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Zhang W, Fine JL, Pei X, Cao Y, Liu Y, Yan J, Ban Z, Zhang T, Wei Y, Zhao X, Wang B, Zhao C, Zeng X. Characteristics and utility of high-resolution optical coherence microscopy images of endocervical canal lesions. Am J Clin Pathol 2024:aqae052. [PMID: 38704601 DOI: 10.1093/ajcp/aqae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 04/06/2024] [Indexed: 05/06/2024] Open
Abstract
OBJECTIVES To investigate optical coherence microscopy (OCM) imaging features and the application value of these high-resolution images for identifying endocervical canal lesions (ECLs), which is a clinical dilemma in cervical cancer screening programs. METHODS In total, 520 OCM images were obtained by scanning the cervical canal lesions with an ultra-high-resolution OCM system (204 specimens from 73 patients). The OCM morphologic characteristics of ECLs were observed and summarized, and then 3 researchers performed a diagnostic test of OCM images of cervical canal lesions. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, 95% confidence interval of each parameter, and interinvestigator agreement (κ) were calculated. RESULTS Normal endocervix, cysts, squamous metaplasia, high-grade squamous intraepithelial lesions involving glands, and invasive carcinoma had distinct OCM characteristics, which correlated well with corresponding H&E histologic sections. The accuracy, sensitivity, and specificity of the 3 researchers were 90.6%, 89.3% (95% CI, 86.5%-91.7%) and 91.6% (95% CI, 89.2%-93.5%), respectively. The positive predictive value was 90.1% (95% CI, 87.3%-92.4%), and the negative predictive value was 90.9% (95% CI, 88.5%-92.9%), with almost perfect agreement (κ = 0.874). CONCLUSIONS The application of the OCM system in cervical canal lesions is feasible and could help improve detection of occult ECLs in cervical cancer screening programs. This study lays the foundation for further research on OCM in cervical canal lesions in vivo, which also has a potential impact on projecting pathologic evaluation beyond what is currently possible, perhaps globally.
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Affiliation(s)
- Wei Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jeffrey L Fine
- Department of Pathology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Xiaoyin Pei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yushan Cao
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yixuan Liu
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinxiang Yan
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenying Ban
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ting Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Wei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Zhao
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baojin Wang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengquan Zhao
- Department of Pathology, UPMC Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Xianxu Zeng
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Radiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Xiao X, Yan L, Yang X, Zhou Z, Shi L, Fu C. Optical Coherence Tomography Can Reduce Colposcopic Referral Rates in Patients With High-Risk Human Papillomavirus. J Low Genit Tract Dis 2023; 27:324-330. [PMID: 37163703 DOI: 10.1097/lgt.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility of combined human papillomavirus (HPV) and optical coherence tomography (OCT) cervical cancer screening strategies. MATERIALS AND METHODS The OCT and cytology results were compared with the pathological results to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and immediate cervical intraepithelial neoplasia grade 3 or worse (CIN3+) risk. The authors compared the efficiency of colposcopy by using different triage strategies. They discussed differentiation in OCT screening in different age groups. RESULTS Eight hundred thirteen participants with high-risk HPV-positive and cervical cytology results underwent OCT before colposcopy between March 1 and October 1, 2021. The HPV16/18 genotyping with OCT triage has a specificity of CIN3+ lesions (61.1%; 95% CI = 57.6%-64.6%), intraepithelial neoplasia grade 2 or worse (CIN2+) (66.0%; 95% CI = 62.4%-69.6%). The HPV16/18 genotyping with cytology triage has a specificity of CIN3+ (44.0%; 95% CI = 40.4%-47.6%), CIN2+ (47.0%; 95% CI = 43.2%-50.8%). The OCT triage has a higher positive predictive value compared with the cytology, with a significant difference in CIN2+ lesions (45.0%; 95% CI = 38.8%-51.3% vs 29.2%; 95% CI = 24.7%-33.7%). CONCLUSIONS The combination of OCT and high-risk HPV triage (both genotyping and nongenotyping) had a similar immediate CIN3+ risk stratification and reduced the number of colposcopies compared with the cytological triage strategy.
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Affiliation(s)
- Xiao Xiao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Yan L, Xiao X, He L, Shi L, Yang X, Zhang J, Zhang Y, Fu C. Efficacy of optical coherence tomography in the triage of women with minor abnormal cervical cytology before colposcopy. PLoS One 2023; 18:e0282833. [PMID: 36913396 PMCID: PMC10010519 DOI: 10.1371/journal.pone.0282833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of Optical Coherence Tomography (OCT) for detecting cervical lesions in women with minor abnormal cytology results (atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL)). METHODS A prospective study was conducted at gynecologic clinic from Mar 2021 to Sep 2021. The recruited women with cervical cytological findings of ASC-US or LSIL were inspected with OCT before colposcopy-directed cervical biopsy. The diagnostic performance of OCT, alone and in combination with high-risk human papillomavirus (hrHPV) testing were evaluated to detect cervical intraepithelial neoplasia of grade 2 or worse (CIN2+)/CIN3 or worse (CIN3+). The rate of colposcopy referral and the immediate risk of CIN3+ of OCT were calculated. RESULTS A total of 349 women with minor abnormal cervical cytology results were enrolled. For detection of CIN2+/CIN3+, the sensitivity and NPV of OCT were lower than those of hrHPV testing (CIN2+: 71.3% vs. 95.4%, 89.0% vs. 91.1%, P < 0.001; CIN3+: 75% vs. 93.8%, 96.5% vs. 95.6%, P < 0.001), but the specificity, accuracy and PPV were higher than those of hrHPV testing (CIN2+: 77.5% vs. 15.6%, 75.9% vs. 35.5%, 51.2% vs. 27.3%, P < 0.001; CIN3+: 69.4% vs. 13.6%, 69.9% vs. 20.9%, 19.8% vs. 9.9%, P < 0.001). OCT combined with hrHPV testing (CIN2+: 80.9%; CIN3+: 72.6%) showed higher specificity than that of OCT alone (P < 0.001). The colposcopy referral rate base on OCT classification was lower than that based on hrHPV testing (34.7% vs. 87.1%, P < 0.001). Patients with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology, the immediate CIN3+ risk in OCT negative cases was less than 4%. CONCLUSIONS OCT alone or combination with hrHPV testing shows good performance for detecting CIN2+/CIN3+ in patients with ASC-US/LSIL cytology. OCT is an effective method for colposcopy triage in women with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology.
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Affiliation(s)
- Lei Yan
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiao Xiao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ling He
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liye Shi
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xue Yang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yongjing Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Chun Fu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Moghaddam AO, Lin Z, Sivaguru M, Phillips H, McFarlin BL, Toussaint KC, Johnson AJW. Heterogeneous microstructural changes of the cervix influence cervical funneling. Acta Biomater 2022; 140:434-445. [PMID: 34958969 PMCID: PMC8828692 DOI: 10.1016/j.actbio.2021.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022]
Abstract
The cervix acts as a dynamic barrier between the uterus and vagina, retaining the fetus during pregnancy and allowing birth at term. Critical to this function, the physical properties of the cervix change, or remodel, but abnormal remodeling can lead to preterm birth (PTB). Although cervical remodeling has been studied, the complex 3D cervical microstructure has not been well-characterized. In this complex, dynamic, and heterogeneous tissue microenvironment, the microstructural changes are likely also heterogeneous. Using quantitative, 3D, second-harmonic generation microscopy, we demonstrate that rat cervical remodeling during pregnancy is not uniform across the cervix; the collagen fibers orient progressively more perpendicular to the cervical canals in the inner cervical zone, but do not reorient in other regions. Furthermore, regions that are microstructurally distinct early in pregnancy become more similar as pregnancy progresses. We use a finite element simulation to show that heterogeneous regional changes influence cervical funneling, an important marker of increased risk for PTB; the internal cervical os shows ∼6.5x larger radial displacement when fibers in the inner cervical zone are parallel to the cervical canals compared to when fibers are perpendicular to the canals. Our results provide new insights into the microstructural and tissue-level cervical changes that have been correlated with PTB and motivate further clinical studies exploring the origins of cervical funneling. STATEMENT OF SIGNIFICANCE: Cervical funneling, or dilation of the internal cervical os, is highly associated with increased risk of preterm birth. This study explores the 3D microstructural changes of the rat cervix during pregnancy and illustrates how these changes influence cervical funneling, assuming similar evolution in rats and humans. Quantitative imaging showed that microstructural remodeling during pregnancy is nonuniform across cervical regions and that initially distinct regions become more similar. We report, for the first time, that remodeling of the inner cervical zone can influence the dilation of the internal cervical os and allow the cervix to stay closed despite increased intrauterine pressure. Our results suggest a possible relationship between the microstructural changes of this zone and cervical funneling, motivating further clinical investigations.
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Affiliation(s)
- A. Ostadi Moghaddam
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - Z. Lin
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - M. Sivaguru
- Flow Cytometry and Microscopy to Omics, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
| | - H. Phillips
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - B. L. McFarlin
- Department of Women, Children and Family Health Science, University of Illinois College of Nursing, Chicago, IL 60612, USA
| | - K. C. Toussaint
- School of Engineering, Brown University, Providence, RI 02912, USA
| | - A. J. Wagoner Johnson
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA,Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA,Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA,Corresponding author at: 2101A Mechanical Engineering Laboratory MC-244, University of Illinois at Urbana-Champaign, 1206 West Green Street, Urbana, IL 61801, United States.
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Bury D, Morais CLM, Martin FL, Lima KMG, Ashton KM, Baker MJ, Dawson TP. Discrimination of fresh frozen non-tumour and tumour brain tissue using spectrochemical analyses and a classification model. Br J Neurosurg 2019; 34:40-45. [PMID: 31642351 DOI: 10.1080/02688697.2019.1679352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: In order for brain tumours to be successfully treated, maximal resection is beneficial. A method to detect infiltrative tumour edges intraoperatively, improving on current methods would be clinically useful. Vibrational spectroscopy offers the potential to provide a handheld, reagent-free method for tumour detection.Purpose: This study was designed to determine the ability of both Raman and Fourier-transform infrared (FTIR) spectroscopy towards differentiating between normal brain tissue, glioma or meningioma.Method: Unfixed brain tissue, which had previously only been frozen, comprising normal, glioma or meningioma tissue was placed onto calcium fluoride slides for analysis using Raman and attenuated total reflection (ATR)-FTIR spectroscopy. Matched haematoxylin and eosin slides were used to confirm tumour areas. Analyses were then conducted to generate a classification model.Results: This study demonstrates the ability of both Raman and ATR-FTIR spectroscopy to discriminate tumour from non-tumour fresh frozen brain tissue with 94% and 97.2% of cases correctly classified, with sensitivities of 98.8% and 100%, respectively. This decreases when spectroscopy is used to determine tumour type.Conclusion: The study demonstrates the ability of both Raman and ATR-FTIR spectroscopy to detect tumour tissue from non-tumour brain tissue with a high degree of accuracy. This demonstrates the ability of spectroscopy when targeted for a cancer diagnosis. However, further improvement would be required for a classification model to determine tumour type using this technology, in order to make this tool clinically viable.
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Affiliation(s)
- Danielle Bury
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Camilo L M Morais
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Francis L Martin
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, UK
| | - Kássio M G Lima
- Biological Chemistry and Chemometrics, Institute of Chemistry, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Katherine M Ashton
- Department of Neuropathology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Matthew J Baker
- WestCHEM, Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, UK
| | - Timothy P Dawson
- Department of Neuropathology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Trust, Preston, UK
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Ma Y, Xu T, Huang X, Wang X, Li C, Jerwick J, Ning Y, Zeng X, Wang B, Wang Y, Zhang Z, Zhang X, Zhou C. Computer-Aided Diagnosis of Label-Free 3-D Optical Coherence Microscopy Images of Human Cervical Tissue. IEEE Trans Biomed Eng 2019; 66:2447-2456. [PMID: 30605087 PMCID: PMC6724217 DOI: 10.1109/tbme.2018.2890167] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Ultrahigh-resolution optical coherence microscopy (OCM) has recently demonstrated its potential for accurate diagnosis of human cervical diseases. One major challenge for clinical adoption, however, is the steep learning curve clinicians need to overcome to interpret OCM images. Developing an intelligent technique for computer-aided diagnosis (CADx) to accurately interpret OCM images will facilitate clinical adoption of the technology and improve patient care. METHODS 497 high-resolution three-dimensional (3-D) OCM volumes (600 cross-sectional images each) were collected from 159 ex vivo specimens of 92 female patients. OCM image features were extracted using a convolutional neural network (CNN) model, concatenated with patient information [e.g., age and human papillomavirus (HPV) results], and classified using a support vector machine classifier. Ten-fold cross-validations were utilized to test the performance of the CADx method in a five-class classification task and a binary classification task. RESULTS An 88.3 ± 4.9% classification accuracy was achieved for five fine-grained classes of cervical tissue, namely normal, ectropion, low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL), and cancer. In the binary classification task [low-risk (normal, ectropion, and LSIL) versus high-risk (HSIL and cancer)], the CADx method achieved an area-under-the-curve value of 0.959 with an 86.7 ± 11.4% sensitivity and 93.5 ± 3.8% specificity. CONCLUSION The proposed deep-learning-based CADx method outperformed four human experts. It was also able to identify morphological characteristics in OCM images that were consistent with histopathological interpretations. SIGNIFICANCE Label-free OCM imaging, combined with deep-learning-based CADx methods, holds a great promise to be used in clinical settings for the effective screening and diagnosis of cervical diseases.
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Jing Y, Wang Y, Wang X, Song C, Ma J, Xie Y, Fei Y, Zhang Q, Mi L. Label-free imaging and spectroscopy for early detection of cervical cancer. JOURNAL OF BIOPHOTONICS 2018; 11:e201700245. [PMID: 29205885 DOI: 10.1002/jbio.201700245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/28/2017] [Indexed: 05/20/2023]
Abstract
The label-free imaging and spectroscopy method was studied on cervical unstained tissue sections obtained from 36 patients. The native fluorescence spectra of tissues are analyzed by the optical redox ratio (ORR), which is defined as fluorescence intensity ratio between NADH and FAD, and indicates the metabolism change with the cancer development. The ORRs of normal tissues are consistently higher than those of precancer or cancerous tissues. A criterion line of ORR at 5.0 can be used to discriminate cervical precancer/cancer from normal tissues. The sensitivity and specificity of the native fluorescence spectroscopy method for cervical cancer diagnosis are determined as 100% and 91%. Moreover, the native fluorescence spectroscopy study is much more sensitive on the healthy region of cervical precancer/cancer patients compared with the traditional clinical staining method. The results suggest label-free imaging and spectroscopy is a fast, highly sensitive and specific method on the detection of cervical cancer.
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Affiliation(s)
- Yueyue Jing
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
| | - Yulan Wang
- Department of Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinyi Wang
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
| | - Chuan Song
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
| | - Jiong Ma
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
| | - Yonghui Xie
- Department of Pathology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yiyan Fei
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
| | - Qinghua Zhang
- Department of Gynecology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Mi
- Department of Optical Science and Engineering, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Shanghai Engineering Research Center of Ultra-Precision Optical Manufacturing, Green Photoelectron Platform, Fudan University, Shanghai, China
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Zeng X, Zhang X, Li C, Wang X, Jerwick J, Xu T, Ning Y, Wang Y, Zhang L, Zhang Z, Ma Y, Zhou C. Ultrahigh-resolution optical coherence microscopy accurately classifies precancerous and cancerous human cervix free of labeling. Am J Cancer Res 2018; 8:3099-3110. [PMID: 29896305 PMCID: PMC5996360 DOI: 10.7150/thno.24599] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
Cervical cancer remains the fourth most common cause of cancer worldwide and the third leading cause of cancer deaths for women in developing countries. Traditional screening tools, such as human papillomavirus and Pap tests, cannot provide results in real-time and cannot localize suspicious regions. Colposcopy-directed biopsies are invasive in nature and only a few sites of the cervix may be chosen for investigation. A non-invasive, label-free and real-time imaging method with a resolution approaching that of histopathology is desirable for early detection of the disease. Methods: Ultrahigh-resolution optical coherence microscopy (OCM) is an emerging imaging technique used to obtain 3-dimensional (3-D) “optical biopsies” of biological samples with cellular resolution. In this study, 497 3-D OCM datasets from 159 specimens were collected from 92 patients. Results: Distinctive patterns for normal cervix, squamocolumnar junction, ectropion, low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL) and invasive cervical lesions were clearly observed from OCM images, which matched well with corresponding histological slides. OCM images demonstrated a sensitivity of 80% (95% confidence interval, CI, 72%-86%) and a specificity of 89% (95% CI, 84%-93%) for detecting high-risk lesions (HSIL and invasive lesions) when blindly tested by three investigators. A substantial inter-observer agreement was observed (κ=0.627), which showed high diagnostic consistency among three investigators. Conclusion: These results laid the foundation for future non-invasive optical evaluation of cervical tissue in vivo, which could lead to a less invasive and more effective screening and “see-and-treat” strategy for the management of cervical cancer.
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Huang J, Ma X, Zhang L, Jia H, Wang F. Diagnostic accuracy of optical coherence tomography in bladder cancer patients: A systematic review and meta-analysis. Mol Clin Oncol 2018. [PMID: 29541471 DOI: 10.3892/mco.2018.1566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A meta-analysis was performed to evaluate the accuracy of optical coherence tomography (OCT) for diagnostic accuracy studies in bladder cancer patients. English language studies reporting the diagnostic accuracy of OCT for bladder cancer were retrieved from the PubMed, EMBASE and Cochrane Library databases in December 2014. Histopathology was a reference standard. Sensitivities, specificities, positive likelihood ratios and negative likelihood ratios were calculated, and summary receiver operating characteristic curves were drawn to determine the diagnostic accuracy of OCT. Finally, 9 eligible studies (468 patients) were included in our meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of OCT were 0.96 [95% confidence interval (CI): 0.94-0.98], 0.82 (95% CI: 0.80-0.85), 6.83 (95% CI: 3.24-14.1) and 0.05 (95% CI: 0.02-0.16), respectively. The summary diagnostic odds ratio was 138.88 (95% CI: 29.63-650.89) and the overall area under the curve was 0.9735. These results suggest that OCT has excellent diagnostic performance in patients with bladder cancer and recurrent lesions.
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Affiliation(s)
- Juan Huang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Hematology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Xuelei Ma
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Chengdu Integrated TCM and Western Medical Hospital, Chengdu, Sichuan 610041, P.R. China
| | - Hongyuan Jia
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Feng Wang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Wang J, Xu Y, Boppart SA. Review of optical coherence tomography in oncology. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-23. [PMID: 29274145 PMCID: PMC5741100 DOI: 10.1117/1.jbo.22.12.121711] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/04/2017] [Indexed: 05/06/2023]
Abstract
The application of optical coherence tomography (OCT) in the field of oncology has been prospering over the past decade. OCT imaging has been used to image a broad spectrum of malignancies, including those arising in the breast, brain, bladder, the gastrointestinal, respiratory, and reproductive tracts, the skin, and oral cavity, among others. OCT imaging has initially been applied for guiding biopsies, for intraoperatively evaluating tumor margins and lymph nodes, and for the early detection of small lesions that would often not be visible on gross examination, tasks that align well with the clinical emphasis on early detection and intervention. Recently, OCT imaging has been explored for imaging tumor cells and their dynamics, and for the monitoring of tumor responses to treatments. This paper reviews the evolution of OCT technologies for the clinical application of OCT in surgical and noninvasive interventional oncology procedures and concludes with a discussion of the future directions for OCT technologies, with particular emphasis on their applications in oncology.
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Affiliation(s)
- Jianfeng Wang
- University of Illinois at Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
| | - Yang Xu
- University of Illinois at Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana–Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
| | - Stephen A. Boppart
- University of Illinois at Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, Illinois, United States
- University of Illinois at Urbana–Champaign, Department of Electrical and Computer Engineering, Urbana, Illinois, United States
- University of Illinois at Urbana–Champaign, Department of Bioengineering, Urbana, Illinois, United States
- University of Illinois at Urbana–Champaign, Carle–Illinois College of Medicine, Urbana, Illinois, United States
- Address all correspondence to: Stephen A. Boppart, E-mail:
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11
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Kirillin M, Motovilova T, Shakhova N. Optical coherence tomography in gynecology: a narrative review. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:1-9. [PMID: 29210220 DOI: 10.1117/1.jbo.22.12.121709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
Modern gynecologic practice requires noninvasive diagnostics techniques capable of detecting morphological and functional alterations in tissues of female reproductive organs. Optical coherence tomography (OCT) is a promising tool for providing imaging of biotissues with high resolution at depths up to 2 mm. Design of the customized probes provides wide opportunities for OCT use in gynecology. This paper contains a retrospective insight into the history of OCT employment in gynecology, an overview of the existing gynecologic OCT probes, including those for combination with other diagnostic modalities, and state-of-the-art application of OCT for diagnostics of tumor and nontumor pathologies of female genitalia. Perspectives of OCT both in diagnostics and treatment planning and monitoring in gynecology are overviewed.
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12
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Novikova T. Optical techniques for cervical neoplasia detection. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2017; 8:1844-1862. [PMID: 29046833 PMCID: PMC5629403 DOI: 10.3762/bjnano.8.186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 05/04/2023]
Abstract
This paper provides an overview of the current research in the field of optical techniques for cervical neoplasia detection and covers a wide range of the existing and emerging technologies. Using colposcopy, a visual inspection of the uterine cervix with a colposcope (a binocular microscope with 3- to 15-fold magnification), has proven to be an efficient approach for the detection of invasive cancer. Nevertheless, the development of a reliable and cost-effective technique for the identification of precancerous lesions, confined to the epithelium (cervical intraepithelial neoplasia) still remains a challenging problem. It is known that even at early stages the neoplastic transformations of cervical tissue induce complex changes and modify both structural and biochemical properties of tissues. The different methods, including spectroscopic (diffuse reflectance spectroscopy, induced fluorescence and autofluorescence spectroscopy, Raman spectroscopy) and imaging techniques (confocal microscopy, optical coherence tomography, Mueller matrix imaging polarimetry, photoacoustic imaging), probe different tissue properties that may serve as optical biomarkers for diagnosis. Both the advantages and drawbacks of these techniques for the diagnosis of cervical precancerous lesions are discussed and compared.
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Affiliation(s)
- Tatiana Novikova
- LPICM, CNRS, Ecole polytechnique, University Paris Saclay, Palaiseau, France
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13
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Gallwas J, Jalilova A, Ladurner R, Kolben TM, Kolben T, Ditsch N, Homann C, Lankenau E, Dannecker C. Detection of cervical intraepithelial neoplasia by using optical coherence tomography in combination with microscopy. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:16013. [PMID: 28118427 DOI: 10.1117/1.jbo.22.1.016013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 05/09/2023]
Abstract
Optical coherence tomography (OCT) is a noninvasive high-resolution imaging technique that permits the detection of cancerous and precancerous lesions of the uterine cervix. The purpose of this study was to evaluate a new system that integrates an OCT device into a microscope. OCT images were taken from loop electrosurgical excision procedure (LEEP) specimens under microscopic guidance. The images were blinded with respect to their origin within the microscopic image and analyzed independently by two investigators using initially defined criteria and later compared to the corresponding histology. Sensitivity and specificity were calculated with respect to the correct identification of high-grade squamous intraepithelial lesions (HSIL). The interinvestigator agreement was assessed by using Cohen’s kappa statistics. About 160 OCT images were obtained from 20 LEEP specimens. Sixty randomly chosen images were used to define reproducible criteria for evaluation. The assessment of the remaining 100 images showed a sensitivity of 88% (second investigator 84%) and a specificity of 69% (65%) in detecting HSIL. Surgical microscopy-guided OCT appears to be a promising technique for immediate assessment of microanatomical changes. In the gynecological setting, the combination of OCT with a colposcope may improve the detection of high-grade squamous intraepithelial lesions.
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Affiliation(s)
- Julia Gallwas
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
| | - Aydan Jalilova
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
| | - Roland Ladurner
- Ludwig-Maximilians University Munich, Innenstadt Medical Campus, Department of Surgery, Nussbaumstrasse 20, 80336 Munich, Germany
| | - Theresa Maria Kolben
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
| | - Thomas Kolben
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
| | - Nina Ditsch
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
| | - Christian Homann
- cLudwig Maximilians University Munich, Grosshadern Medical Campus, Laser-Research Laboratory, LIFE Center, Feodor-Lynen-Strasse 19, 81377 Munich, Germany
| | - Eva Lankenau
- OptoMedical Technologies GmbH, Maria Goeppert Strasse 9, 23562 Luebeck, Germany
| | - Christian Dannecker
- Ludwig Maximilians University Munich, Grosshadern Medical Campus, Department of Obstetrics and Gynecology, Marchioninistrasse 15, 81377 Munich, Germany
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Banerjee S, Chatterjee S, Anura A, Chakrabarty J, Pal M, Ghosh B, Paul RR, Sheet D, Chatterjee J. Global spectral and local molecular connects for optical coherence tomography features to classify oral lesions towards unravelling quantitative imaging biomarkers. RSC Adv 2016. [DOI: 10.1039/c5ra24117k] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The biopsy based diagnosis of oral precancers like leukoplakia (OLK) and submucous fibrosis (OSF) as well as squamous cell carcinoma (OSCC) suffers from observer specific variability.
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Affiliation(s)
- Satarupa Banerjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | - Swarnadip Chatterjee
- Advanced Technology Development Centre
- Indian Institute of Technology
- Kharagpur
- India
| | - Anji Anura
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
| | | | - Mousumi Pal
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Bhaskar Ghosh
- Department of ENT & Head Neck Surgery
- Medical College
- Kolkata
- India
| | - Ranjan Rashmi Paul
- Department of Oral and Maxillofacial Pathology
- Guru Nanak Institute of Dental Science and Research
- Kolkata
- India
| | - Debdoot Sheet
- Department of Electrical Engineering
- Indian Institute of Technology
- Kharagpur
- India
| | - Jyotirmoy Chatterjee
- School of Medical Science and Technology
- Indian Institute of Technology
- Kharagpur
- India
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Novel advancements in colposcopy: historical perspectives and a systematic review of future developments. J Low Genit Tract Dis 2015; 18:246-60. [PMID: 24633164 DOI: 10.1097/lgt.0b013e3182a72170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe novel innovations and techniques for the detection of high-grade dysplasia. MATERIALS AND METHODS Studies were identified through the PubMed database, spanning the last 10 years. The key words (["computerized colposcopy" or "digital colposcopy" or "spectroscopy" or "multispectral digital colposcopy" or "dynamic spectral imaging", or "electrical impedance spectroscopy" or "confocal endomicroscopy" or "confocal microscopy"or "optical coherence tomography"] and ["cervical dysplasia" or cervical precancer" or "cervix" or "cervical"]) were used. The inclusion criteria were published articles of original research referring to noncolposcopic evaluation of the cervix for the detection of cervical dysplasia. Only English-language articles from the past 10 years were included, in which the technologies were used in vivo, and sensitivities and specificities could be calculated. RESULTS The single author reviewed the articles for inclusion. Primary search of the database yielded 59 articles, and secondary cross-reference yielded 12 articles. Thirty-two articles met the inclusion criteria. CONCLUSIONS An instrument that globally assesses the cervix, such as computer-assisted colposcopy, optical spectroscopy, and dynamic spectral imaging, would provided the most comprehensive estimate of disease and is therefore best suited when treatment is preferred. Electrical impedance spectroscopy, confocal microscopy, and optical coherence tomography provide information at the cellular level to estimate histology and are therefore best suited when deferment of treatment is preferred. If a device is to eventually replace the colposcope, it will likely combine technologies to best meet the needs of the target population, and as such, no single instrument may prove to be universally appropriate. Analyses of false-positive rates, additional colposcopies and biopsies, cost, and absolute life-savings will be important when considering these technologies and are limited thus far.
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Peng K, He L, Wang B, Xiao J. Detection of cervical cancer based on photoacoustic imaging-the in-vitro results. BIOMEDICAL OPTICS EXPRESS 2015; 6:135-43. [PMID: 25657882 PMCID: PMC4317127 DOI: 10.1364/boe.6.000135] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/20/2014] [Accepted: 11/13/2014] [Indexed: 05/20/2023]
Abstract
In current clinical practice, the diagnosis of cervical cancer (CC) is mainly through the cervical screening followed by a necessary biopsy, but this method is labor consuming and expensive, and can only detect superficial lesions around the external cervical orifice. In contrast, photoacoustic imaging (PAI) is sensitive to the abnormal angiogenesis deep in the biological tissue, and may be capable for the intact scanning both around the external orifice and in cervical canal. In this paper, we for the first time put forward the photoacoustic diagnosis of CC. A total of 30 in-vitro experiments were carried out in this study, and the obtained depth maximum amplitude projection (DMAP) images were analyzed to evaluate the extent of the angiogenesis for different clinical stages of CC. Stronger absorption from the cervical lesions is observed relative to that of normal tissue. Paired t-test indicates that the difference in mean optical absorption (MOA) between normal tissue and cervical lesion has statistical significance with a confidential coefficient of 0.05. Statistical results also show that the MOAs of the cervical lesions are closely related to the severity of CC. These results imply that PAI may have great utility in the clinical diagnosis of CC.
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Affiliation(s)
- Kuan Peng
- Department of Biomedical Engineering, School of Geosciences and Info-Physics, Central South University, Changsha, Hunan 410083,
China
| | - Ling He
- Obstetrics & Gynecology Department, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011,
China
| | - Bo Wang
- Department of Biomedical Engineering, School of Geosciences and Info-Physics, Central South University, Changsha, Hunan 410083,
China
- College of Biology, Hunan University, Changsha, Hunan 410082,
China
| | - Jiaying Xiao
- Department of Biomedical Engineering, School of Geosciences and Info-Physics, Central South University, Changsha, Hunan 410083,
China
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17
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Effect of optical clearing agents on optical coherence tomography images of cervical epithelium. Lasers Med Sci 2014; 30:517-25. [PMID: 25503301 DOI: 10.1007/s10103-014-1674-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/24/2014] [Indexed: 12/12/2022]
Abstract
Optical coherence tomography (OCT) can be used as an adjunct to colposcopy in order to detect precancerous and cancerous cervical lesions. Optical clearing agents (OCAs) temporarily reduce the optical scattering of biological tissues. The purpose of this study was to investigate their influence on OCT imaging. OCT images were taken from unsuspicious and suspicious areas of fresh conization specimens immediately after resection and 5, 10, and 20 min after application of dimethyl sulfoxide (DMSO) or polyethylene glycol (PEG). Corresponding histologies were obtained from all sites. The images taken 5, 10, and 20 min after application of OCA were compared to the initial images with respect to changes in brightness, contrast, and scanning depth using a standard nonparametric test of differences of proportions. Further, mean intensity backscattering curves were calculated from all OCT images in the histological groups CIN2, CIN3, inflammation, and normal epithelium. Mean difference profiles within each of these groups were determined, reflecting the mean differences between the condition before the application of OCA and the exposure times 5, 10, and 20 min, respectively. The null hypothesis was tested employing the Dicky-Fuller-test, Hotelings-test and run test. The visual analysis of 434 OCT images from 109 different sites of 24 conization specimens showed a statistically significant increase in brightness and contrast for normal and dysplastic epithelium after application of DMSO or PEG. Further, the analysis of mean intensity profiles suggests the existence of an increased backscattering intensity after application of DMSO or PEG. DMSO and PEG contribute substantially to optical clearing in cervical squamous epithelium and therefore influence OCT imaging in a positive way. With further refinement of the OCT technology, the observed changes may be beneficial in interpreting the tissue microstructure and identifying cervical intraepithelial neoplasia.
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18
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Acceptability of optical coherence tomography and abstinence requirements among women participating in microbicide safety trials. Sex Transm Dis 2014; 39:28-31. [PMID: 22183842 DOI: 10.1097/olq.0b013e318231575f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Developing effective and safe microbicides requires study procedures (e.g., technology used, abstinence requirements, and product use) that are acceptable to participants. METHODS Thirty women completed 4 study visits including pelvic examination, colposcopy, optical coherence tomography (OCT), and semistructured, qualitative interviews. Additional requirements included abstinence (for approximately 16 days) and twice daily vaginal product use (for 5.5 days). Interviews were audio-recorded, transcribed, and analyzed using framework analysis. Themes addressing OCT experiences, acceptability of abstinence, and vaginal product use were examined. RESULTS OCT was viewed favorably as an imaging technology. Some women reported feeling the fiber-optic probe "poking" them and more than one-third spontaneously reported feeling pressure or pinching upon rotation of the speculum in connection with the OCT evaluation. Compliance with vaginal gel use was high, but for many women assigned to use a product containing nonoxynol-9 (vs. placebo), the postproduct use examination was more uncomfortable, relative to the initial examination or 1 week following product discontinuation. Nearly all women experienced product leakage; acceptability of leakage varied. Two women were not abstinent and several more found abstinence challenging. Some women involved their partner in decision making regarding trial enrollment. Strategies to remain abstinent included participating when the partner was away, avoiding early intimacy, and engaging in alternative sexual activities. CONCLUSIONS Qualitative interviews in early-phase studies provide insights and capture information that would be missed by behavioral inference alone. Understanding participant's experiences is important in order to provide anticipatory guidance and plan future microbicide studies that facilitate adherence with trial requirements.
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Effect of acetic acid on optical coherence tomography (OCT) images of cervical epithelium. Lasers Med Sci 2014; 29:1821-8. [DOI: 10.1007/s10103-014-1581-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
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20
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Oros D, Altermir I, Elia N, Tuquet H, Pablo LE, Fabre E, Pueyo V. Pathways of neuronal and cognitive development in children born small-for-gestational age or late preterm. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:41-47. [PMID: 23836499 DOI: 10.1002/uog.12556] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/19/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the effects of late small-for-gestational-age (SGA) birth and late prematurity on cognitive outcomes and structural changes in the central nervous system at primary school age, using a novel approach to examine changes in neuronal integrity of the retina. METHODS We conducted a cross-sectional study of 347 children aged 6-13 years, including in the analysis only infants born after 34 weeks' gestation. We recorded all perinatal outcomes through a survey of parents. Neuronal damage was evaluated using optical coherence tomography of the retina. In a subgroup of 112 children aged 6-8 years, visuospatial perception was evaluated with the Children's Bender Visual Motor Gestalt Test. RESULTS The proportions of SGA and late preterm children were 11.8 and 6.3%, respectively. Prematurity and SGA were simultaneously present in five children. When compared with controls, SGA children showed significantly lower than average retinal nerve fiber layer (RNFL) thickness (94.1 vs 98.8 μm; P = 0.007) and an increased percentage of abnormal Bender scores (27.3 vs 6.2%; P = 0.017) (odds ratio 5.6 (95% CI, 1.2-26.8)). These differences increased when late SGA infants with a birth weight below the 3(rd) percentile were compared with SGA infants with a birth weight between the 3(rd) and 10(th) percentiles and with controls, for RNFL thickness (92.5 vs 94.6 and 98.8 μm, respectively; P = 0.021) and abnormal Bender tests (33.3 vs 25.0 and 6.2%, respectively; P = 0.036). However, no differences were found in retinal structure and visuomotor performance between late preterm and term infants. CONCLUSIONS These data suggest that late SGA and late prematurity induce a distinct neuronal pattern of structural changes that persist at school age. Late-onset SGA infants are at increased risk for axonal loss in the retina and present specific visuomotor difficulties.
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Affiliation(s)
- D Oros
- Obstetrics Department, Hospital Clínico Universitario Lozano Blesa Zaragoza, Instituto Aragonés de Ciencias de la Salud, University of Zaragoza, Zaragoza, Spain
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Cervical Epithelial Brightness by Optical Coherence Tomography Can Determine Histological Grades of Cervical Neoplasia. J Low Genit Tract Dis 2013; 17:160-6. [DOI: 10.1097/lgt.0b013e31825d7bf0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Wade R, Spackman E, Corbett M, Walker S, Light K, Naik R, Sculpher M, Eastwood A. Adjunctive colposcopy technologies for examination of the uterine cervix--DySIS, LuViva Advanced Cervical Scan and Niris Imaging System: a systematic review and economic evaluation. Health Technol Assess 2013; 17:1-240, v-vi. [PMID: 23449335 PMCID: PMC4781255 DOI: 10.3310/hta17080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Women in England (aged 25-64 years) are invited for cervical screening every 3-5 years to assess for cervical intraepithelial neoplasia (CIN) or cancer. CIN is a term describing abnormal changes in the cells of the cervix, ranging from CIN1 to CIN3, which is precancerous. Colposcopy is used to visualise the cervix. Three adjunctive colposcopy technologies for examination of the cervix have been included in this assessment: Dynamic Spectral Imaging System (DySIS), the LuViva Advanced Cervical Scan and the Niris Imaging System. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of adjunctive colposcopy technologies for examination of the uterine cervix for patients referred for colposcopy through the NHS Cervical Screening Programme. DATA SOURCES Sixteen electronic databases [Allied and Complementary Medicine Database (AMED), BIOSIS Previews, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Management Information Consortium (HMIC), Health Technology Assessment (HTA) database; Inspec, Inside Conferences, MEDLINE, NHS Economic Evaluation Database (NHS EED), PASCAL, Science Citation Index Expanded (SCIE) and Science Citation Index (SCI) - Conference Proceedings], and two clinical trial registries [ClinicalTrials.gov and Current Controlled Trials (CCT)] were searched to September-October 2011. REVIEW METHODS Studies comparing DySIS, LuViva or Niris with conventional colposcopy were sought; a narrative synthesis was undertaken. A decision-analytic model was developed, which measured outcomes in terms of quality-adjusted life-years (QALYs) and costs were evaluated from the perspective of the NHS and Personal Social Services with a time horizon of 50 years. RESULTS Six studies were included: two studies of DySIS, one study of LuViva and three studies of Niris. The DySIS studies were well reported and had a low risk of bias; they found higher sensitivity with DySIS (both the DySISmap alone and in combination with colposcopy) than colposcopy alone for identifying CIN2+ disease, although specificity was lower with DySIS. The studies of LuViva and Niris were poorly reported and had limitations, which indicated that their results were subject to a high risk of bias; the results of these studies cannot be considered reliable. The base-case cost-effectiveness analysis suggests that both DySIS treatment options are less costly and more effective than colposcopy alone in the overall weighted population; these results were robust to the ranges tested in the sensitivity analysis. DySISmap alone was more costly and more effective in several of the referral groups but the incremental cost-effectiveness ratio (ICER) was never higher than £1687 per QALY. DySIS plus colposcopy was less costly and more effective in all reasons for referral. Only indicative analyses were carried out on Niris and LuViva and no conclusions could be made on their cost-effectiveness. LIMITATIONS The assessment is limited by the available evidence on the new technologies, natural history of the disease area and current treatment patterns. CONCLUSIONS DySIS, particularly in combination with colposcopy, has higher sensitivity than colposcopy alone. There is no reliable evidence on the clinical effectiveness of LuViva and Niris. DySIS plus colposcopy appears to be less costly and more effective than both the DySISmap alone and colposcopy alone; these results were robust to the sensitivity analyses undertaken. Given the lack of reliable evidence on LuViva and Niris, no conclusions on their potential cost-effectiveness can be drawn. There is some uncertainty about how generalisable these findings will be to the population of women referred for colposcopy in the future, owing to the introduction of the human papillomavirus (HPV) triage test and uptake of the HPV vaccine.
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Affiliation(s)
- R Wade
- CRD/CHE Technology Assessment Group, Centre for Reviews and Dissemination, University of York, York, UK
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23
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Pueyo V, Oros D, Valle S, Tuquet H, Güerri N, Argüelles M, Ventura P. Axonal loss and cognitive deficits in term infants with normal umbilical artery Doppler born small-for-gestational age. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:297-303. [PMID: 22740299 DOI: 10.1002/uog.11215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess cognitive outcomes and structural changes in the central nervous system, the latter using a novel approach to examine changes in neuronal integrity of the optic nerve, in children at 5-6½ years of age who were born small-for-gestational age (SGA) at term having shown normal umbilical artery (UA) Doppler. METHODS We compared neuronal damage, cognitive deficits and visuospatial perception in two cohorts of infants, one born SGA (n = 40) and one born appropriate-for-gestational age (AGA) (n = 39) in weight. Neuronal damage was evaluated using optical coherence tomography (OCT) of the optic nerve. Cognitive deficits were assessed with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) test. Visuospatial perception was evaluated with Rey-Osterreich Complex Figure (ROCF) tasks. RESULTS Children from the SGA group had a significantly thinner average retinal nerve fiber layer (RNFL) compared with those from the AGA group (98.2 vs 104.5 µm, P = 0.012). Children from the SGA group exhibited impaired performance in copy tasks on the ROCF (3.27 vs 3.56, P = 0.036) and a higher rate of suboptimal WPPSI test performance intelligence quotient scores (15% vs 0%; P = 0.025) compared with those from the AGA group. CONCLUSION Term infants with normal UA Doppler born SGA are at increased risk for cognitive deficits and axonal loss in the RNFL at the age of 5-6½ years.
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Affiliation(s)
- V Pueyo
- Ophthalmology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain.
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Carignan CS, Yagi Y. Optical endomicroscopy and the road to real-time, in vivo pathology: present and future. Diagn Pathol 2012; 7:98. [PMID: 22889003 PMCID: PMC3502368 DOI: 10.1186/1746-1596-7-98] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/19/2012] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Epithelial cancers account for substantial mortality and are an important public health concern. With the need for earlier detection and treatment of these malignancies, the ability to accurately detect precancerous lesions has an increasingly important role in controlling cancer incidence and mortality. New optical technologies are capable of identifying early pathology in tissues or organs in which cancer is known to develop through stages of dysplasia, including the esophagus, colon, pancreas, liver, bladder, and cervix. These diagnostic imaging advances, together as a field known as optical endomicroscopy, are based on confocal microscopy, spectroscopy-based imaging, and optical coherence tomography (OCT), and function as "optical biopsies," enabling tissue pathology to be imaged in situ and in real time without the need to excise and process specimens as in conventional biopsy and histopathology. Optical biopsy techniques can acquire high-resolution, cross-sectional images of tissue structure on the micron scale through the use of endoscopes, catheters, laparoscopes, and needles. Since the inception of these technologies, dramatic technological advances in accuracy, speed, and functionality have been realized. The current paradigm of optical biopsy, or single-area, point-based images, is slowly shifting to more comprehensive microscopy of larger tracts of mucosa. With the development of Fourier-domain OCT, also known as optical frequency domain imaging or, more recently, volumetric laser endomicroscopy, comprehensive surveillance of the entire distal esophagus is now achievable at speeds that were not possible with conventional OCT technologies. Optical diagnostic technologies are emerging as clinically useful tools with the potential to set a new standard for real-time diagnosis. New imaging techniques enable visualization of high-resolution, cross-sectional images and offer the opportunity to guide biopsy, allowing maximal diagnostic yields and appropriate staging without the limitations and risks inherent with current random biopsy protocols. However, the ability of these techniques to achieve widespread adoption in clinical practice depends on future research designed to improve accuracy and allow real-time data transmission and storage, thereby linking pathology to the treating physician. These imaging advances are expected to eventually offer a see-and-treat paradigm, leading to improved patient care and potential cost reduction. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5372548637202968.
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Gallwas J, Mortensen U, Gaschler R, Stepp H, Ditsch N, Friese K, Dannecker C. Diagnostic efficacy of backscattering intensity measurements in optical coherence tomography of cervical intraepithelial dysplasia. Lasers Surg Med 2012; 44:11-9. [PMID: 22246983 DOI: 10.1002/lsm.21146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the diagnostic efficacy of backscattering intensity measurements in optical coherence tomography in identifying different grades of cervical intraepithelial dysplasia. STUDY DESIGN/MATERIALS AND METHODS OCT images were taken from 153 unsuspicious and suspicious areas of 30 fresh conisation and hysterectomy specimens, evaluated by two blinded investigators using a six-grade classification (normal, inflammation, CIN1, CIN2, CIN3, squamous carcinoma) and later compared to the corresponding histology. Differences between judgments based on either the histology or the OCT images were investigated employing Correspondence Analysis (CA). Further, we explored the extent as to which backscattering intensity profiles of OCT images contained the essential information required for a reliable and valid diagnosis, using Linear Discriminant Analysis (LDA). RESULTS The CA of histology- and OCT-based judgments suggests that the diagnostic process may be characterized in terms of two stochastically independent underlying ("latent") variables, the first of them reflecting the definiteness with which CIN classes are identified, the second reflecting a bias towards diagnosing inflammation on the side of the OCT-based judgments. This finding is supported by the results of LDAs, where histology and OCT categorizations differ in particular with respect to the positions of inflammation and CIN1. Possibly, a second canonical variable has to be assumed accounting for the evaluation of carcinoma. CONCLUSIONS The systematic differences between histology-based and OCT-based diagnoses suggest that the use of available information is influenced by perceptual and/or cognitive biases. Apart from this it seems that the profiles appear to provide a remarkably large amount of information determining the main course of the diagnostic process.
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Affiliation(s)
- Julia Gallwas
- Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany.
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Gallwas J, Mortensen U, Gaschler R, Ochsenkuehn R, Stepp H, Friese K, Dannecker C. Validation of an ex vivo human cervical tissue model for optical imaging studies. Lasers Surg Med 2012; 44:245-8. [PMID: 22246999 DOI: 10.1002/lsm.22001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2011] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To establish and validate an ex vivo human cervical tissue model for optical coherence tomography (OCT) studies with special emphasis on investigating time dependent structural changes of the epithelium. METHODS Four hundred OCT images were taken from 80 unsuspicious and suspicious areas of 18 fresh conisation specimens immediately after resection (0 hour) and 1, 2, 3, and 4 hours, referred to as waiting times in the following, postoperatively and compared to the corresponding histology. For each 2D-OCT-image, a 1D-intensity profile was generated. The profiles were analyzed with respect to systematic differences which may result from different waiting times, employing discriminant analysis (DA). RESULTS The different waiting times do not appear to imply significant differences among the corresponding OCT-images as represented by the intensity profiles. CONCLUSION We conclude that the proposed cervical tissue model appears to be applicable for ex vivo OCT studies.
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Affiliation(s)
- Julia Gallwas
- Department of Obstetrics and Gynecology, Ludwig- Maximilians University, Munich, Germany.
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Nazeer S, Shafi MI. Objective perspective in colposcopy. Best Pract Res Clin Obstet Gynaecol 2011; 25:631-40. [PMID: 21839686 DOI: 10.1016/j.bpobgyn.2011.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/01/2011] [Indexed: 10/17/2022]
Abstract
Colposcopy is a widely used diagnostic procedure, primarily in the assessment of women with abnormal cervical cytology. It is used by appropriately trained individuals using techniques that allow a full assessment of the abnormality and plan for further investigation or treatment. Certain key features are specifically looked for, and a colposcopic impression formed. Using a systematic approach to the colposcopic assessment can improve the diagnostic accuracy. In this chapter, we review various factors and meta-analyses in relation to the diagnostic performance of colposcopy. Newer technologies are being developed that will assist the clinician in assessing the colposcopic changes. Quality assurance of the training and practise of colposcopy is important to maintain appropriate management for women with cytological abnormalities.
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Affiliation(s)
- Saloney Nazeer
- International Network for Control of Gynaecological Cancers, Geneva Foundation for Medical Education and Research, WHO Collaborating Centre in Education and Research in Human Reproduction, Switzerland.
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Recent advances in optical imaging for cervical cancer detection. Arch Gynecol Obstet 2011; 284:1197-208. [PMID: 21800084 DOI: 10.1007/s00404-011-2009-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 07/08/2011] [Indexed: 12/26/2022]
Abstract
Cervical cancer is one of the most common and lethal gynecological malignancies in both developing and developed countries, and therefore, there is a considerable interest in early diagnosis and treatment of precancerous lesions. Although the current standard care mainly based on cytology and colposcopy has reduced rates of cervical cancer morbidity and mortality, many lesions are still missed or overcalled and referred for unnecessary biopsies. Optical imaging technologies, spectroscopy approaches and high-resolution imaging methods are anticipated to improve the conventional cervical cancer screening providing in vivo diagnosis with high sensitivity and specificity. Their concept is that morphologic and biochemical properties of the cervical tissue are altered in response to its malignant transformation. In addition, contrast agents that target against specific neoplastic biomarkers can enhance the effectiveness of this new technology. Due to the unprecedented growth of these optical techniques accompanied probably by favorable cost-effectiveness, the primary detection of premalignant lesions may become more accessible in both the developing and the developed countries and can offer see-to-treat workflows and early therapeutic interventions.
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Gallwas JK, Turk L, Stepp H, Mueller S, Ochsenkuehn R, Friese K, Dannecker C. Optical coherence tomography for the diagnosis of cervical intraepithelial neoplasia. Lasers Surg Med 2011; 43:206-12. [DOI: 10.1002/lsm.21030] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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