**Colposcopy Accuracy and Diagnostic Performance: A Quality Control and Quality Assurance Survey in Italian Tertiary-Level Teaching and Academic Institutions—The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV)**

**Massimo Origoni 1,\* , Francesco Cantatore <sup>1</sup> , Francesco Sopracordevole <sup>2</sup> , Nicolò Clemente <sup>2</sup> , Arsenio Spinillo <sup>3</sup> Barbara Gardella <sup>3</sup> , Rosa De Vincenzo 4,5 , Caterina Ricci <sup>5</sup> , Fabio Landoni <sup>6</sup> , Maria Letizia Di Meo <sup>6</sup> , Andrea Ciavattini <sup>7</sup> , Jacopo Di Giuseppe <sup>7</sup> , Eleonora Preti <sup>8</sup> , Anna Daniela Iacobone 8,9 , Carmine Carriero <sup>10</sup> , Miriam Dellino <sup>10</sup>, Massimo Capodanno <sup>11</sup>, Antonino Perino <sup>12</sup>, Cesare Miglioli <sup>13</sup> , Luca Insolia <sup>13</sup> , Maggiorino Barbero <sup>14</sup> and Massimo Candiani <sup>1</sup>**

> <sup>1</sup> Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy; francesco.cantatore@hsr.it (F.C.); massimo.candiani@hsr.it (M.C.)

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**Abstract:** Quality Control (QC) and Quality Assurance (QA) principles are essential for effective cervical cancer prevention. Being a crucial diagnostic step, colposcopy's sensitivity and specificity improvements are strongly advocated worldwide since inter- and intra-observer differences are the main limiting factors. The objective of the present study was the evaluation of colposcopy accuracy through the results of a QC/QA assessment from a survey in Italian tertiary-level academic and teaching hospitals. A web-based, user-friendly platform based on 100 colposcopic digital images was forwarded to colposcopists with different levels of experience. Seventy-three participants were asked to identify colposcopic patterns, provide personal impressions, and indicate the correct clinical practice. The data were correlated with a panel of experts' evaluation and with the clinical/pathological data of the cases. Overall sensitivity and specificity with the threshold of CIN2+ accounted for 73.7% and 87.7%, respectively, with minor differences between senior and junior candidates. Identification and interpretation of colposcopic patterns showed full agreement with the experts' panel, ranging

**Citation:** Origoni, M.; Cantatore, F.; Sopracordevole, F.; Clemente, N.; Spinillo, A.; Gardella, B.; De Vincenzo, R.; Ricci, C.; Landoni, F.; Di Meo, M.L.; et al. Colposcopy Accuracy and Diagnostic Performance: A Quality Control and Quality Assurance Survey in Italian Tertiary-Level Teaching and Academic Institutions—The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). *Diagnostics* **2023**, *13*, 1906. https:// doi.org/10.3390/diagnostics13111906

Academic Editor: Gloria Calagna

Received: 5 May 2023 Revised: 27 May 2023 Accepted: 27 May 2023 Published: 29 May 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

from 50% to 82%, in some instances with better results from junior colposcopists. Colposcopic impressions correlated with a 20% underestimation of CIN2+ lesions, with no differences linked to level of experience. Our results demonstrate the good diagnostic performance of colposcopy and the need for improving accuracy through QC assessments and adhesion to standard requirements and recommendations.

**Keywords:** colposcopy; QC; QA; colposcopy sensitivity; diagnostic accuracy; cervical cancer prevention; CIN; SIL; colposcopy standards
