Abstract
We tested the performance of telecolposcopy in the diagnosis of various squamous intraepithelial lesions. There were three groups of physicians: Group 1 consisted of 15 gynaecologists who were not trained in colposcopy; Group 2 consisted of six experienced colposcopists (specialists); Group 3 was a supervising team consisting of three experts (colposcopists with more than 15 years of colposcopy experience). The first group took colpophotographs during gynaecological examinations and used a Web browser to compare them with examples from a database of colposcopy findings. Group 2 made their own diagnoses independently. Then the supervising team examined the findings from all 250 patients and made diagnoses that could be considered the ' ‘gold standard’. The findings were identical for Groups 1 and 2 in 219 cases, i.e. an inter-observer agreement of 88%; Cohen's kappa was 0.81. The findings were identical for Groups 1 and 3 in 208 cases, i.e. an inter-observer agreement of 83%; Cohen's kappa was 0.74. The findings were identical for Groups 2 and 3 in 239 cases, i.e. an inter-observer agreement of 96%; Cohen's kappa was 0.93. There was high inter-observer agreement between all participants. However, there were also significant differences in some cases. In the cases of suspected invasive carcinoma, the results showed a significant difference (χ2=4.8, P<0.005) because gynaecologists from Group 1 were not sure of their diagnosis and they wanted to obtain a second opinion by referring the decision to a higher level.