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The Efficacy of Telecolposcopy Compared With Traditional Colposcopy

From the Gynecologic Cancer Prevention Center, Departments of Family Medicine, and Obstetrics and Gynecology, and Office of Biostatistics and Bioinformatics, Medical College of Georgia, Augusta, Georgia;Tri-County Health Clinic, Warrenton, Georgia; andWare County Health Department, Waycross, Georgia.

Address reprint requests to: Daron G. Ferris, MD, Medical College of Georgia, 1423 Harper Street, HH-100, Augusta, GA 30912; E-mail: dferris{at}mail.mcg.edu.

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 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% ( = 0.31) for local colposcopists, 52.7% ( = 0.22) for site experts, 55.7% ( = 0.27) for distant experts who concurrently viewed the examination, and 49.7% ( = 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.

This article has been cited by other articles:

				D. M. Bishai, D. G. Ferris, and M. S. Litaker What Is the Least Costly Strategy to Evaluate Cervical Abnormalities in Rural Women? Comparing Telemedicine, Local Practitioners, and Expert Physicians Med Decis Making, November 1, 2003; 23(6): 463 - 470. [Abstract] [PDF]

				D. G. Ferris, M. S. Litaker, P. A. Gilman, and A. G. Leyva Lopez Patient Acceptance and the Psychological Effects of Women Experiencing Telecolposcopy and Colposcopy J Am Board Fam Med, September 1, 2003; 16(5): 405 - 411. [Abstract] [Full Text]