ABSTRACT

It is proposed that digital and telecolposcopy should facilitate the medical decision-making process and raise the validity of the diagnosis of cervical carcinoma thereby lowering the incidence and mortality rate of the disease. In order to test this, a digital colposcopy system was developed and clinically evaluated within the framework of a two-phase scientific study at the Charité dysplasia clinic Berlin.

In Phase 1 of the evaluation a total of 315 patients were examined with the digital colposcopy system consisting of a binocular colposcope supplemented with a colour camera and PC, to see whether colposcopic findings can be re-evaluated on the basis of the stored digital images alone, i.e. without the patient being present. Phase 2 was used to test the technical feasibility and reliability of sending colposcopic images by electronic mail. A total of 30 patients from four selected gynaecological practices in Berlin had been referred for diagnostic clarification to the Charité dysplasia clinic. The digital colposcopic images made there were sent as e-letters to the referring doctors, who in turn evaluated the data transfer.

In Phase 1, the primary and secondary examiners were in total agreement in 69% of the cases (Kappa = 0.60). No significant bias in terms of under- or over-rating was observed (P<0.05 by McNemar’s test). In Phase 2, in 57% (n=17) of the cases, a lack of experience with the new technique led to difficulties with downloading the images. When the practices had become more familiar with the procedure, the incidence of problems fell from 90% (9/10), in the first half of the project, to 40% (8/20) in the second half. In 87% of the cases, the diagnosis of the consulting specialist at the Charité dysplasia clinic was comprehensible to the practising physicians.

Digital and telecolposcopy can be effectively used in colposcopy to compensate for the inherent disadvantages of the method i.e. a high level of inter- and intra-observer variability, inadequate reproducibility and objectivity of colposcopic findings, data storage, data transmission. In practice there are clear advantages for the diagnosis documentation, follow-up monitoring, further medical education, as well as interdisciplinary communication.

Keywords: Cervical carcinoma, early diagnosis of cancer, digital colposcopy, telecolposcopy