Reviewer ’s report  
 
Title:  Colposcopy Telemedicine: live versus static Swede score and accuracy in detecting 
CIN2+, a cross -sectional pilot study  
 
Version: 0 Date: 05 Apr 2018 
 
Reviewer:  Margaret  Cruickshank  
 
Reviewer’s report:  
 
This is an important area - validating technology in low resource settings to ensure effectiveness 
and quality of care in the prevention of cervic al cancer.  The rates are increasing and will 
continue to do so in LMIC unless feasible and effective programmes to screen and treat can be 
delivered.  
 
The study compares the use of a unocular system (it is not clarified that this is not a binocular 
fixed colposcope) with a trained colposcopists on site and transmission of still images using 
mobile phone technology for remote assessment.  
 
The background should set out clearly why live versus static images and their accuracy for 
detecting CIN2+ is an issue.  
 
The strengths are number of cases and biopsies to ascertain disease in all cases.  
 
 
Limitations:  
 
Only one colposcpoists viewing dynamic images  
 
No consistency in images as described and number of images per case which could affect 
performance in either dire ction.  376 images from 94 women.  Can you provide data on the 
number of imiages per women median/mean and range.  was there any correlation between 
number of images and histology?  
 
I agree that it would be useful to also see analysis with CIN3+  
 
 
minor co mments  
 
I agree that the ALTS data is now 20 years ago and from the US and these data are therefore less 
relevant today.  I understood the images in ALTS to be cervicograms rather than colposcopy 
images. I agree that there has be evolution of image capture technologies and this supports 
interest in this paper.  
 
Methods state that the treatment threshold was score of 5 and results score of 4 - please can you 
explain in discussion.  
 
Line 151 says biopsies were taken from the TZ but line 125 from the SCJ. Which was it?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
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3. Do you hold or are you currently applying for any patents relating to the content of the 
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4. Have you received reimbursements, fees, funding, or salary from an organization that 
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5. Do you have any other financial competing interests?  
 
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below. If your reply is yes to any, please give details below.  
 
I declare that I have  no competing interests  
 
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