Portable Pocket colposcopy performs comparably to standard‐of‐care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru

Objective Our goal was to develop a tele‐colposcopy platform for primary‐care clinics to improve screening sensitivity and access. Specifically, we developed a low‐cost, portable Pocket colposcope and evaluated its performance in a tertiary healthcare centre in Peru. Design and setting Images of the cervix were captured with a standard‐of‐care and Pocket colposcope at la Liga Contra el Cáncer in Lima, Peru. Population Two hundred Peruvian women with abnormal cytology and/or human papillomavirus positivity were enrolled. Methods Images were collected using acetic acid and Lugol's iodine as contrast agents. Biopsies were taken as per standard‐of‐care procedures. Main outcome measures After passing quality review, images from 129 women were sent to four physicians who provided a diagnosis for each image. Results Physician interpretation of images from the two colposcopes agreed 83.1% of the time. The average sensitivity and specificity of physician interpretation compared with pathology was similar for the Pocket (sensitivity = 71.2%, specificity = 57.5%) and standard‐of‐care (sensitivity = 79.8%, specificity = 56.6%) colposcopes. When compared with a previous study where only acetic acid was applied to the cervix, results indicated that adding Lugol's iodine as a secondary contrast agent improved the percent agreement between colposcopes for all pathological categories by up to 8.9% and the sensitivity and specificity of physician interpretation compared with pathology by over 6.0 and 9.0%, respectively. Conclusions The Pocket colposcope performance was similar to that of a standard‐of‐care colposcope when used to identify precancerous and cancerous lesions using acetic acid and Lugol's iodine during colposcopy examinations in Peru. Tweetable The Pocket colposcope performance was similar to that of a standard‐of‐care colposcope when identifying cervical lesions. Tweetable The Pocket colposcope performance was similar to that of a standard‐of‐care colposcope when identifying cervical lesions.