposcopy

https://doi.org/10.1016/S0029-7844(01)01671-4Get rights and content

Abstract

OBJECTIVE: Rural women have increased rates of cervical neoplasia, but colposcopic services are limited in rural clinics. The purpose of this study was to estimate the efficacy of telecolposcopy for women in rural health care sites.

METHODS: Women with an indication for colposcopy were examined by local colposcopists at one of two rural clinics. Images of the colposcopic examination were transmitted to a tertiary care center for interpretation by an expert colposcopist. Another colposcopist (site expert) in attendance at the rural site also examined the same subjects, but did not share findings with the other colposcopists. Colposcopists independently determined the adequacy of the examination, colposcopic impression, biopsy intent and site, and management. Agreement between colposcopic impressions and cervical histology were assessed by using percent agreement, Cohen’s κ statistic, and McNemar’s test with Bonferroni’s adjustment.

RESULTS: Teleconsultation was required for 36.2% of colposcopic examinations. A significantly lower percentage of satisfactory colposcopic examinations was noted by the distant colposcopists (60.0%) compared with the other colposcopists (P < .001). Colposcopic impression agreement with histology varied minimally, 59.7% (κ = 0.31) for local colposcopists, 52.7% (κ = 0.22) for site experts, 55.7% (κ = 0.27) for distant experts who concurrently viewed the examination, and 49.7% (κ = 0.16) for distant experts who viewed the examination on videotape at a later time.

CONCLUSION: Teleconsultation was used for a substantial number of examinations. Diagnostic accuracy was maintained, but determination of colposcopic examination adequacy may be impaired by telecolposcopy. Telecolposcopy may help reduce barriers to medical access for women in rural areas.

Section snippets

Materials and methods

Women 18 years of age or older presenting consecutively for colposcopic evaluation after detection of an abnormal Papanicolaou smear or genital condyloma, abnormal appearing cervix, or other condition conducive to colposcopic examination were asked to participate. Women were enrolled at one of two rural sites, the Ware County Health Department, Waycross, and the Tri-County Health Clinic, Warrenton, Georgia. All subjects read and signed the institutional review board-approved informed consent

Results

A total of 264 subjects were enrolled in the trial and, depending upon the specific measure, matched responses ranged from 262 for ECC intent to 175 for colposcopic impression agreement with histology. The mean age of the subjects was 31.7 years, and the range was 18–78. Mean gravidity, parity, and abortive status were 2.4, 2.1, and 0.3, respectively. The subject’s cytologic and histologic results are listed in Table 1.

Colposcopic adequacy and management parameters for each type of

Discussion

The goal of telemedicine is to enable quality health care delivery to populations without readily available access to certain medical expertise. The efficacy of telecolposcopy is based on its diagnostic accuracy and subsequent patient management decisions. Telecolposcopy efficacy is contingent upon sufficient and accurate visual image transfer and communications to derive satisfactory outcomes. Efficacy is realized if telecolposcopy delivers care equivalent to in-person traditional colposcopy.

References (26)

  • P.L Martin

    How preventable is invasive cervical cancer? A community study of preventable factors

    Am J Obstet Gynecol

    (1972)
  • D.G Ferris

    Colposcopy

  • W.S Andrus et al.

    TeleradiologyEvolution through bias to reality

    Chest

    (1972)
  • P Carey et al.

    Follow-up of abnormal Papanicolaou smears among women of different races

    J Fam Pract

    (1993)
  • C.R Baquet et al.

    Socioeconomic factors and cancer incidence among blacks and whites

    J Natl Cancer Inst

    (1991)
  • H.P Freeman

    Cancer in the socioeconomically disadvantaged

    CA Cancer J Clin

    (1989)
  • G.H Friedell et al.

    Incidence of dysplasia and carcinoma of the uterine cervix in an Appalachian population

    J Natl Cancer Inst

    (1992)
  • Breast and cervical cancer surveillance. United States, 1973–1987

    MMWR

    (1992)
  • S.P Ackerman et al.

    Cancer screening behaviors among U.S. womenBreast cancer, 1987–1989, and cervical cancer 1988–1989

    MMWR

    (1992)
  • Cervical cancer control — Rhode Island

    MMWR

    (1989)
  • T.W Laedtke et al.

    Compliance with therapy for cervical dysplasia among women of low socioeconomic status

    So Med J

    (1992)
  • P Gordon et al.

    Survey of colposcopy practices by obstetrician/gynecologists

    J Reprod Med

    (1992)
  • R.L Bashshur

    Telemedicine and medical care

  • Cited by (0)

    Supported by a grant (R01 HS08814) from the Agency for Health Care Policy and Research, and the National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

    We thank Max Stachura, MD, and Ann Brown, MHSA, of the Medical College of Georgia Telemedicine Center for administrative and technical assistance; and Eileen Dickman, PhD, MBA, and Roberta Shiver for data management services.

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