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BioMed Research International
Volume 2015, Article ID 614035, 6 pages
Research Article

Accuracy of Colposcopically Directed Biopsy: Results from an Online Quality Assurance Programme for Colposcopy in a Population-Based Cervical Screening Setting in Italy

1Preventive Gynaecology Unit, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
2Department of Obstetrics and Gynaecology, University Hospital, Via Aldo Moro 8, Cona, 44124 Ferrara, Italy
3Department of Obstetrics and Gynaecology, St. Orsola Hospital, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
4Cervical Cancer Screening Unit, Bologna Health Care District, Via della Repubblica 11, San Lazzaro di Savena, 40068 Bologna, Italy
5Cancer Prevention Centre, Ravenna Health Care District, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
6Department of Health, Regione Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy
7Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Via Piero Maroncelli 40, Meldola, 47014 Forlì, Italy

Received 4 August 2014; Accepted 15 December 2014

Academic Editor: Walter Prendiville

Copyright © 2015 Mario Sideri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. To report the accuracy of colposcopically directed biopsy in an internet-based colposcopy quality assurance programme in northern Italy. Methods. A web application was made accessible on the website of the regional Administration. Fifty-nine colposcopists out of the registered 65 logged in, viewed a posted set of 50 digital colpophotographs, classified them for colposcopic impression and need for biopsy, and indicated the most appropriate site for biopsy with a left-button mouse click on the image. Results. Total biopsy failure rate, comprising both nonbiopsy and incorrect selection of biopsy site, was 0.20 in CIN1, 0.11 in CIN2, 0.09 in CIN3, and 0.02 in carcinoma. Errors in the selection of biopsy site were stable between 0.08 and 0.09 in the three grades of CIN while decreasing to 0.01 in carcinoma. In multivariate analysis, the risk of incorrect selection of biopsy site was 1.97 for CIN2, 2.52 for CIN3, and 0.29 for carcinoma versus CIN1. Conclusions. Although total biopsy failure rate decreased regularly with increasing severity of histological diagnosis, the rate of incorrect selection of biopsy site was stable up to CIN3. In multivariate analysis, CIN2 and CIN3 had an independently increased risk of incorrect selection of biopsy site.