During the colposcopy examination, one of the two standard colposcopes (Leisegang 1DF, Leisegang, Feinmechanik-Optik GmbH, Berling, Germany or Karl Kaps Som 52, Karl Kaps GmbH & Co.KG, Asslar/Wetzlar, Germany) and the Gynocular (Gynius AB, Stockholm, Sweden) were used. selleck kinase inhibitor Women were

randomly allocated in blocks of 50 to start the examination by one of the nurses, followed by an examination by one of the doctors with either the stationary colposcope or the Gynocular. Then the same examiners examined the woman with the second instrument in order to assess the performance of agreement between the Swede scores of the nurse and of the doctor and of the two instruments. The crossover design was chosen in order to lessen possible observer variability.21 A total of 524 women started the examination

with the stationary colposcope and 408 women with the Gynocular. During the Swede score examination, each of the five colposcopic variables (acetowhiteness, margins plus surface, vessel pattern, lesion size and iodine staining) was given a score of 0, 1 or 2 points.12–15 A self-holding non-lubricated speculum was placed in the vagina and the cervix was visualised. The nurse started the examination with an inspection of the cervical vessels of mosaic pattern, punctuation, atypical vessels or absence of vessels as randomised with the colposcope or the Gynocular using the red-free (green filter) mode and switched instruments. Then the doctor evaluated the vessel patterns with both instruments as randomised. This procedure differs slightly from the original Swede score,12 where the vessels are inspected after application of acetic acid to the cervix. However, after application of acetic acid, the whitening effect on the cervix slowly fades. Therefore, we chose to first inspect the vessel

pattern, and then apply the acetic acid to ensure that both nurses and doctors would have enough time to accurately estimate the acetowhitening effect before fading. Thus, the cervix was wiped with 5% acetic acid for 1 min, followed by evaluation by the nurse of three Swede score variables (acetowhiteness, margins plus surface and lesion size) and scored Brefeldin_A by the nurse by both instruments and then again by the doctor. Next, the cervix was swabbed with 5% Lugol iodine solution, and the nurse scored the Swede score’s fifth variable (iodine staining) with both instruments as randomised and then again by the doctor. The results from the examinations were reported by the nurses and the doctors to the study nurse in a separate location. The other examiners could not overhear the reports and they could not see the results of the previous examiner. The nurses and the doctors were also not allowed to communicate the patient’s examination results. The examination was completed with one or more biopsies taken from areas of suspected cervical lesions.