Accuracy of physician and nurse practitioner colposcopy to effect improved surveillance of cervical cancer

Purpose: To compare physician and nurse practitioner accuracy in recognizing cervical dysplasia during colposcopy. Materials and Methods: A retrospective review was performed of cervical excisional biopsies from 2007 to 2009 performed by gynecologists and nurse practitioners in the same patient population. Cervical cone biopsy and loop electrosurgical excision procedure (LEEP) pathology were used as a gold standard compared to the previous colposcopy biopsies. Results: Four hundred fifty-five patients qualified for the study. Patients were stratified according to age: under 30 years, 30-39, and 40 and above. For physicians, 77% of high-grade colposcopy biopsy results agreed with high-grade pathology on cone biopsy or LEEP. This was statistically similar to nurse practitioner results (p = 0.12). Likewise, there was no significant difference between physician and nurse practitioner accuracy within the various patient age strata. Conclusion: Colposcopy biopsy results compared to cone biopsy or LEEP results were statistically similar between gynecologists and nurse practitioners.

Colposcopy; Colposcopic training; Cervical dysplasia; LEEP; Cold knife conization

[1] ACOG Practice Bulletin #109, December 2009.

[2] American Cancer Society. Cancer facts and figures 2010. http://www5.cancer.org/downloads/STT/Cancer_Facts_and_Figures_2010.pdf. Accessed February 21, 2011.

[3] Quinn M., Babb P., Jones J., Allen E.: “Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics”. BMJ, 1999, 318, 904.

[4] Cox J.T.: “More questions about the accuracy of colposcopy: what does this mean for cervical cancer prevention?”. Obstet. Gynecol., 2008, 111, 1266.

[5] Baum M.E., Rader J.S., Gibb R.K., McAllister R.B., Powell M.A., Mutch D.G. et al.: “Colposcopic accuracy of obstetrics and gynecology residents”. Gynecol. Oncol., 2006, 103, 966.

[6] Caruthers B.S., Sheets K.J.: “Development of a curriculum in colposcopy”. J. Fam. Pract., 1991, 32, 590.

[7] Brotzman G.L., Apgar B.S.: “Assessing colposcopic skills: the instructor’s handbook”. Fam. Med., 1998, 30, 350.

[8] Spitzer M., Apgar B.S., Brotzman G.L., Krumholz B.A.: “Residency training in colposcopy: a survey of program directors in obstetrics and gynecology and family practice”. Am. J. Obstet. Gynecol., 2001, 185, 507.

[9] Council on Resident Education in Obstetrics and Gynecology. Educational objectives: core curriculum in obstetrics and gynecology. 8th edition, New York, NY: American College of Obstetrics and Gynecology, 2005.

[10] American Society for Colposcopy and Cervical Pathology. Comprehensive Curriculum. http://www.asccp.org/EducationeLearning/ComprehensiveColposcopyCurriculum/tabid/5974/Default.asp x. Updated July 6, 2011. Accessed July 11, 2011.

[11] Waxman A.G., Rubin M.M., Apgar B.S., Krumholz B.A., Tedeschi C., Potter M.E.: “Essentials of colposcopy education: the curriculum revised”. J. Low Genit. Tract. Dis., 2003, 7, 221.

[12] Prendiville W.: “The treatment of CIN: What are the risks?”. Cytopathology, 2009, 20, 145.

[13] Massad L.S., Jeronimo J., Schiffman M.: “National Institutes of Health/American Society for Colposcopy and Cervical Pathology (NIH/ASCCP) Research Group Interobserver Agreement in the Assessment of Components of Colposcopic Grading”. Obstet. Gynecol., 2008, 111, 1279.

[14] The ASCUS-LSIL Triage Study (ALTS) Group: “Results of a randomized study on the management of cytology interpretation of atypical squamous cells of undetermined significance”. Am. J. Obstet. Gynecol., 2003, 188, 1383.

[15] Fleiss J.L.: “Statistical Methods for Rates and Proportions”. 2nd ed. New York: John Wiley and Sons, 1981, Chapter 13.

[16] Gage J.C., Hanson V.W., Abbey K., Dippery S., Gardner S., Kubota J. et al., ASCUS LSIL Triage Study (ALTS) Group: “Number of cervical biopsies and sensitivity of colposcopy”. Obstet. Gynecol., 2006, 108, 264.