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Clinical Decisionmaking

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Computer-based telecolposcopy may offer superior diagnostic services to clinicians and patients in remote areas

Physicians typically use an instrument with a magnifying lens or camera on the end (colposcope) to aid in the diagnosis of cervical cancer or precancerous cervical lesions. In the future, a mere laptop and cell phone may enable doctors in rural or underserved areas to get the diagnostic opinion of distant experts, who view the colposcopic image on a distant computer screen. This enables more women in these areas to access expert cervical diagnoses. In fact, computer-based and network telecolposcopy detected more cervical neoplasia (abnormal, often premalignant cells) than cervicography, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08814).

Cervicography produces two low-magnification slides of the cervix with a special 35-mm camera following 5 percent acetic acid application, and it generally takes several weeks to receive a diagnostic report. Computer-based telecolposcopy provides the remote expert with digitized images of a low- and high-power magnification view of the cervix, allows interaction between the on-site provider and remote expert, and can provide instantaneous consultation. The provision of a high-power cervical image may explain the better sensitivity of computer-based telecolposcopy, explain Daron G. Ferris, M.D., and colleagues at the Medical College of Georgia.

The researchers compared the diagnostic accuracy of on-site, network, and computer-based colposcopy with cervicography for cervical problems among 264 adult women who came to one of two rural clinics for a colposcopic examination due to a recent abnormal Pap smear or suspicious finding affecting the lower genital tract. Telecolposcopy was at least as effective as cervicography for detecting cervical cancer precursors. Although the difference was not significant, both network (real-time) and computer-based telecolposcopy systems detected a higher percentage of women with more advanced cervical neoplasia than cervicography. On-site colposcopy had the most sensitivity for disease detection due to the ability to manipulate the cervix, stereoscopic viewing, and other factors.

See "Remote diagnosis of cervical neoplasia: 2 types of telecolposcopy compared with cervicography," by Dr. Ferris, Mark S. Litaker, Ph.D., Michael S. Macfee, M.D., and Jill A. Miller, M.D., in the April 2003 Journal of Family Practice 52(4), pp. 298-304.

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