COMPUTERIZED COLPOSCOPY - RESULTS OF A PILOT-STUDY AND ANALYSIS OF ITS CLINICAL RELEVANCE

Objective: To evaluate the clinical usefulness of a computer-based sys tem that stores and analyzes high-resolution digital colposcopic image s. Methods: Three hundred patients referred to our institutions for ev aluation of abnormal cervical cytology underwent colposcopy with devel opment of digital images. The first 70 patients were used to standardi ze the system. The images obtained from 188 evaluable patients were an alyzed and scored by software according to internationally recognized colposcopic criteria. The results were compared with traditional colpo scopic diagnoses and with corresponding histology results using kappa statistics for inter-observer agreement and McNemar test for significa nce. Results: The exact concordance rate between computer-aided impres sions and histology (85.1%, kappa = 0.77) was significantly higher (P < .001) than that observed between traditional colposcopic findings an d histology (66%, kappa = 0.40). The computer-assisted colposcopy was much more accurate than traditional colposcopy in diagnosing high-grad e lesions (91.2 versus 61.8% of exact concordance, P < .001) as well a s normal histology (74.1 versus 34.5%, P < .001), but not significantl y different when evaluating low-grade lesions (89.6 versus 86.5%). Con clusion: The integration of computer imaging and colposcopy can improv e the colposcopic diagnostic accuracy. An inexperienced colposcopist m ay benefit from computerized support to obtain the most appropriate hi stologic specimen, and eventually access to distant consultation via m odem or through on-line services. An additional advantage is the abili ty to develop a space-saving permanent record of digitized images read ily available to review a patient's cervical history or perform effect ive programs of quality control in colposcopy.