Evaluation of a digital store-and-forward colposcopic system--a pilot study to assess usability for telemedicine.

We evaluated the diagnostic reliability of cervical examination using digital colposcopy compared with conventional binocular colposcopy. A total of 315 patients were examined and diagnosed by a colposcopist on-site. During the colposcopic examination, digital camera images were stored on a PC (median five pictures per patient). A second physician, experienced in colposcopy, re-evaluated the initial diagnostic findings using the stored digital images. The primary and secondary findings in each patient were categorized according to the Rome classification system. There was agreement between the primary and secondary examiners in 69% of cases (kappa=0.60). There was no systematic bias in terms of under- or over-rating. The proportion of non-assessable colposcopic examinations was 9%. Digital colposcopy was reliable and provided advantages in terms of a better follow-up examination and internal quality control of the diagnosis. The pilot study suggests that telecolposcopy may provide better training and further education for physicians and students, and may also improve the diagnostic possibilities in gynaecology.

[The suitability of digital colposcopy for telematic applications]. / Die Anwendbarkeit der digitalen Kolposkopie für telematische Fragestellungen.

Since carcinoma of the cervix is one of the most common cancers in women, screening of the cervix has acquired considerable importance. Colposcopy is a simple diagnostic method of detecting suspicious changes at an early stage. Shortcomings of this method are its low specificity and high inter- and intra-observer variability. A clinical pilot study was therefore carried out to investigate the advantages of a digital colposcopic system comprising a binocular colposcope coupled to a CCD camera and a computer. The aim of the study was to evaluate the reliability of diagnostic findings of the cervix obtained with digital colposcopy in comparison with standard binocular colposcopy, and to assess its suitability for telematic applications (teleconsultation, telediagnostics, treaching). A total of 315 patients were examined and statistically analysed. The patients were first submitted to a conventional colposcopic examination and a diagnosis was established. During the colposcopic examination camera images were stored on a computer, on the basis of which a second physician experienced in colposcopy reviewed the initial diagnosis. The primary and secondary findings of each patient were classified into 4 categories and compared following the Rome classification system. Agreement between the primary and secondary diagnosis was established in 69% of the cases (kappa = 0.60 +/- 0.03). No bias was observed in terms of under- or overrating. The percentage of non-assessable colposcopic examinations was 9.2%. Digital colposcopy is therefore suitable for reproducing diagnostic findings on the computer, given adequate digital image quality and a suitable classification model. The method has clear advantages with regard to follow-up, internal quality control of the diagnosis, and the training and further education of physicians and students. In the future, telecolposcopy may open up new opportunities in gynaecology.

Differentiation of breast lesions by measurements under craniocaudal and lateromedial compression using a new sonographic method.

RATIONALE AND OBJECTIVES: The authors differentiate breast lesions on sonography by measurements in two compression states that are perpendicular to each other. METHODS: Diameters of 100 breast lesions were measured preoperatively under lateromedial and craniocaudal compression with a new sonographic method. This method uses mammography-identical positioning of the breast and a reference structure for detection of changes of sound amplitude and velocity by through transmission of lesions. Sizes parallel to sound propagation were corrected for abridgement by increased velocity within some lesions. For each lesion, an average length and breadth was calculated by adding sizes parallel and perpendicular to sound propagation in the two compression states and dividing it by 2. An average ratio was calculated for each lesion by dividing the average size perpendicular to sound propagation by the corrected average size along sound propagation. After obtaining histopathologic results, a threshold of ratios and other features that might help differentiate benign from malignant lesions were studied. RESULTS: Ninety-six percent of the malignant lesions appeared with ratios < or = 1.2, whereas 92% of the benign lesions had a ratio > 1.2. Further differentiation is possible by observation of velocity in lesions with ratios > 1.2. CONCLUSIONS: Examination of lesions in two compression states that are perpendicular to each other allows discrimination of benign and malignant masses by measurements in most patients.