The three components of any cervical screening programme - cytology, histopathology and colposcopy are prone to subjectivity and hence variation in practice. To optimise care and outcomes it is essential that these variations are minimised for the benefit of women who enter a screening programme. Quality assurance (QA) strategies can help to achieve this aim. The role of a lead in colposcopy is pivotal to the success of a QA programme.
The role requires the development of standard operating procedures (SOPs), local guidelines and introduction of a local multidisciplinary meeting to discuss challenging and difficult cases. Ideally the role of lead in colposcopy should be associated with administrative time to fulfill the job. Local guidelines and SOPs will in the greater part reflect national standards.
The latest guidance was published in March 2016 and deals with both the organization of the screening programme – age range, screening intervals, primary cytology with reflex HPV testing for low grade cytology, colposcopic diagnosis, conservative management, treatment, glandular neoplasia, immunosuppression, follow up and test of cure post treatment. The performance of an individual colposcopist can be difficult to quantify. Currently it is not possible to assess colposcopic opinion and many studies have shown wide inter and intra observer error when colposcopic images are evaluated. Therefore we use a range of surrogate parameters to assess individual colposcopic performance including: positive predictive value for a high grade colposcopic impression, excision of TZ in one piece, depth of excision, complications rates, rates for treatment under GA, histological failure rates 12 months after treatment.
To ensure that a screening programme is effective and delivers an equitable service to all women QA systems can play an effective role. QA across a clinic can assess overall performance for comparison with other clinics, across a region of a country and nationally. In the UK there are regional and national QA structures to deliver and monitor the process. In a national programme this information can be used to improve standards of care.
1. Cervical screening: programme and colposcopy management NHSCSP No.20 3rd ed. www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management