Colposcopy is an outpatient procedure for evaluating abnormal Pap smears. The number of abnormal Paps is increasing and the test is being used by an increasing number of community based physicians (CBP's), yet no information is available to document the accuracy of these physicians performing the test. The goal of this two year observational baseline study is to assess the diagnostic accuracy of CBP's performing colposcopy. Cervicography has been added to this revised submission to address the possibility that the CBP might miss the most abnormal site in an abnormal quadrant. Objective 1 is to assess the diagnostic accuracy, defined as the concordance between the physician's colposcopic diagnosis and the histologic diagnosis, of a cohort of CBP's. The steps to accomplish this objective include: (i) contacting the group of 115 physicians (Ob/gyn's and FP's) currently practicing colposcopy who have already expressed interest; (ii) developing a profile of these CBP's (sex, age, years in practice, colposcopy training, practice location, type of practice, number of colposcopy exams performed and type of colposcopic procedures performed) and (iii) utilizing the colposcopically directed four-quadrant biopsy technique and cervicography pre- and post-biopsy to measure the diagnostic accuracy of this cohort over time. Each study physician will enter all patients requiring colposcopy until 50 patients are entered. For each patient, the study physicians will indicate what they believe to be the colposcopic diagnosis for each quadrant at the time of the exam. The pathologist will then note the comparable histologic diagnosis. The cervicograms will assess whether or not the CBP biopsied the most abnormal site in an abnormal quadrant. Objective 2 is to develop normative statements about the diagnostic accuracy of physicians performing colposcopy. Physician demographic and practice variables and data collected during the study will be analyzed to identify physicians at risk for sub-standard diagnostic accuracy. Objective 3 is to assess the ability of the four quadrant biopsy technique alone to define diagnostic accuracy.
