Evaluation of Transvaginal Colposcopy as a Screening Device for Cervical Cancer among International Physicians

Abstract

Cervical cancer disproportionately burdens women in low-resource settings, with over 85% of cervical cancer deaths occurring in developing countries due to lack of access to effective, high-quality screening programs that facilitate early detection and treatment. The aim of this study is to evaluate whether the performance of a transvaginal digital colposcope (TVDC) developed at Duke University is equivalent to the more expensive standard-of-care colposcope at identifying precancerous lesions of the cervix. Thirty-five paired cervix images, with confirmed pathologies and blinded by device, were sent electronically to six physicians, at four separate institutions, Duke University Medical Center (Durham, North Carolina, USA), La Liga Peruana de Lucha Contra el Cancer (Lima, Peru), Cancer Institute WIA (Chennai, India), and Kenyatta University (Nairobi, Kenya). Physicians completed a 1-page survey assessing cervix characteristics and overall severity of precancerous lesions for each image. Analysis included percent agreement between devices as well as identifying patterns across misdiagnosed images. The agreement between physicians using each device is 80.1% with kappa of 0.6049. The TVDC performed equivalent to standard-of-care colposcopy at identifying precancerous lesions of the cervix. Implications of these findings have the potential to create increased access to a culturally appropriate screening technology, thus reducing the burden of cervical cancer throughout the developing world.