In the nomenclature trained colposcopists, the perfect agreement between the IFCPC classification colposcopic diagnosis and the histopathology was 64.95%, with consistency of kappa = 0.436 (P < 0.001, 95% CI = 0.370-0.502), and the agreement within one grade was 97.14% (Table 1).
According to the level of examiner experience, we subdivided 13 IFCPC nomenclature trained colposcopists into three groups: more than 10 years (4 colposcopists), 5-10 years (6 colposcopists), and less than 5 years (3 colposcopists).
Utility and Reproducibility of TZs in the IFCPC Nomenclature.
Comparison between the IFCPC Classification and the Three Scoring Systems.
As the newest international colposcopic terminology, the 2011 IFCPC nomenclature has been proposed for several years; however, the evaluation studies are extremely scant.
Furthermore, the IFCPC classification was balanced in overestimated and underestimated diagnoses, in which overestimated diagnoses may increase the number of unnecessary cervical biopsies or conizations in clinical practice, while underestimated diagnoses lead to inadequate biopsy or inaccurate positioning.
In our study, the colposcopic sensitivity, specificity, PPV, and NPV for HSIL+ according to the IFCPC classification were all better than those using the RCI, modified RCI, and Swede Score.
With the extensive spread of the IFCPC nomenclature and more detailed improvements in the new version, colposcopists received increasing recognition and confidence in normal/abnormal findings.
One of the highlights of the IFCPC nomenclature is term cervical TZ between the original squamous epithelium and columnar epithelium within which varying degrees of maturity may be identified.
However, this study shows that when the 2011 IFCPC classification is used, colposcopic accuracy by examiners with differing amounts of experience has no significant difference.
Although the reproducibility of TZ and a few signs of predictive value remain to be discussed, the present study confirms that colposcopy according to the 2011 IFCPC classification in trained colposcopists is a potential screening method.