Advertisement

European Federation of Colposcopy quality standards Delphi consultation

      Abstract

      Objective

      Optimization of colposcopy practice requires a program of quality assurance including the monitoring of performance indicators. The European Federation of Colposcopy (EFC) aimed to identify a list of quality indicators for colposcopic practice, which are relevant, reproducible and practical across all of the member countries.

      Study design

      A five-round Delphi consultation was conducted in 30 full, 5 associate and 4 potential member countries in order to determine a core list of quality indicators including optimal target ranges.

      Results

      Six indicators were selected from a list of 37 proposed standards. Two further rounds of consultation were conducted to determine expert opinion on the target level for each of the standards. The six indicators identified and corresponding targets were: documentation of whether or not the squamocolumnar junction has been seen (100%); colposcopy prior to treatment for abnormal cervical cytology (100%); percentage of excisional treatments/conizations to contain cervical intra-epithelial neoplasia grade two or worse (≥85%); percentage of excised lesions/conizations with clear margins (≥80%); and two indicators concerned the number of cases to be colposcoped per year: ≥50 low-grade/minor and ≥50 high-grade/major cytological abnormalities.

      Conclusions

      A Delphi consultation identified six EFC quality indicators. These are a first step in an international attempt to optimize colposcopy practice throughout Europe. The current targets are based on expert opinion and may need adaptation in the future. Data are needed from European colposcopy settings to determine whether the indicators are achievable practice-based benchmarks and will help in improving and fine tuning the list of performance indicators and targets.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Arbyn M.
        • Herbert A.
        • Schenck U.
        • et al.
        European guidelines for quality assurance in cervical cancer screening: recommendations for collecting samples for conventional and liquid-based cytology.
        Cytopathology. 2007; 18: 133-139
        • Herbert A.
        • Bergeron C.
        • Wiener H.
        • et al.
        European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology.
        Cytopathology. 2007; 18: 213-219
        • Jordan J.
        • Martin-Hirsch P.
        • Arbyn M.
        • et al.
        European guidelines for clinical management of abnormal cervical cytology, part 2.
        Cytopathology. 2009; 20: 5-16
        • Wiener H.G.
        • Klinkhamer P.
        • Schenck U.
        • et al.
        European guidelines for quality assurance in cervical cancer screening: recommendations for cytology laboratories.
        Cytopathology. 2007; 18: 67-78
        • Arbyn M.
        • Anttila A.
        • Jordan J.
        • et al.
        European Guidelines for Quality Assurance in Cervical Cancer Screening. Second edition – summary document.
        Ann Oncol. 2010; 21: 448-458
        • Graham B.
        • Regehr G.
        • Wright J.G.
        Delphi as a method to establish consensus for diagnostic criteria.
        J Clin Epidemiol. 2003; 56: 1150-1156
        • Redman C.W.
        • Dollery E.
        • Jordan J.A.
        Development of the European Colposcopy Core Curriculum: use of the Delphi technique.
        J Obstet Gynaecol. 2004; 24: 780-784
        • Likert R.
        A technique for measurement of attitudes.
        Arch Psychol. 1932; 140: 44-53
        • Wright Jr., T.C.
        • Massad L.S.
        • Dunton C.J.
        • Spitzer M.
        • Wilkinson E.J.
        • Solomon D.
        2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ.
        Am J Obstet Gynecol. 2007; 197: 340-345
        • Wright Jr., T.C.
        • Massad L.S.
        • Dunton C.J.
        • Spitzer M.
        • Wilkinson E.J.
        • Solomon D.
        2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests.
        Am J Obstet Gynecol. 2007; 197: 346-355
        • NHSCSP
        Colposcopy and programme management: guidelines for the NHS Cervical Screening Programme.
        2nd ed. 2010
        • Moss E.L.
        • Jones P.W.
        • Finn C.
        • Redman C.W.
        • Todd R.
        Current views and practices in the management of low-grade cervical abnormalities – results of a British Society for Colposcopy and Cervical Pathology Study.
        J Low Genit Tract Dis. 2010; 14: 277-281
        • Ghaem-Maghami S.
        • De-Silva D.
        • Tipples M.
        • Lam S.
        • Perryman K.
        • Soutter W.
        Determinants of success in treating cervical intraepithelial neoplasia.
        BJOG. 2011; 118: 679-684
        • Lu C.H.
        • Liu F.S.
        • Kuo C.J.
        • Chang C.C.
        • Ho E.S.
        Prediction of persistence or recurrence after conization for cervical intraepithelial neoplasia III.
        Obstet Gynecol. 2006; 107: 830-835
        • Paraskevaidis E.
        • Kalantaridou S.N.
        • Paschopoulos M.
        • et al.
        Factors affecting outcome after incomplete excision of cervical intraepithelial neoplasia.
        Eur J Gynaecol Oncol. 2003; 24: 541-543
        • Arbyn M.
        • Kyrgiou M.
        • Simoens C.
        • et al.
        Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis.
        BMJ. 2008; 337: a1284
        • Noehr B.
        • Jensen A.
        • Frederiksen K.
        • Tabor A.
        • Kjaer S.K.
        Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery.
        Obstet Gynecol. 2009; 114: 1232-1238