Comparison of accuracy and reproducibility of colposcopic impression based on a single image versus a two-minute time series of colposcopic images

Objective. Colposcopy is an important part of cervical screening/management programs. Colposcopic appear-ance 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 di-vided 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 as-sessment (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.(c) 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This study compared the accuracy and reproducibility of colposcopic impression based on single images versus a time-series of sequential images. The results showed substantial variation in single image assessment, with the use of time-series improving classification but fair inter-rater reliability.