OPERATOR VARIABILITY IN DISEASE DETECTION AND GRADING BY COLPOSCOPY IN PATIENTS WITH MILD DYSPLASTIC SMEARS

Background. To determine interoperator variability in the colposcopic evaluation of patients with mild dysplastic smears, retrospective comp arison of colposcopy and biopsy results in 856 patients examined by II colposcopists in the Outpatient Colposcopy Clinic of ''L. Mangiagalli '' Institute, Milano, was performed. Methods. The patients underwent a complete colposcopic assessment and target biopsy on suspect areas if a screening smear showed mild dysplasia. Colposcopic findings and dis ease detection rate for each operator were compared. Results. There wa s no significant (P > 0.05) difference in the recording of abnormal co lposcopic findings. Significant differences were found, however, in ab normal transformation zone grading (P < 0.001), biopsy rate (P < 0.05) , and squamocolumnar junction visualization (P < 0.005). There was no significant difference in overall disease detection (P > 0.5) but ther e was a statistically significant, inverse relation (r = -0.6, P < 0.0 1) between the high grade (cervical intraepithelial neoplasia grades 2 and 3) and low grade (human papillomavirus/cervical intraepithelial n eoplasia grade 1) detection rate for each operator. Conclusions. High grade disease detection in patients with mild dysplastic smears is inf luenced the subjectivity of the colposcopic examination. This should b e considered when planning optimal management for patients with mild d ysplasia.