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Hong Z, Xiong J, Yang H, Mo YK. Lightweight Low-Rank Adaptation Vision Transformer Framework for Cervical Cancer Detection and Cervix Type Classification. Bioengineering (Basel) 2024; 11:468. [PMID: 38790335 PMCID: PMC11118906 DOI: 10.3390/bioengineering11050468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical cancer is a major health concern worldwide, highlighting the urgent need for better early detection methods to improve outcomes for patients. In this study, we present a novel digital pathology classification approach that combines Low-Rank Adaptation (LoRA) with the Vision Transformer (ViT) model. This method is aimed at making cervix type classification more efficient through a deep learning classifier that does not require as much data. The key innovation is the use of LoRA, which allows for the effective training of the model with smaller datasets, making the most of the ability of ViT to represent visual information. This approach performs better than traditional Convolutional Neural Network (CNN) models, including Residual Networks (ResNets), especially when it comes to performance and the ability to generalize in situations where data are limited. Through thorough experiments and analysis on various dataset sizes, we found that our more streamlined classifier is highly accurate in spotting various cervical anomalies across several cases. This work advances the development of sophisticated computer-aided diagnostic systems, facilitating more rapid and accurate detection of cervical cancer, thereby significantly enhancing patient care outcomes.
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Affiliation(s)
- Zhenchen Hong
- Department of Physics and Astronomy, University of California, Riverside, CA 92521, USA
| | - Jingwei Xiong
- Graduate Group in Biostatistics, University of California, Davis, CA 95616, USA
| | - Han Yang
- Department of Chemistry, Columbia University, New York, NY 10027, USA;
| | - Yu K. Mo
- Department of Computer Science, Indiana University, Bloomington, IN 47405, USA;
- Department of Biology, Indiana University, Bloomington, IN 47405, USA
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Lycke KD, Kalpathy-Cramer J, Jeronimo J, de Sanjose S, Egemen D, Del Pino M, Marcus J, Schiffman M, Hammer A. Agreement on Lesion Presence and Location at Colposcopy. J Low Genit Tract Dis 2024; 28:37-42. [PMID: 37963327 DOI: 10.1097/lgt.0000000000000786] [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: 11/16/2023]
Abstract
OBJECTIVES/PURPOSE The reproducibility and sensitivity of image-based colposcopy is low, but agreement on lesion presence and location remains to be explored. Here, we investigate the interobserver agreement on lesions on colposcopic images by evaluating and comparing marked lesions on digitized colposcopic images between colposcopists. METHODS Five colposcopists reviewed images from 268 colposcopic examinations. Cases were selected based on histologic diagnosis, i.e., normal/cervical intraepithelial neoplasia (CIN)1 ( n = 50), CIN2 ( n = 50), CIN3 ( n = 100), adenocarcinoma in situ ( n = 53), and cancer ( n = 15). We obtained digitized time-series images every 7-10 seconds from before acetic acid application to 2 minutes after application. Colposcopists were instructed to digitally annotate all areas with acetowhitening or suspect of lesions. To estimate the agreement on lesion presence and location, we assessed the proportion of images with annotations and the proportion of images with overlapping annotated area by at least 4 (4+) colposcopists, respectively. RESULTS We included images from 241 examinations (1 image from each) with adequate annotations. The proportion with a least 1 lesion annotated by 4+ colposcopists increased by severity of histologic diagnosis. Among the CIN3 cases, 84% had at least 1 lesion annotated by 4+ colposcopists, whereas 54% of normal/CIN1 cases had a lesion annotated. Notably, the proportion was 70% for adenocarcinoma in situ and 71% for cancer. Regarding lesion location, there was no linear association with severity of histologic diagnosis. CONCLUSION Despite that 80% of the CIN2 and CIN3 cases were annotated by 4+ colposcopists, we did not find increasing agreement on lesion location with histology severity. This underlines the subjective nature of colposcopy.
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Affiliation(s)
| | | | | | | | | | | | - Jenna Marcus
- Feinberg School of Medicine at Northwestern University, Chicago, IL
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Mathematical Modelling of Cervical Precancerous Lesion Grade Risk Scores: Linear Regression Analysis of Cellular Protein Biomarkers and Human Papillomavirus E6/E7 RNA Staining Patterns. Diagnostics (Basel) 2023; 13:diagnostics13061084. [PMID: 36980391 PMCID: PMC10047622 DOI: 10.3390/diagnostics13061084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
The current practice of determining histologic grade with a single molecular biomarker can facilitate differential diagnosis but cannot predict the risk of lesion progression. Cancer is caused by complex mechanisms, and no single biomarker can both make accurate diagnoses and predict progression risk. Modelling using multiple biomarkers can be used to derive scores for risk prediction. Mathematical models (MMs) may be capable of making predictions from biomarker data. Therefore, this study aimed to develop MM–based scores for predicting the risk of precancerous cervical lesion progression and identifying precancerous lesions in patients in northern Thailand by evaluating the expression of multiple biomarkers. The MMs (Models 1–5) were developed in the test sample set based on patient age range (five categories) and biomarker levels (cortactin, p16INK4A, and Ki–67 by immunohistochemistry [IHC], and HPV E6/E7 ribonucleic acid (RNA) by in situ hybridization [ISH]). The risk scores for the prediction of cervical lesion progression (“risk biomolecules”) ranged from 2.56–2.60 in the normal and low–grade squamous intraepithelial lesion (LSIL) cases and from 3.54–3.62 in cases where precancerous lesions were predicted to progress. In Model 4, 23/86 (26.7%) normal and LSIL cases had biomolecule levels that suggested a risk of progression, while 5/86 (5.8%) cases were identified as precancerous lesions. Additionally, histologic grading with a single molecular biomarker did not identify 23 cases with risk, preventing close patient monitoring. These results suggest that biomarker level–based risk scores are useful for predicting the risk of cervical lesion progression and identifying precancerous lesion development. This multiple biomarker–based strategy may ultimately have utility for predicting cancer progression in other contexts.
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Valls J, Baena A, Venegas G, Celis M, González M, Sosa C, Santin JL, Ortega M, Soilán A, Turcios E, Figueroa J, Rodríguez de la Peña M, Figueredo A, Beracochea AV, Pérez N, Martínez-Better J, Lora O, Jiménez JY, Giménez D, Fleider L, Salgado Y, Martínez S, Bellido-Fuentes Y, Flores B, Tatti S, Villagra V, Cruz-Valdez A, Terán C, Sánchez GI, Rodríguez G, Picconi MA, Ferrera A, Mendoza L, Calderón A, Murillo R, Wiesner C, Broutet N, Luciani S, Pérez C, Darragh TM, Jerónimo J, Herrero R, Almonte M. Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study. Lancet Glob Health 2023; 11:e350-e360. [PMID: 36796982 PMCID: PMC10020136 DOI: 10.1016/s2214-109x(22)00545-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. METHODS This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. FINDINGS Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). INTERPRETATION Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. FUNDING WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.
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Affiliation(s)
- Joan Valls
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain.
| | - Armando Baena
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Gino Venegas
- Clínica Angloamericana, Lima, Peru; Escuela de Medicina Humana, Universidad de Piura, Lima, Peru
| | - Marcela Celis
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Carlos Sosa
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Jorge Luis Santin
- Hospital Monseñor Victor Manuel Sanabria Martínez, Puntarenas, Costa Rica
| | - Marina Ortega
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Instituto Nacional del Cáncer, Ministerio de Salud Pública y Bienestar Social, Capiatá, Paraguay
| | - Ana Soilán
- Hospital Nacional, Ministerio de Salud Pública y Bienestar Social, Itauguá, Paraguay; Hospital Materno Infantil de San Lorenzo, Ministerio de Salud Pública y Bienestar Social, San Lorenzo, Paraguay
| | - Elmer Turcios
- Programa Nacional contra el Cáncer, Tegucigalpa, Honduras
| | | | | | - Alicia Figueredo
- Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | | | - Natalia Pérez
- Hospital de Clínicas, Facultad de Medicina, Montevideo, Uruguay
| | | | - Oscar Lora
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia; Hospital Gineco-Obstétrico y Neonatal Dr Jaime Sánchez Porcel, Sucre, Bolivia
| | | | - Diana Giménez
- Hospital Materno Infantil de Trinidad, Ministerio de Salud Pública y Bienestar Social, Asunción, Paraguay
| | - Laura Fleider
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | - Yuly Salgado
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Bettsy Flores
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Silvio Tatti
- Hospital de Clínicas, José de San Martín, Buenos Aires, Argentina
| | | | | | - Carolina Terán
- Facultad de Medicina, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | | | | | | | - Annabelle Ferrera
- Instituto de Infecciones en Microbiología, Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Laura Mendoza
- Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alejandro Calderón
- Caja Costarricense de Seguro Social, Región Pacífico Central, San José, Costa Rica
| | - Raul Murillo
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Carlos Pérez
- Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Teresa M Darragh
- Department of Pathology, University of California, San Francisco, CA, USA
| | - José Jerónimo
- Liga contra el Cáncer-Peru, Lima, Peru; US National Cancer Institute, Bethesda, MD, USA
| | - Rolando Herrero
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Agencia Costarricense de Investigaciones Biomédicas, Fundación Inciensa, Guanacaste, Costa Rica
| | - Maribel Almonte
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France; Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Tsampazis N, Vavoulidis E, Siarkou CM, Siarkou GM, Pratilas GC, Symeonidou M, Intzes S, Petousis S, Papanikolaou A, Dinas K. Diagnostic comparison of electrical impedance spectroscopy with colposcopy and HPV mRNA-testing in the prediction of CIN2+ women in Greece. J Obstet Gynaecol Res 2023; 49:1222-1229. [PMID: 36658620 DOI: 10.1111/jog.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
AIM To compare the diagnostic parameters of electrical impedance spectroscopy (EIS) via ZedScan, a device that measures spectra to differentiate between normal and abnormal cervical tissues, when used as an adjunct to colposcopies in the diagnosis of HSILs/CIN2+ in Greek women with abnormal referral cytology toward colposcopy alone and HPV mRNA-testing. METHODS This study analyzed 86 women, patients of the Colposcopy and Cervical Pathology Clinic of 2nd Obstetrics and Gynecology Department, Aristotle University of Thessaloniki at Hippokration General Hospital, between January 2022 and September 2022. During the visits, women were subjected to cytology, colposcopy alone and then with EIS/ZedScan and histological sampling. RESULTS Common use of colposcopies and EIS/ZedScan allowed detecting an additional 14 cases of CIN2+ (16.2%) that colposcopy alone failed to report. EIS enhanced the sensitivity of colposcopy from 80.65% to 100% equal with that of HPV-mRNA test while retaining a high specificity (94.74%) which is much higher than specificity of HPV mRNA-testing (65.45%). EIS-assisted colposcopy had the highest value combination of positive and negative predictive values (96.15% and 100%) compared to colposcopy alone (100% and 75%) and HPV mRNA-testing (72.46% and 100%). CONCLUSIONS Colposcopies performed with EIS/ZedScan demonstrated effectiveness in the diagnosing of CIN2+ leading to a significant increase in the number of CIN2+ that would have been missed if only colposcopy was applied especially in women with LSIL referral cytology. EIS/ZedScan seems to possess the ideal diagnostic threshold for sensitivity, specificity, and predictive values for CIN2+ compared to colposcopy alone and HPV mRNA-testing.
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Affiliation(s)
- Nikolaos Tsampazis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Chrysoula Margioula Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgia Margioula Siarkou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Georgios C Pratilas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Marianthi Symeonidou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stergios Intzes
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Alexios Papanikolaou
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
| | - Konstantinos Dinas
- 2nd Department of Obstetrics & Gynecology, Medical Faculty Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece
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Classification and diagnosis of cervical lesions based on colposcopy images using deep fully convolutional networks: a man-machine comparison cohort study. FUNDAMENTAL RESEARCH 2022. [DOI: 10.1016/j.fmre.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Coole JB, Brenes D, Possati-Resende JC, Antoniazzi M, Fonseca BDO, Maker Y, Kortum A, Vohra IS, Schwarz RA, Carns J, Borba Souza KC, Vidigal Santana IV, Kreitchmann R, Salcedo MP, Ramanujam N, Schmeler KM, Richards-Kortum R. Development of a multimodal mobile colposcope for real-time cervical cancer detection. BIOMEDICAL OPTICS EXPRESS 2022; 13:5116-5130. [PMID: 36425643 PMCID: PMC9664871 DOI: 10.1364/boe.463253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Cervical cancer remains a leading cause of cancer death among women in low-and middle-income countries. Globally, cervical cancer prevention programs are hampered by a lack of resources, infrastructure, and personnel. We describe a multimodal mobile colposcope (MMC) designed to diagnose precancerous cervical lesions at the point-of-care without the need for biopsy. The MMC integrates two complementary imaging systems: 1) a commercially available colposcope and 2) a high speed, high-resolution, fiber-optic microendoscope (HRME). Combining these two image modalities allows, for the first time, the ability to locate suspicious cervical lesions using widefield imaging and then to obtain co-registered high-resolution images across an entire lesion. The MMC overcomes limitations of high-resolution imaging alone; widefield imaging can be used to guide the placement of the high-resolution imaging probe at clinically suspicious regions and co-registered, mosaicked high-resolution images effectively increase the field of view of high-resolution imaging. Representative data collected from patients referred for colposcopy at Barretos Cancer Hospital in Brazil, including 22,800 high resolution images and 9,900 colposcope images, illustrate the ability of the MMC to identify abnormal cervical regions, image suspicious areas with subcellular resolution, and distinguish between high-grade and low-grade dysplasia.
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Affiliation(s)
- Jackson B. Coole
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - David Brenes
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | - Márcio Antoniazzi
- Barretos Cancer Hospital, Department of Prevention, Barretos, Brazil
| | | | - Yajur Maker
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Alex Kortum
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | - Imran S. Vohra
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | - Jennifer Carns
- Rice University, Department of Bioengineering, Houston, TX 77005, USA
| | | | | | - Regis Kreitchmann
- Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Department of Obstetrics and Gynecology, Porto Alegre, Brazil
| | - Mila P. Salcedo
- Federal University of Health Sciences of Porto Alegre (UFCSPA)/Santa Casa Hospital of Porto Alegre, Department of Obstetrics and Gynecology, Porto Alegre, Brazil
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77005, USA
| | - Nirmala Ramanujam
- Duke University, Department of Biomedical Engineering, Durham, NC 27708, USA
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, TX 77005, USA
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Tidy JA, Brown BH. Increased detection of high grade CIN, when using electrical impedance spectroscopy as an adjunct to routine colposcopy, is maintained when used across international boundaries: Prospective data from nine European countries. Eur J Obstet Gynecol Reprod Biol 2022; 275:41-45. [PMID: 35724563 DOI: 10.1016/j.ejogrb.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the performance of EIS (ZedScan) with colposcopy in the detection of high grade CIN (HG-CIN) in different health care settings. METHOD Pooled analysis of data from 26 colposcopy centres in 9 countries. All women underwent colposcopy and ZedScan examination. Data was recorded prospectively via a proforma. Indications for referral to colposcopy were according to national guidelines. Pathology was reported according to national guidelines. RESULTS 5257 women were examined by 82 colposcopists, median 93 women per centre (range 41 - 2684), 3 users per centre (range 1-8). Referral indications were; 19.3% high grade cytology, 50.4% low grade, 30.3% clinical or HPV positive / cytology negative. The prevalence of HG-CIN was 26.5%; 79.1% in high grade referrals, 16.7% low grade, 9.4% clinical or HPV positive / cytology negative. The use of ZedScan detected an extra 269 cases of high grade CIN (24% increase) (7.5% increase for high grade referrals, 57.9% for low grade and 52% for clinical or HPV positive/cytology negative). Based upon colposcopic impression (CI), the sensitivity of colposcopy for CIN2 + was 74.1% compared with 91.6% for colposcopy with ZedScan (Chi2 p < 0.0001). The PPV for a ZedScan directed biopsy varied according to referral cytology and colposcopic impression (19.5% to 85.7%). 489 women underwent treatment at first visit, when ZedScan suggested treatment, 95.1% had HG-CIN/HG-CGIN or cervical cancer. The pooled results for the whole 26 centres were consistent with the results obtained for the largest centre (Sheffield) alone and also with the results with this largest centre excluded. CONCLUSIONS The addition of EIS (ZedScan) increases detection of HG-CIN with the PPV for a ZedScan directed biopsy consistent with the published literature. Results were similar in multiple healthcare settings. With more women being referred to colposcopy at low risk of HG-CIN, due to HPV vaccination and primary HPV screening, this study confirms the value of a real time adjunctive technology.
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Affiliation(s)
- John A Tidy
- Gynaecological Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
| | - Brian H Brown
- Medical Physics Group, Department of, Infection, Immunity and Cardiovascular Science, The University of Sheffield, UK
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RGB Channel Superposition Algorithm with Acetowhite Mask Images in a Cervical Cancer Classification Deep Learning Model. SENSORS 2022; 22:s22093564. [PMID: 35591254 PMCID: PMC9099840 DOI: 10.3390/s22093564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
Cervical cancer is one of the main causes of death from cancer in women. However, it can be treated successfully at an early stage. This study aims to propose an image processing algorithm based on acetowhite, which is an important criterion for diagnosing cervical cancer, to increase the accuracy of the deep learning classification model. Then, we mainly compared the performance of the model, the original image without image processing, a mask image made with acetowhite as the region of interest, and an image using the proposed algorithm. In conclusion, the deep learning classification model based on images with the proposed algorithm achieved an accuracy of 81.31%, which is approximately 9% higher than the model with original images and approximately 4% higher than the model with acetowhite mask images. Our study suggests that the proposed algorithm based on acetowhite could have a better performance than other image processing algorithms for classifying stages of cervical images.
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Fu L, Xia W, Shi W, Cao GX, Ruan YT, Zhao XY, Liu M, Niu SM, Li F, Gao X. Deep learning based cervical screening by the cross-modal integration of colposcopy, cytology, and HPV test. Int J Med Inform 2021; 159:104675. [PMID: 34979436 DOI: 10.1016/j.ijmedinf.2021.104675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To develop and evaluate the colposcopy based deep learning model using all kinds of cervical images for cervical screening, and investigate the synergetic benefits of the colposcopy, the cytology test, and the HPV test for improving cervical screening performance. METHODS This study consisted of 2160 women who underwent cervical screening, there were 442 cases with the histopathological confirmed high-grade squamous intraepithelial lesion (HSIL) or cancer, and the remained 1718 women were controls. Three kinds of cervical images were acquired from colposcopy including the saline image of cervix after saline irrigation, the acetic acid image of cervix after applying acetic acid solution, and the iodine image of cervix after applying Lugol's iodine solution. Each kind of image was used to build a single-image based deep learning model by the VGG-16 convolutional neural network, respectively. A multiple-images based deep learning model was built using multivariable logistic regression (MLR) by combining the single-image based models. The performance of the visual inspection was also obtained. The results of the cytology test and HPV test were used to build a Cytology-HPV joint diagnostic model by MLR. Finally, a cross-modal integrated model was built using MLR by combining the multiple-images based deep learning model, the cytology test results, and the HPV test results. The performances of models were tested in an independent test set using the area under the receiver operating characteristic curve (AUC). RESULTS The saline image, acetic acid image, and iodine image based deep learning models had AUC of 0.760, 0.791, and 0.840. The multiple-images based deep learning model achieved an improved AUC of 0.845. The AUC of the visual inspection was 0.751. The Cytology-HPV joint diagnostic model had an AUC of 0.837, which was higher than the cytology test (AUC = 0.749) and the HPV test (AUC = 0.742). The cross-modal integrated model achieved the best performance with AUC of 0.921. CONCLUSIONS Combining all kinds of cervical images were benefit for improving the performance of the colposcopy based deep learning model, and more accurate cervical screening could be achieved by incorporating the colposcopy based deep learning model, the cytology test results, and the HPV test results.
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Affiliation(s)
- Le Fu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China; Department of Radiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Xia
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China; Jinan Guoke Medical Engineering and Technology Development Co., Ltd, Pharmaceutical Valley New Drug Creation Platform, Jinan, Shandong 250109, China
| | - Wei Shi
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Guang-Xu Cao
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ye-Tian Ruan
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xing-Yu Zhao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Min Liu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Su-Mei Niu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang Li
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Xin Gao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China; Jinan Guoke Medical Engineering and Technology Development Co., Ltd, Pharmaceutical Valley New Drug Creation Platform, Jinan, Shandong 250109, China.
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11
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Awolude OA, Oyerinde SO, Ayeni AO, Adewole IF. Human papillomavirus-based cervical precancer screening with visual inspection with acetic acid triage to achieve same-day treatments among women living with human immunodeficiency virus infection: test-of-concept study in Ibadan, Nigeria. Pan Afr Med J 2021; 40:48. [PMID: 34795828 PMCID: PMC8571938 DOI: 10.11604/pamj.2021.40.48.28628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. Methods in this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. Results same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. Conclusion triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.
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Affiliation(s)
- Olutosin Alaba Awolude
- Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria.,University College Hospital, Ibadan, Nigeria
| | | | | | - Isaac Folorunso Adewole
- Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Nigeria
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12
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Desai KT, Befano B, Xue Z, Kelly H, Campos NG, Egemen D, Gage JC, Rodriguez AC, Sahasrabuddhe V, Levitz D, Pearlman P, Jeronimo J, Antani S, Schiffman M, de Sanjosé S. The development of "automated visual evaluation" for cervical cancer screening: The promise and challenges in adapting deep-learning for clinical testing. Int J Cancer 2021; 150:741-752. [PMID: 34800038 PMCID: PMC8732320 DOI: 10.1002/ijc.33879] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 12/22/2022]
Abstract
There is limited access to effective cervical cancer screening programs in many resource‐limited settings, resulting in continued high cervical cancer burden. Human papillomavirus (HPV) testing is increasingly recognized to be the preferable primary screening approach if affordable due to superior long‐term reassurance when negative and adaptability to self‐sampling. Visual inspection with acetic acid (VIA) is an inexpensive but subjective and inaccurate method widely used in resource‐limited settings, either for primary screening or for triage of HPV‐positive individuals. A deep learning (DL)‐based automated visual evaluation (AVE) of cervical images has been developed to help improve the accuracy and reproducibility of VIA as assistive technology. However, like any new clinical technology, rigorous evaluation and proof of clinical effectiveness are required before AVE is implemented widely. In the current article, we outline essential clinical and technical considerations involved in building a validated DL‐based AVE tool for broad use as a clinical test.
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Affiliation(s)
- Kanan T Desai
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Brian Befano
- Information Management Services Inc., Calverton, Maryland, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Zhiyun Xue
- US National Library of Medicine, Bethesda, Maryland, USA
| | - Helen Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Didem Egemen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Julia C Gage
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Ana-Cecilia Rodriguez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - David Levitz
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Paul Pearlman
- Center for Global Health, National Cancer Institute, Rockville, Maryland, USA
| | - Jose Jeronimo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Sameer Antani
- US National Library of Medicine, Bethesda, Maryland, USA
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Silvia de Sanjosé
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.,ISGlobal, Barcelona, Spain
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13
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Fachetti-Machado G, Figueiredo-Alves RR, Moreira MAR. Performance of three colposcopic images for the identification of squamous and glandular cervical precursor neoplasias. Arch Gynecol Obstet 2021; 305:1319-1327. [PMID: 34727221 PMCID: PMC9013338 DOI: 10.1007/s00404-021-06284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
Abstract
Purpose
To evaluate prevalence and diagnostic performance of three colposcopic images to diagnose squamous and glandular cervical precursor neoplasias.
Methods
Cross-sectional study, conducted through analysis of stored digital colposcopic images. To evaluate the diagnostic performance of three images, herein named grouped glands, aceto-white villi, and atypical vessels, for detection of adenocarcinoma in situ (AIS) and cervical squamous intraepithelial neoplasias (CIN) grades 2 and 3, calculations of sensitivity, specificity, accuracy, positive likelihood ratio, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were made, with their respective 95% confidence intervals.
Results
Grouped glands, aceto-white villi, and atypical vessels images had: prevalence of 21.3, 53.8, and 33.8% in patients with AIS, and 16.2, 19.5, and 9.3% in those with CIN 2 and 3; for the diagnosis of AIS, sensitivity of 21.3, 53.8, and 33.8%, specificity of 89.8, 95.2, and 94.9%, accuracy of 76.6, 87.2, and 83.1%, positive likelihood ratio of 2.1, 11.2, and 6.6, and AUC of 0.55, 0.74, and 0.64; for the diagnosis of CIN 2 and 3, sensitivity of 16.2, 19.5, and 9.3%, specificity of 89.8, 95.2, and 94.9%, accuracy of 39.4, 43.4, and 36.3%, positive likelihood ratio of 1.6, 4.1, and 1, 8, and AUC of 0.53, 0.57, and 0.52, respectively.
Conclusion
Prevalence and accuracy of the three images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias. Sensitivity, specificity, positive likelihood, and AUC of aceto-white villi and atypical vessels images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias.
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14
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Network Visualization and Pyramidal Feature Comparison for Ablative Treatability Classification Using Digitized Cervix Images. J Clin Med 2021; 10:jcm10050953. [PMID: 33804469 PMCID: PMC7957626 DOI: 10.3390/jcm10050953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/30/2021] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Uterine cervical cancer is a leading cause of women’s mortality worldwide. Cervical tissue ablation is an effective surgical excision of high grade lesions that are determined to be precancerous. Our prior work on the Automated Visual Examination (AVE) method demonstrated a highly effective technique to analyze digital images of the cervix for identifying precancer. Next step would be to determine if she is treatable using ablation. However, not all women are eligible for the therapy due to cervical characteristics. We present a machine learning algorithm that uses a deep learning object detection architecture to determine if a cervix is eligible for ablative treatment based on visual characteristics presented in the image. The algorithm builds on the well-known RetinaNet architecture to derive a simpler and novel architecture in which the last convolutional layer is constructed by upsampling and concatenating specific RetinaNet pretrained layers, followed by an output module consisting of a Global Average Pooling (GAP) layer and a fully connected layer. To explain the recommendation of the deep learning algorithm and determine if it is consistent with lesion presentation on the cervical anatomy, we visualize classification results using two techniques: our (i) Class-selective Relevance Map (CRM), which has been reported earlier, and (ii) Class Activation Map (CAM). The class prediction heatmaps are evaluated by a gynecologic oncologist with more than 20 years of experience. Based on our observation and the expert’s opinion, the customized architecture not only outperforms the baseline RetinaNet network in treatability classification, but also provides insights about the features and regions considered significant by the network toward explaining reasons for treatment recommendation. Furthermore, by investigating the heatmaps on Gaussian-blurred images that serve as surrogates for out-of-focus cervical pictures we demonstrate the effect of image quality degradation on cervical treatability classification and underscoring the need for using images with good visual quality.
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15
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Rahman Z, Yadav G, Tripathi U. The Diagnostic Efficacy of Swede Score for Prediction of Pre-invasive Cervical Lesions: A Prospective Hospital-Based Study. J Obstet Gynaecol India 2021; 70:497-502. [PMID: 33417628 DOI: 10.1007/s13224-020-01344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/21/2020] [Indexed: 12/01/2022] Open
Abstract
Context The accuracy of colposcopy has recently been called into question particularly with regard to determining the site requiring biopsy. The technique of colposcopy is largely operator dependent, and the agreement between colposcopists is less reliable than once presumed. In an attempt to standardize colposcopy a new scoring system, the Swede score has been devised, which includes lesion size as a variable to be scored in addition to the 4 variables found in the modified Reids Colposcopic Index (RCI). Aim To assess the diagnostic accuracy of Swede score for pre-invasive cervical lesion. Setting and Design A cross-sectional study in a tertiary care centre. Method Swede score was calculated for assessment of pre-invasive cervical lesions on patients undergoing colposcopy who were suspected with pre-invasive cervical lesion. Cervical biopsy was taken if modified RCI ≥ 3 or Swede score ≥ 5. Histopathology report of the cervical biopsy was taken as gold standard. Results Swede scores of 5 or more had sensitivity, specificity, positive and negative predictive values of 94.9%, 88.4%, 75.5% and 92.9% respectively. Conclusion The Swede score by just incorporating one additional variable that is size of the lesion, showed better correlation with histopathology.
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Affiliation(s)
- Zakia Rahman
- Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh 474001 India
| | - Garima Yadav
- Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh 474001 India
| | - Urmila Tripathi
- Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh 474001 India
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16
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Xue P, Tang C, Li Q, Li Y, Shen Y, Zhao Y, Chen J, Wu J, Li L, Wang W, Li Y, Cui X, Zhang S, Zhang W, Zhang X, Ma K, Zheng Y, Qian T, Ng MTA, Liu Z, Qiao Y, Jiang Y, Zhao F. Development and validation of an artificial intelligence system for grading colposcopic impressions and guiding biopsies. BMC Med 2020; 18:406. [PMID: 33349257 PMCID: PMC7754595 DOI: 10.1186/s12916-020-01860-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Colposcopy diagnosis and directed biopsy are the key components in cervical cancer screening programs. However, their performance is limited by the requirement for experienced colposcopists. This study aimed to develop and validate a Colposcopic Artificial Intelligence Auxiliary Diagnostic System (CAIADS) for grading colposcopic impressions and guiding biopsies. METHODS Anonymized digital records of 19,435 patients were obtained from six hospitals across China. These records included colposcopic images, clinical information, and pathological results (gold standard). The data were randomly assigned (7:1:2) to a training and a tuning set for developing CAIADS and to a validation set for evaluating performance. RESULTS The agreement between CAIADS-graded colposcopic impressions and pathology findings was higher than that of colposcopies interpreted by colposcopists (82.2% versus 65.9%, kappa 0.750 versus 0.516, p < 0.001). For detecting pathological high-grade squamous intraepithelial lesion or worse (HSIL+), CAIADS showed higher sensitivity than the use of colposcopies interpreted by colposcopists at either biopsy threshold (low-grade or worse 90.5%, 95% CI 88.9-91.4% versus 83.5%, 81.5-85.3%; high-grade or worse 71.9%, 69.5-74.2% versus 60.4%, 57.9-62.9%; all p < 0.001), whereas the specificities were similar (low-grade or worse 51.8%, 49.8-53.8% versus 52.0%, 50.0-54.1%; high-grade or worse 93.9%, 92.9-94.9% versus 94.9%, 93.9-95.7%; all p > 0.05). The CAIADS also demonstrated a superior ability in predicting biopsy sites, with a median mean-intersection-over-union (mIoU) of 0.758. CONCLUSIONS The CAIADS has potential in assisting beginners and for improving the diagnostic quality of colposcopy and biopsy in the detection of cervical precancer/cancer.
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Affiliation(s)
- Peng Xue
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chao Tang
- School of Public Health, Dalian Medical University, Dalian, China
| | - Qing Li
- Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | | | - Yu Shen
- Zonsun Healthcare, Shenzhen, China
| | - Yuqian Zhao
- Center for Cancer Prevention Research, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | | | | | - Longyu Li
- Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Wei Wang
- Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yucong Li
- Chongqing University Cancer Hospital, Chongqing, China
| | - Xiaoli Cui
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shaokai Zhang
- Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, Zhengzhou, China
| | - Wenhua Zhang
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xun Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Ma
- Tencent Jarvis Lab, Shenzhen, China
| | | | | | | | - Zhihua Liu
- Department of Gynecology, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China
| | - Youlin Qiao
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Fanghui Zhao
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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17
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Kendall WY, Ho D, Chu K, Zinaman M, Wieland D, Moragne K, Wax A. Prospective detection of cervical dysplasia with scanning angle-resolved low coherence interferometry. BIOMEDICAL OPTICS EXPRESS 2020; 11:5197-5211. [PMID: 33014608 PMCID: PMC7510862 DOI: 10.1364/boe.401000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 05/08/2023]
Abstract
We present a prospective clinical study using angle-resolved low-coherence interferometry (a/LCI) to detect cervical dysplasia via depth resolved nuclear morphology measurements. The study, performed at the Jacobi Medical Center, compares 80 a/LCI optical biopsies taken from 20 women with histopathological tissue diagnosis of co-registered physical biopsies. A novel instrument was used for this study that enables 2D scanning across the cervix without repositioning the probe. The main study goal was to compare performance with a previous clinical a/LCI point-probe instrument [Int. J. Cancer140, 1447 (2017)] and use the same diagnostic criteria as in that study. Tissue was classified in two schemes: non-dysplastic vs. dysplastic and low-risk vs. high-risk, with the latter classification aligned with clinically actionable diagnosis. High sensitivity (non-dysplastic vs. dysplastic: 0.903, low-risk vs. high-risk: 1.000) and NPV (0.930 and 1.000 respectively) were obtained when using the previously established decision boundaries, showing the success of the scanning a/LCI instrument and reinforcing the clinical viability of a/LCI in disease detection.
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Affiliation(s)
- Wesley Y. Kendall
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Derek Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27708, USA
| | - Kengyeh Chu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Michael Zinaman
- Department of Obstetrics and Gynecology, Jacobi Medical Center, Bronx, NY 10461, USA
| | - Daryl Wieland
- Department of Obstetrics and Gynecology, Jacobi Medical Center, Bronx, NY 10461, USA
| | - Kandis Moragne
- Department of Obstetrics and Gynecology, Jacobi Medical Center, Bronx, NY 10461, USA
| | - Adam Wax
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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18
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Harris KE, Lavin PT, Akin MD, Papagiannakis E, Denardis S. Rate of detecting CIN3+ among patients with ASC-US using digital colposcopy and dynamic spectral imaging. Oncol Lett 2020; 20:17. [PMID: 32774490 PMCID: PMC7406885 DOI: 10.3892/ol.2020.11878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/05/2020] [Indexed: 01/07/2023] Open
Abstract
The present study compared two methods for the detection of severe cervical dysplasia in women with atypical squamous cells of underdetermined significance (ASC-US) cytology; digital colposcopy with adjunctive dynamic spectral imaging (DSI) and conventional colposcopy. IMPROVE-COLPO was a two-arm cross-sectional study of US community-based colposcopy. The active (prospective) arm of this study recruited patients examined by digital colposcopy and adjunctive DSI. Preceding consecutive patients that had been examined with conventional methods were used as historical controls in the retrospective arm of the study after being matched in number to those in the prospective arm by a colposcopist. In the present study, the primary measure was the number of women detected with cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) following punch biopsy. The study included 1,353 retrospective and 1,226 prospective patients eligible for this analysis who were examined by 146 colposcopists in 42 community-based clinics. The patient baseline characteristics were comparable between the two arms. The average number of biopsies taken per patient was higher among the prospective arm patients (including standard and DSI-assisted biopsies) compared with the retrospective arm control patients (1.21 vs. 0.97 respectively). Biopsy detected 31 patients with CIN3+ [2.29%; 95% confidence interval (CI), 1.56-3.24] in the retrospective arm, and 48 patients with CIN3+ (3.92%; 95% CI, 2.90-5.16) in the prospective arm. The difference in the number of patients detected with CIN3+ in the two arms of the study was 1.62% (95% CI, 0.30-3.04; P=0.022), which corresponds to a 70.9% relative increase in the prospective compared with the retrospective arm. Biopsy appeared less efficient in detecting patients with CIN3+ in the retrospective arm compared with the prospective arm. However, there was no statistically significant difference between the retrospective arm and the prospective arm in terms of: i) Biopsies taken (over the entire population) per patient detected with CIN3+ (42.2 in the retrospective arm vs. 30.8 in the prospective arm; P=0.164) and ii) positive predictive value of using biopsies to identify patients with CIN3+ (2.83 vs. 3.92; P=0.118). Adoption of digital colposcopy with DSI increased the number of biopsies collected from ASC-US patients compared with retrospective controls of standard colposcopy and detected a significantly higher number of patients who were CIN3+. The number of additional biopsies taken in the prospective arm compared with the retrospective arm was too small to explain the increased detection of patients with CIN3+ observed in the prospective arm, suggesting that biopsies in the prospective arm were better at identifying CIN3+.
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Affiliation(s)
- Karen Eloise Harris
- Department of Obstetrics and Gynecology, College of Medicine, University of Central Florida, Gainesville, FL 32605, USA
| | - Philip Todd Lavin
- Boston Biostatistics Research Foundation, Framingham, MA 01702-6105, USA
| | - Mark Donnell Akin
- Austin Area Obstetrics, Gynecology and Fertility, Austin, TX 78758, USA
| | | | - Sara Denardis
- Department of Obstetrics/Gynecology, University of Central Florida, Orlando, FL 32827, USA
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Lim AWW, Neves AA, Lam Shang Leen S, Lao-Sirieix P, Bird-Lieberman E, Singh N, Sheaff M, Hollingworth T, Brindle K, Sasieni P. Lectins in Cervical Screening. Cancers (Basel) 2020; 12:E1928. [PMID: 32708812 PMCID: PMC7409129 DOI: 10.3390/cancers12071928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 12/29/2022] Open
Abstract
Cervical screening in low-resource settings remains an unmet need. Lectins are naturally occurring sugar-binding glycoproteins whose binding patterns change as cancer develops. Lectins discriminate between dysplasia and normal tissue in several precancerous conditions. We explored whether lectins could be developed for cervical screening via visual inspection. Discovery work comprised lectin histochemistry using a panel of candidate lectins on fixed-human cervix tissue (high-grade cervical intraepithelial neoplasia (CIN3, n = 20) or normal (n = 20)), followed by validation in a separate cohort (30 normal, 25 CIN1, 25 CIN3). Lectin binding was assessed visually according to staining intensity. To validate findings macroscopically, near-infra red fluorescence imaging was conducted on freshly-resected cervix (1 normal, 7 CIN3), incubated with topically applied fluorescently-labelled lectin. Fluorescence signal was compared for biopsies and whole specimens according to regions of interest, identified by the overlay of histopathology grids. Lectin histochemistry identified two lectins-wheat germ agglutinin (WGA) and Helix pomatia agglutinin (HPA)-with significantly decreased binding to CIN3 versus normal in both discovery and validation cohorts. Findings at the macroscopic level confirmed weaker WGA binding (lower signal intensity) in CIN3 vs. normal for biopsies (p = 0.0308) and within whole specimens (p = 0.0312). Our findings confirm proof-of-principle and indicate that WGA could potentially be developed further as a probe for high-grade cervical disease.
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Affiliation(s)
- Anita WW Lim
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK;
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9RT, UK
| | - André A. Neves
- Cancer Research UK Cambridge Institute, Li-Ka Shing Centre, University of Cambridge, Cambridge CB2 0RE, UK; (A.A.N.); (K.B.)
| | - Sarah Lam Shang Leen
- Department of Cellular Pathology, Barts and the London NHS Trust, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK; (S.L.S.L.); (N.S.); (M.S.)
| | - Pierre Lao-Sirieix
- MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge CB2 0XZ, UK; (P.L.-S.); (E.B.-L.)
| | - Elizabeth Bird-Lieberman
- MRC Cancer Cell Unit, Hutchison-MRC Research Centre, Cambridge CB2 0XZ, UK; (P.L.-S.); (E.B.-L.)
- Translational Gastroenterology Unit and Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Naveena Singh
- Department of Cellular Pathology, Barts and the London NHS Trust, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK; (S.L.S.L.); (N.S.); (M.S.)
| | - Michael Sheaff
- Department of Cellular Pathology, Barts and the London NHS Trust, Pathology and Pharmacy Building, The Royal London Hospital, 80 Newark Street, London E1 2ES, UK; (S.L.S.L.); (N.S.); (M.S.)
| | - Tony Hollingworth
- Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, London E11 1NR, UK;
| | - Kevin Brindle
- Cancer Research UK Cambridge Institute, Li-Ka Shing Centre, University of Cambridge, Cambridge CB2 0RE, UK; (A.A.N.); (K.B.)
| | - Peter Sasieni
- Wolfson Institute of Preventive Medicine, Centre for Cancer Prevention, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK;
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 9RT, UK
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Nessa A, Ara R, Fatema P, Nasrin B, Chowdhury A, Khan KH, Barua AR, Rashid MHU. Influence of Demographic and Reproductive Factors on Cervical Pre-Cancer and Cancer in Bangladesh. Asian Pac J Cancer Prev 2020; 21:1883-1889. [PMID: 32711411 PMCID: PMC7573429 DOI: 10.31557/apjcp.2020.21.7.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In Bangladesh, cervical cancer (CC) is the 2nd most common cancer with estimated 8068 new cases and 5,214 deaths every year. It is also revealed that different socio-demographic factors have association with CC. This study was performed to evaluate the colposcopy outcomes and the association of different demographic and reproductive risk factors with cervical pre-cancer and cancer. METHODS This retrospective cross-sectional study was carried out at the colposcopy clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU) between January 2010 and December 2016. RESULTS A total 16147 women attended the colposcopy clinic of BSMMU with VIA positive reports. Among them, 65.73% women were referred from different VIA centers of Dhaka district. Mean age of marriage of the subjects was 16. 93 (± 1) and mean age of 1st delivery was 18.45 years (± 4.10). Almost three-fourth of them were married before 18 years and had their 1st delivery by 20 years. Colposcopy examination of the VIA positive women revealed that 36.7% had CINI, 10.6% had CINII/ III and 7.1% had carcinoma of cervix. Considering CIN as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 99.7%, 75.3%, 70.3% and 99.8% respectively. On other hand considering CIN2+ as disease the Sensitivity, Specificity, PPV and NPV of colposcopy were found 73.8%, 92.7%, 64.4% and 95.2% respectively. Statistical analysis revealed that higher age (p=0.000), lower level of education (p=0.007), lower socioeconomic status (p=0.014), higher parity (p=0.001) had individual influence on cervical pre-cancer and cancer. CONCLUSIONS This study indicated higher age, low level of education, lower socio-economic condition and higher parity as most important socio-demographic factors for developing cervical pre-cancer and cancer in Bangladesh.
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Affiliation(s)
- Ashrafun Nessa
- Department of Gynaeclogical Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka-1000, Bangladesh
| | - Rowson Ara
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Parveen Fatema
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Begum Nasrin
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Afroza Chowdhury
- Department of Obstetrics and Gynaecology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | - Kamrul Hasan Khan
- Department of Histopathology, BSMMU, Shahbag, Dhaka-1000, Bangladesh
| | | | - Mohammad Harun Ur Rashid
- Institute of Epidemiology, Diseese Control and Research (IEDCR), Directorate General of Health Services, Mohakhali, Dhaka-1212, Bangladesh
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Hu L, Bell D, Antani S, Xue Z, Yu K, Horning MP, Gachuhi N, Wilson B, Jaiswal MS, Befano B, Long LR, Herrero R, Einstein MH, Burk RD, Demarco M, Gage JC, Rodriguez AC, Wentzensen N, Schiffman M. An Observational Study of Deep Learning and Automated Evaluation of Cervical Images for Cancer Screening. J Natl Cancer Inst 2020; 111:923-932. [PMID: 30629194 DOI: 10.1093/jnci/djy225] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/12/2018] [Accepted: 12/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Human papillomavirus vaccination and cervical screening are lacking in most lower resource settings, where approximately 80% of more than 500 000 cancer cases occur annually. Visual inspection of the cervix following acetic acid application is practical but not reproducible or accurate. The objective of this study was to develop a "deep learning"-based visual evaluation algorithm that automatically recognizes cervical precancer/cancer. METHODS A population-based longitudinal cohort of 9406 women ages 18-94 years in Guanacaste, Costa Rica was followed for 7 years (1993-2000), incorporating multiple cervical screening methods and histopathologic confirmation of precancers. Tumor registry linkage identified cancers up to 18 years. Archived, digitized cervical images from screening, taken with a fixed-focus camera ("cervicography"), were used for training/validation of the deep learning-based algorithm. The resultant image prediction score (0-1) could be categorized to balance sensitivity and specificity for detection of precancer/cancer. All statistical tests were two-sided. RESULTS Automated visual evaluation of enrollment cervigrams identified cumulative precancer/cancer cases with greater accuracy (area under the curve [AUC] = 0.91, 95% confidence interval [CI] = 0.89 to 0.93) than original cervigram interpretation (AUC = 0.69, 95% CI = 0.63 to 0.74; P < .001) or conventional cytology (AUC = 0.71, 95% CI = 0.65 to 0.77; P < .001). A single visual screening round restricted to women at the prime screening ages of 25-49 years could identify 127 (55.7%) of 228 precancers (cervical intraepithelial neoplasia 2/cervical intraepithelial neoplasia 3/adenocarcinoma in situ [AIS]) diagnosed cumulatively in the entire adult population (ages 18-94 years) while referring 11.0% for management. CONCLUSIONS The results support consideration of automated visual evaluation of cervical images from contemporary digital cameras. If achieved, this might permit dissemination of effective point-of-care cervical screening.
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Xue Z, Novetsky AP, Einstein MH, Marcus JZ, Befano B, Guo P, Demarco M, Wentzensen N, Long LR, Schiffman M, Antani S. A demonstration of automated visual evaluation of cervical images taken with a smartphone camera. Int J Cancer 2020; 147:2416-2423. [PMID: 32356305 DOI: 10.1002/ijc.33029] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/19/2020] [Accepted: 04/09/2020] [Indexed: 02/05/2023]
Abstract
We examined whether automated visual evaluation (AVE), a deep learning computer application for cervical cancer screening, can be used on cervix images taken by a contemporary smartphone camera. A large number of cervix images acquired by the commercial MobileODT EVA system were filtered for acceptable visual quality and then 7587 filtered images from 3221 women were annotated by a group of gynecologic oncologists (so the gold standard is an expert impression, not histopathology). We tested and analyzed on multiple random splits of the images using two deep learning, object detection networks. For all the receiver operating characteristics curves, the area under the curve values for the discrimination of the most likely precancer cases from least likely cases (most likely controls) were above 0.90. These results showed that AVE can classify cervix images with confidence scores that are strongly associated with expert evaluations of severity for the same images. The results on a small subset of images that have histopathologic diagnoses further supported the capability of AVE for predicting cervical precancer. We examined the associations of AVE severity score with gynecologic oncologist impression at all regions where we had a sufficient number of cases and controls, and the influence of a woman's age. The method was found generally resilient to regional variation in the appearance of the cervix. This work suggests that using AVE on smartphones could be a useful adjunct to health-worker visual assessment with acetic acid, a cervical cancer screening method commonly used in low- and middle-resource settings.
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Affiliation(s)
- Zhiyun Xue
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Akiva P Novetsky
- Rutgers New Jersey Medical School, Cancer Institute of New Jersey (CINJ), Newark, New Jersey, USA
| | - Mark H Einstein
- Rutgers New Jersey Medical School, Cancer Institute of New Jersey (CINJ), Newark, New Jersey, USA
| | - Jenna Z Marcus
- Rutgers New Jersey Medical School, Cancer Institute of New Jersey (CINJ), Newark, New Jersey, USA
| | - Brian Befano
- Information Management Services, Inc, Rockville, Maryland, USA
| | - Peng Guo
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Demarco
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicolas Wentzensen
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Leonard Rodney Long
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark Schiffman
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sameer Antani
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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23
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Świderska-Kiec J, Czajkowski K, Zaręba-Szczudlik J, Kacperczyk-Bartnik J, Bartnik P, Romejko-Wolniewicz E. Comparison of HPV Testing and Colposcopy in Detecting Cervical Dysplasia in Patients With Cytological Abnormalities. In Vivo 2020; 34:1307-1315. [PMID: 32354923 DOI: 10.21873/invivo.11906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
AIM The aim of the study was to compare the diagnostic value of HPV testing and colposcopy in patients with abnormal cytology results. PATIENTS AND METHODS A total of 186 women with cytological abnormalities were included in the study. The patients underwent colposcopy examinations and DNA HPV testing of cervical smear with genotyping. RESULTS The HPV test was demonstrated to be more sensitive (79.4%) than specific (60.2%) and was more sensitive than colposcopy for detecting CIN changes (79.4% vs. 73.7%). Combined tests achieved a high sensitivity (90.9%) and negative predictive value (96.1%) in detecting patients with CIN2+ and demonstrated the highest positive predictive value (77.3%) for detecting CIN1+. Colposcopy had a very good specificity (83.5%) and positive predictive value (71.2%) in finding CIN1+ cases. CONCLUSION HPV tests showed a higher sensitivity than colposcopy, but colposcopy results presented higher specificity. Combining HPV testing and colposcopy proved to be the most efficient method for detecting CIN lesions.
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Affiliation(s)
- Joanna Świderska-Kiec
- 2 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Julia Zaręba-Szczudlik
- 2 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Bartnik
- 2 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Romejko-Wolniewicz
- 2 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
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24
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Yu W, Long C, Zhu T, Zhu H, Han Z, Li F. High resolution multispectral endoscopy significantly improves the diagnostic accuracy of cervical intraepithelial lesions. J Obstet Gynaecol Res 2020; 46:939-944. [PMID: 32342628 DOI: 10.1111/jog.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/06/2020] [Accepted: 03/04/2020] [Indexed: 12/01/2022]
Abstract
Colposcopy is a visual technique to examine the cervix and determine selection of sites for biopsies and eligibility for treatment. It's always been a critical part of identifying preinvasive and early invasive cervical carcinoma. Unfortunately, challenges exist with regards to the accuracy of traditional colposcopy. Hence, to fully exploit the benefit of increasing diagnostic sensitivity, there is a pressing need to improve the performance of colposcopy by applying novel innovations and techniques. In this case report, we used a recently developed, high-resolution multispectral endoscopy and evaluated its performance by comparing colposcopic image features (the vascular pattern, in particular, depending upon the improved optics and illumination) with histology results. High-resolution multispectral endoscopy makes it easier to distinguish the features of pathological vessels, so that it has a higher sensitivity and specificity to detect cervical lesions, especially in discriminating the vascular pattern using multispectral technology.
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Affiliation(s)
- Wen Yu
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Gynecology, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Cai Long
- Department of Gynecology, Taierzhuang Hospital, Zaozhuang, China
| | | | - Huiting Zhu
- Department of Pathology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiqiang Han
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Li
- Department of Obstetrics and Gynecology, East Hospital, Tongji University School of Medicine, Shanghai, China
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Boonlikit S, Arnont P. Replacing Iodine Staining with Size of Lesion: The Performance of Modified Reid Colposcopic Index. Asian Pac J Cancer Prev 2019; 20:3021-3028. [PMID: 31653150 PMCID: PMC6982656 DOI: 10.31557/apjcp.2019.20.10.3021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 11/25/2022] Open
Abstract
AIM This study of diagnostic accuracy aimed to assess the performance of authors' proposing colposcopic index for detecting histological diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2 or worse). METHODS Retrospective analysis of data was carried out on medical records of women who underwent colposcopy in Rajavithi hospital from January 2007 to December 2014. The authors' proposed score included the first 3 criteria of RCI (margin, color, vascular pattern) and replacing the last RCI criterion (iodine staining) with the detail of size and location of a lesion which was retrospectively retrieved from medical records. Total score for detecting any lesion was ranged from 0-8, similar to the RCI. Performance of the score was assessed for sensitivity, specificity, and positive and negative predictive values at every cut-off level. RESULTS Among 207 eligible women, 87 (42%) had CIN2 or worse. Cut-off level of score ≥ 6 had a sensitivity, specificity, and positive and negative predictive values of 54.0%,97.5%,94.0%,74.5%, respectively while cut-off value ≥ 2 had sensitivity , specificity, positive and negative predictive values of 94.2% ,55.8% ,60.7%, and 93.0%, respectively, for histological diagnosis of CIN 2 or worse. The area under ROC curve was 0.88. In women with type 3 T-zone, the area under ROC curve was 0.94 which was excellent. CONCLUSION The performance of the colposcopic score that replaces iodine staining with the size and location of the lesion is good and practical. High cut-off level can be used in see and treat approach for high-grade squamous intraepithelial lesions. Low cut-off level may be used for omitting biopsy in case of low grade impression. This scoring system seems to have greater performance in womens with type 3 T- zone.
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Affiliation(s)
- Sathone Boonlikit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Pornrapee Arnont
- Department of Obstetrics and Gynecology, Pathum Thani Hospital, Pathum Thani, Thailand
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Rodpenpear N, Pataradool K. The efficacy of modified Swede Colposcopic Index in prediction of high-grade lesion and cancer of cervix. J Gynecol Oncol 2019; 30:e78. [PMID: 31328460 PMCID: PMC6658606 DOI: 10.3802/jgo.2019.30.e78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the efficacy of modified Swede Colposcopic Index (MSCI) to predict high-grade lesion and cancer of cervix (CIN2+, cervical intraepithelial neoplasia grade 2 or worse) in women with abnormal cervical cytology who underwent a colposcopy. Methods We conducted a retrospective study and MSCI using 5 features of cervical lesions evidenced from colposcopy: acetouptake, margin and surface, vessels, lesion size, and location of lesion. Each feature was scored from cervicograhpic findings which transformation zone was completely seen. Odds ratio of each feature was obtained by logistic regression analysis. Receiver operating characteristic curve was used to assess the efficacy of summation score to predict CIN2+. An appropriate cut-off point score was assigned. Results Two hundred and twenty women were included in the study. The assigned score for each factor in level 1 to 3 was 1, 2 and 3 points with a total score of 15 points. The most appropriate cut-off points score for MSCI to predict CIN2+ was 11 points. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy using MSCI were 82.2%, 96.2%, 96.0%, 85.0%, and 90.0% respectively. Conclusion MSCI showed a high efficacy for predicting CIN2+ in satisfactory colposcopy.
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Affiliation(s)
- Nopporn Rodpenpear
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kamol Pataradool
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
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Visual techniques for cervical cancer screening in Colombia. BIOMEDICA 2019; 39:65-74. [DOI: 10.7705/biomedica.v39i1.4007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Indexed: 11/21/2022]
Abstract
Introduction: Direct visual inspection for cervical cancer screening remains controversial, whereas colposcopy-biopsy is considered the gold standard for diagnosis of preneoplastic cervical lesions.Objectives: To determine the rates of cervical intraepithelial neoplasia grade 2 or more and of false positives for colposcopy and direct visual inspection.Materials and methods: Women aged 25-59 underwent direct visual inspection with acetic acid (VIA), Lugol’s iodine (VIA-VILI), and colposcopy. Punch biopsies were obtained for all positive tests. Using histology as the gold standard, detection and false positive rates were compared for VIA, VIA-VILI, and colposcopy (two thresholds). Sensitivity and false positive ratios with the corresponding 95% confidence intervals were estimated.Results: We included 5,011 women in the analysis and we obtained 602 biopsies. Positivity rates for colposcopy high-grade and low-grade diagnosis were 1.6% and 10.8%. Positivity rates for VIA and VIA-VILI were 7.4% and 9.9%. VIA showed a significantly lower detection rate than colposcopy with low-grade diagnosis as the threshold (SR=0.72; 95% CI 0.57-0.91), and significantly lower false positive rate (FPR=0.70; 95% CI 0.65-0.76). No differences between VIA-VILI and colposcopy low-grade threshold were observed. VIA and VIA-VILI showed significantly higher detection and false positive rates than colposcopy high-grade threshold. Sensitivity rates for visual inspection decreased with age and false positive rates increased. For all age groups, false positive rates for VIA and VIA-VILI were significantly higher than colposcopy.Conclusions: Detection rates for VIA-VILI similar to colposcopy low-grade threshold represent a chance to reduce cervical cancer mortality through see-and-treat approaches among women with limited access to health care. Lower detection rates suggest reviewing high-grade colposcopy findings as the threshold for biopsy in certain settings.
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Conrad RD, Liu AH, Wentzensen N, Zhang RR, Dunn ST, Wang SS, Schiffman M, Gold MA, Walker JL, Zuna RE. Cytologic patterns of cervical adenocarcinomas with emphasis on factors associated with underdiagnosis. Cancer Cytopathol 2018; 126:950-958. [PMID: 30351473 PMCID: PMC6231976 DOI: 10.1002/cncy.22055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND New cervical cancers continue to be diagnosed despite the success of Papanicolaou (Pap) tests. In an effort to identify pitfalls that limit the diagnosis of adenocarcinoma, the authors reviewed the cytologic characteristics of endocervical adenocarcinomas in their patient population. METHODS Liquid-based cytology slides from 45 women who had concurrent, histologically confirmed cervical adenocarcinomas were reviewed retrospectively and semiquantitatively for 25 key cytologic traits. The original sign-out diagnosis, available clinical findings, and high-risk human papillomavirus (HR HPV) results also were noted. RESULTS Abundant tumor cellularity, nuclear size from 3 to 6 times normal, abundant 3-dimensional tumor cell groups, round cell shape, and cytoplasmic neutrophils characterized the 23 cases that were identified correctly as adenocarcinomas. Key reasons for undercalls included low tumor cellularity and low-grade columnar morphology; these also tended to correlate with low-grade or unusual adenocarcinoma variants on histology. Overall, 73% of adenocarcinomas had a concurrent positive HR HPV test. CONCLUSIONS Most endocervical adenocarcinomas can be diagnosed accurately in cases with classical features, but some cases continue to be problematic when evaluated based on cytologic features alone. Reflex HPV testing may help increase Pap test sensitivity for challenging cases that have atypical glandular cells of undetermined significance. Occasional cases with negative HR HPV test results remain of concern.
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Affiliation(s)
- Rachel D. Conrad
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Angela H. Liu
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Roy R. Zhang
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - S. Terence Dunn
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Sophia S. Wang
- Cancer EtiologyBeckman Institute, City of HopeDuarteCalifornia
| | - Mark Schiffman
- Division of Cancer Epidemiology and GeneticsNational Cancer Institute, National Institutes of HealthBethesdaMaryland
| | - Michael A. Gold
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Joan L. Walker
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
| | - Rosemary E. Zuna
- Department of PathologyUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahoma
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Digital Colposcopy With Dynamic Spectral Imaging for Detection of Cervical Intraepithelial Neoplasia 2+ in Low-Grade Referrals: The IMPROVE-COLPO Study. J Low Genit Tract Dis 2018; 22:21-26. [PMID: 28953107 PMCID: PMC5768224 DOI: 10.1097/lgt.0000000000000353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a study of “real-world” practice, digital colposcopy with dynamic spectral imaging mapping increased the detection of women with high-grade CIN compared with standard colposcopy. Objective The aim of the study was to determine, in a wide “real-world” setting, whether digital colposcopy with adjunctive dynamic spectral imaging (DSI) mapping increases the detection of women with high-grade cervical intraepithelial neoplasia (CIN). Materials and Methods A multicenter, two-arm, observational, cross-sectional study that recruited women 21 years and older, having colposcopy after a low-grade abnormality screening result. The prospective arm collected outcomes of digital colposcopy with DSI used for identifying biopsy sites at the colposcopists' discretion. The retrospective control arm (number of subjects matched 1:1 per colposcopist) collected outcomes of standard colposcopy. The primary outcome was histopathological detection of women with CIN 2+ by colposcopic biopsy. Results The study included 1,788 women in the retrospective and 1,857 in the prospective arm from 39 US community-based clinics. Subject characteristics were comparable. A total of 71.6% of the women in the retrospective and 71.5% in the prospective arm underwent biopsy. The average number of biopsies increased from 1.032 (retrospective) to 1.256 (prospective). The yield of CIN 2+ patients was 7.21% in the retrospective and 9.48% in the prospective arm, a 2.27% difference (95% confidence interval = 0.47%–4.07%, p = .014) and 31.4% relative increase. The yield of CIN 3+ patients was 2.07% in the retrospective and 3.23% in the prospective arm, a 1.16% (95% confidence interval = 0.12%–2.24%, p = .031) absolute difference and 56.1% relative increase. The false-positive rates for biopsied patients were comparable (64.43% vs 62.04%, p = .139). Conclusions Digital colposcopy with the adjunctive DSI increased CIN 2+ and CIN 3+ detection in low-grade referrals compared with standard colposcopy, with a similar number of women undergoing biopsy.
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Doubeni CA, Gabler NB, Wheeler CM, McCarthy AM, Castle PE, Halm EA, Schnall MD, Skinner CS, Tosteson ANA, Weaver DL, Vachani A, Mehta SJ, Rendle KA, Fedewa SA, Corley DA, Armstrong K. Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium. CA Cancer J Clin 2018; 68:199-216. [PMID: 29603147 PMCID: PMC5980732 DOI: 10.3322/caac.21452] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 12/19/2022] Open
Abstract
Timely follow-up for positive cancer screening results remains suboptimal, and the evidence base to inform decisions on optimizing the timeliness of diagnostic testing is unclear. This systematic review evaluated published studies regarding time to follow-up after a positive screening for breast, cervical, colorectal, and lung cancers. The quality of available evidence was very low or low across cancers, with potential attenuated or reversed associations from confounding by indication in most studies. Overall, evidence suggested that the risk for poorer cancer outcomes rises with longer wait times that vary within and across cancer types, which supports performing diagnostic testing as soon as feasible after the positive result, but evidence for specific time targets is limited. Within these limitations, we provide our opinion on cancer-specific recommendations for times to follow-up and how existing guidelines relate to the current evidence. Thresholds set should consider patient worry, potential for loss to follow-up with prolonged wait times, and available resources. Research is needed to better guide the timeliness of diagnostic follow-up, including considerations for patient preferences and existing barriers, while addressing methodological weaknesses. Research is also needed to identify effective interventions for reducing wait times for diagnostic testing, particularly in underserved or low-resource settings. CA Cancer J Clin 2018;68:199-216. © 2018 American Cancer Society.
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Affiliation(s)
- Chyke A. Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Nicole B. Gabler
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Cosette M. Wheeler
- Departments of Pathology, and Obstetrics and Gynecology, University of New Mexico Health Science Center, Albuquerque, NM
| | - Anne Marie McCarthy
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Philip E. Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ethan A. Halm
- Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mitchell D. Schnall
- Department of Radiology, Breast Imaging Section, University of Pennsylvania, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Celette S. Skinner
- Department of Clinical Sciences and Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Donald L. Weaver
- Department of Pathology, UVM Cancer Center, University of Vermont, Burlington, VT
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine and Penn Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society. Atlanta, GA
| | - Douglas A. Corley
- Kaiser Permanente Division of Research, Oakland, CA, and San Francisco Medical, Kaiser Permanente Northern California, San Francisco, CA
| | - Katrina Armstrong
- General Medicine Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Effect of High-Risk Human Papillomavirus but Normal Cytology at Test of Cure on Achieving Colposcopy Standards. J Low Genit Tract Dis 2018; 22:110-114. [DOI: 10.1097/lgt.0000000000000373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Uchita K, Kanenishi K, Hirano K, Kobara H, Nishiyama N, Kawada A, Fujihara S, Ibuki E, Haba R, Takahashi Y, Kai Y, Yorita K, Mori H, Kunikata J, Nishimoto N, Hata T, Masaki T. Characteristic findings of high-grade cervical intraepithelial neoplasia or more on magnifying endoscopy with narrow band imaging. Int J Clin Oncol 2018; 23:707-714. [PMID: 29446041 DOI: 10.1007/s10147-018-1247-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/04/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Colposcopy, which is a standard modality for diagnosing cervical intraepithelial neoplasia (CIN), can have limited accuracy owing to poor visibility. Flexible magnifying endoscopy with narrow band imaging (ME-NBI) has excellent diagnostic accuracy for early gastrointestinal neoplasms and is expected to be highly useful for CIN diagnosis. This study aimed to determine the characteristic findings and evaluate the diagnostic ability of ME-NBI for lesions ≥ CIN 3. METHODS A well-designed prospective diagnostic case series conducted at multiple tertiary-care centers. A total of 24 patients who underwent cervical conization with a preoperative diagnosis of high-grade squamous cell intraepithelial lesions (HSILs) or lesions ≥ CIN 3 were enrolled. Prior to conization, still images and video of ME-NBI were captured to investigate the cervical lesions. The images were reviewed based on histological examination of the resected specimens. RESULTS The NBI-ME images revealed the following abnormal findings: (1) light white epithelium (l-WE), (2) heavy white epithelium (h-WE), and (3) atypical intra-epithelial papillary capillary loop (IPCL). Pathological examination of the resected specimens confirmed cervical lesions ≥ CIN 3 in 21 patients. The ME-NBI findings were classified into four groups: l-WE, l-WE with atypical IPCL, h-WE, and h-WE with atypical IPCL, at rates of 0, 23.8, 9.5, and 66.7%, respectively. Additionally, all 3 patients with micro-invasive carcinoma showed a strong irregularity of IPCLs. CONCLUSION The lesions ≥ CIN 3 demonstrated characteristic ME-NBI findings of h-WE alone, or l-/h-WE with atypical micro-vessels. This study indicates that ME-NBI may have novel value for CIN diagnosis.
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Affiliation(s)
- Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Kenji Kanenishi
- Department of Gynecology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Koki Hirano
- Department of Gynecology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Ai Kawada
- Department of Gastroenterology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Emi Ibuki
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Yohei Takahashi
- Department of Gynecology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Yuka Kai
- Department of Gynecology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Kochi Red Cross Hospital, 2-13-51 Sinhonmachi, Kochi, 780-8562, Japan
| | - Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Jun Kunikata
- Department of Clinical Research Support Center, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Naoki Nishimoto
- Department of Clinical Research Support Center, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Gynecology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
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Standardized Digital Colposcopy with Dynamic Spectral Imaging for Conservative Patient Management. Case Rep Obstet Gynecol 2017; 2017:5269279. [PMID: 29435378 PMCID: PMC5757110 DOI: 10.1155/2017/5269279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022] Open
Abstract
Background Colposcopy is subjective and management of young patients with high-grade disease is challenging, as treatments may impair subsequent pregnancies and adversely affect obstetric outcomes. Conservative management of selected patients is becoming more popular amongst clinicians; however it requires accurate assessment and documentation. Novel adjunctive technologies for colposcopy could improve patient care and help individualize management decisions by introducing standardization, increasing sensitivity, and improving documentation. Case A nulliparous 27-year-old woman planning pregnancy underwent colposcopy following high-grade cytology. The colposcopic impression was of low-grade changes, whilst the Dynamic Spectral Imaging (DSI) map of the cervix suggested potential high-grade. A DSI-directed biopsy confirmed CIN2. At follow-up, both colposcopy and DSI were suggestive of low-grade disease only, and image comparison confirmed the absence of previously present acetowhite epithelium areas. Histology of the transformation zone following excisional treatment, as per patient's choice, showed no high-grade changes. Conclusion Digital colposcopy with DSI mapping helps standardize colposcopic examinations, increase diagnostic accuracy, and monitor cervical changes over time, improving patient care. When used for longitudinal tracking of disease and when it confirms a negative colposcopy, it can help towards avoiding overtreatment and hence decrease morbidity related to cervical excision.
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DeNardis SA, Lavin PT, Livingston J, Salter WR, James-Patrick N, Papagiannakis E, Olson CG, Weinberg L. Increased detection of precancerous cervical lesions with adjunctive dynamic spectral imaging. Int J Womens Health 2017; 9:717-725. [PMID: 29033612 PMCID: PMC5628669 DOI: 10.2147/ijwh.s144577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To validate, in US community-based colposcopy clinics, previous reports of increased detection of high-grade cervical intraepithelial neoplasia (CIN2+) with biopsies selected using dynamic spectral imaging (DSI) mapping after standard colposcopy. Study design Cross-sectional observational study of 26 colposcopists across nine clinics recruiting consecutive colposcopy patients. Standard assessment with biopsy selections was completed before seeing the DSI map which was subsequently interpreted and used for additional biopsies per clinical judgment. Primary measure was the number of women with CIN2+ detected by DSI-assisted biopsies, over those detected by standard colposcopy biopsies. Results A total of 887 women were recruited. After exclusions, 881 women and 1,189 biopsies were analyzed. Standard biopsy detected 78 women with CIN2+ and DSI-assisted biopsies another 34, increasing the detection rate from 8.85% to 12.71% (p=0.00016). This was achieved with 16.16% of DSI-assisted biopsies finding CIN2+ compared to 13.24% for the preceding standard biopsies. For secondary specificity analysis, 431 women had only <CIN2 in standard biopsy/ies, a 48.92% rate, while 131 women who underwent no standard biopsy/ies had DSI-assisted biopsy/ies which were all <CIN2, a 35.22% rate (p<0.0001). Conclusion The largest study, to date, of DSI used in colposcopy confirms previously reported increased detection of CIN2+, across multiple US community-based clinics. Based on the improved efficiency of the DSI-assisted biopsies, this increase suggests an improved diagnostic capacity achieved with DSI and cannot be explained solely by the taking of additional biopsies.
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Affiliation(s)
- Sara A DeNardis
- Department of Obstetrics/Gynecology, University of Central Florida, Orlando, FL, USA
| | - Philip T Lavin
- Boston Biostatistics Research Foundation, Framingham, MA, USA
| | | | | | | | | | | | - Lori Weinberg
- Department of Obstetrics/Gynecology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Cytologic-Histologic Discrepancies in Pathology of the Uterine Cervix: Analysis of the Clinical and Pathologic Factors. Adv Anat Pathol 2017; 24:304-309. [PMID: 28777141 DOI: 10.1097/pap.0000000000000165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cytologic-histologic correlation (CHC) represents a documented effort to obtain and compare, when available, gynecologic cytology reports with an interpretation of high-grade squamous intraepithelial lesion or malignancy, with the subsequent histopathology report, and to determine the possible cause of any discrepancy. The correlation is influenced by multiple closely interdependent clinical and pathologic factors. Many of these factors including the sensitivity and accuracy of colposcopy-directed biopsy, the diligence of the colposcopist, and the attributes of the cervical lesion represent "preanalytical" factors which can significantly affect the CHC outcome, but are often less emphasized during CHC process. The status of "gold standard" of cervical biopsy histology will be less "golden" if clinicians miss, during colposcopy, the lesion which had been flagged by cytology. CHC also serves as one of the important assurance tools to monitor and improve the pathology laboratory overall quality, and the ability of the pathologists to enhance their diagnostic interpretation. As pathologists, we should make every effort to improve on CHC, by applying systematic approaches, both in technical laboratory and interpretive diagnosis, which increase yield and reduce diagnostic discrepancies. The widespread use of Human Papilloma Virus testing and p16 immunohistochemistry have significantly enhanced diagnostic accuracy both in cytology and in histology. Herein, we review the intimate relationships and factors that may govern discrepancies between cytology, colposcopy-directed biopsies, and biopsies with subsequent Loop Electroexcision Procedure for cervical squamous intraepithelial lesions. Ultimately the projected risk for high-grade squamous intraepithelial lesion and cancer and the suggested management guidelines are directly tied in with effective CHC.
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Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin‐Hirsch PPL, Mustafa RA, Schünemann H, Paraskevaidis E, Arbyn M. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 8:CD008587. [PMID: 28796882 PMCID: PMC6483676 DOI: 10.1002/14651858.cd008587.pub2] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cervical cancer screening has traditionally been based on cervical cytology. Given the aetiological relationship between human papillomavirus (HPV) infection and cervical carcinogenesis, HPV testing has been proposed as an alternative screening test. OBJECTIVES To determine the diagnostic accuracy of HPV testing for detecting histologically confirmed cervical intraepithelial neoplasias (CIN) of grade 2 or worse (CIN 2+), including adenocarcinoma in situ, in women participating in primary cervical cancer screening; and how it compares to the accuracy of cytological testing (liquid-based and conventional) at various thresholds. SEARCH METHODS We performed a systematic literature search of articles in MEDLINE and Embase (1992 to November 2015) containing quantitative data and handsearched the reference lists of retrieved articles. SELECTION CRITERIA We included comparative test accuracy studies if all women received both HPV testing and cervical cytology followed by verification of the disease status with the reference standard, if positive for at least one screening test. The studies had to include women participating in a cervical cancer screening programme who were not being followed up for previous cytological abnormalities. DATA COLLECTION AND ANALYSIS We completed a 2 x 2 table with the number of true positives (TP), false positives (FP), true negatives (TN), and false negatives for each screening test (HPV test and cytology) used in each study. We calculated the absolute and relative sensitivities and the specificities of the tests for the detection of CIN 2+ and CIN 3+ at various thresholds and computed sensitivity (TP/(TP + TN) and specificity (TN/ (TN + FP) for each test separately. Relative sensitivity and specificity of one test compared to another test were defined as sensitivity of test-1 over sensitivity of test-2 and specificity of test-1 over specificity of test-2, respectively. To assess bias in the studies, we used the Quality Assessment of Diagnostic test Accuracy Studies (QUADAS) tool. We used a bivariate random-effects model for computing pooled accuracy estimates. This model takes into account the within- and between-study variability and the intrinsic correlation between sensitivity and specificity. MAIN RESULTS We included a total of 40 studies in the review, with more than 140,000 women aged between 20 and 70 years old. Many studies were at low risk of bias. There were a sufficient number of included studies with adequate methodology to perform the following test comparisons: hybrid capture 2 (HC2) (1 pg/mL threshold) versus conventional cytology (CC) (atypical squamous cells of undetermined significance (ASCUS)+ and low-grade squamous intraepithelial lesions (LSIL)+ thresholds) or liquid-based cytology (LBC) (ASCUS+ and LSIL+ thresholds), other high-risk HPV tests versus conventional cytology (ASCUS+ and LSIL+ thresholds) or LBC (ASCUS+ and LSIL+ thresholds). For CIN 2+, pooled sensitivity estimates for HC2, CC and LBC (ASCUS+) were 89.9%, 62.5% and 72.9%, respectively, and pooled specificity estimates were 89.9%, 96.6%, and 90.3%, respectively. The results did not differ by age of women (less than or greater than 30 years old), or in studies with verification bias. Accuracy of HC2 was, however, greater in European countries compared to other countries. The results for the sensitivity of the tests were heterogeneous ranging from 52% to 94% for LBC, and 61% to 100% for HC2. Overall, the quality of the evidence for the sensitivity of the tests was moderate, and high for the specificity.The relative sensitivity of HC2 versus CC for CIN 2+ was 1.52 (95% CI: 1.24 to 1.86) and the relative specificity 0.94 (95% CI: 0.92 to 0.96), and versus LBC for CIN 2+ was 1.18 (95% CI: 1.10 to 1.26) and the relative specificity 0.96 (95% CI: 0.95 to 0.97). The relative sensitivity of HC2 versus CC for CIN 3+ was 1.46 (95% CI: 1.12 to 1.91) and the relative specificity 0.95 (95% CI: 0.93 to 0.97). The relative sensitivity of HC2 versus LBC for CIN 3+ was 1.17 (95% CI: 1.07 to 1.28) and the relative specificity 0.96 (95% CI: 0.95 to 0.97). AUTHORS' CONCLUSIONS Whilst HPV tests are less likely to miss cases of CIN 2+ and CIN 3+, these tests do lead to more unnecessary referrals. However, a negative HPV test is more reassuring than a negative cytological test, as the cytological test has a greater chance of being falsely negative, which could lead to delays in receiving the appropriate treatment. Evidence from prospective longitudinal studies is needed to establish the relative clinical implications of these tests.
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Affiliation(s)
- George Koliopoulos
- Elena Venizelou Maternity HospitalDepartment of Obstetrics and Gynaecology1 Elena Venizelou SquareAthensGreece11521
| | - Victoria N Nyaga
- Scientific Institute of Public HealthUnit of Cancer EpidemiologyJuliette Wytsmanstraat 14BrusselsBelgium1050
| | - Nancy Santesso
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Pierre PL Martin‐Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospital NHS TrustGynaecological Oncology UnitSharoe Green LaneFullwoodPrestonLancashireUKPR2 9HT
| | - Reem A Mustafa
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHamiltonONCanadaL8N 3Z5
| | - Holger Schünemann
- McMaster UniversityDepartments of Health Research Methods, Evidence, and Impact and of Medicine1280 Main Street WestHamiltonONCanadaL8N 4K1
| | | | - Marc Arbyn
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
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Catarino R, Schäfer S, Vassilakos P, Petignat P, Arbyn M. Accuracy of combinations of visual inspection using acetic acid or lugol iodine to detect cervical precancer: a meta-analysis. BJOG 2017; 125:545-553. [PMID: 28603909 DOI: 10.1111/1471-0528.14783] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Visual inspection of the cervix with acetic acid (VIA) or with Lugol's iodine (VILI) have been evaluated for cervical cancer screening in developing countries. OBJECTIVES To assess the diagnostic accuracy and clinical utility of visual methods to detect cervical intraepithelial neoplasia grade 2+ (CIN2+) using: (1) VIA alone; (2) VILI alone; (3) co-testing; and (4) VILI as a triage test of a positive VIA result. SEARCH STRATEGY PubMed, EMBASE, and the Cochrane Library were searched up to May 2016. SELECTION CRITERIA All reports on the accuracy of VIA and VILI, or combinations of VIA/VILI, to detect CIN2+ were identified. Histology and colposcopy when no biopsy was taken were used as the reference standard. DATA COLLECTION AND ANALYSIS Selected studies were scored on methodological quality, and sensitivity and specificity were computed. Clinical utility was assessed from the positive predictive value (PPV) and the complement of the negative predictive value (cNPV). MAIN RESULTS We included 23 studies comprising 101 273 women. The pooled sensitivity and specificity of VILI was 88 and 86%, respectively. VILI was more sensitive, but not less specific, compared with VIA (relative sensitivity = 1.11; 95% confidence interval, 95% CI, 1.06-1.16; relative specificity = 0.98; 95% CI 0.95-1.01). Co-testing was hardly more sensitive, but significantly less specific, than VILI alone. VILI to triage VIA-POSITIVE women was not less sensitive, but more specific, compared with VIA alone (relative sensitivity = 0.98, 95% CI 0.96-1.01; relative specificity = 1.04, 95% CI 1.02-1.05). The average PPVs were low (range 11-16%), whereas the cNPV varied between 0.3% (VILI, co-testing) and 0.6% (triage). CONCLUSIONS Although imperfect, VILI alone appeared to be the most useful visual screening strategy. TWEETABLE ABSTRACT VILI alone seems to be the most useful visual screening test for cervical cancer screening.
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Affiliation(s)
- R Catarino
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - S Schäfer
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - P Vassilakos
- Geneva Foundation for Medical Education and Research, Geneva, Switzerland
| | - P Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - M Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Macdonald MC, Brown BH, Lyon RE, Healey TJ, Palmer JE, Tidy JA. Influence of high risk HPV genotype on colposcopic performance: A large prospective study demonstrates improved detection of disease with ZedScan I , particularly in non-HPV 16 patients. Eur J Obstet Gynecol Reprod Biol 2017; 211:194-198. [DOI: 10.1016/j.ejogrb.2017.02.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/18/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To describe the change in colposcopy volume in light of recent guideline shifts, which target higher-risk women while limiting unnecessary procedures in low-risk women. METHODS After institutional review board approval, colposcopy clinic visits at a large-volume referral center from January 2010 to December 2015 were reviewed. All women diagnosed with abnormal cervical cytology who were referred and subsequently underwent colposcopic evaluation were included. Mean monthly and annual clinic volumes were calculated. Return visit proportions were compared using chi-square test. Negative binomial regression analysis was used to examine trends. RESULTS There were a total of 8722 colposcopy clinic visits between January 2010 and December 2015. Approximately 7395 visits (85%) were new patient visits, and 1327 visits (15%) were return visits. The percentage of return visits declined dramatically during the study period from 22.9% (2011) of total visits to 9.0% in 2015 (P < 0.001). Annual clinic volume ranged from 903 to 1884 with a mean monthly volume of 121.13 visits (SD, 42.1). Annual volume was highest in 2011 (n = 1884) and has since demonstrated a steady decline. In 2015, average monthly volume (75.3 visits) dropped to nearly one third of its peak 218 visits per month in July 2010. CONCLUSIONS In a large referral clinic that adheres to guideline-based screening and management recommendations, monthly colposcopy volume has declined dramatically with a reduction by two thirds compared with peak volume in 2010.
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How Colposcopy Misses Invasive Cervical Cancer: A Case Report from the IMPROVE-COLPO Study. Case Rep Obstet Gynecol 2016; 2016:5857370. [PMID: 27830099 PMCID: PMC5088331 DOI: 10.1155/2016/5857370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/31/2016] [Accepted: 09/28/2016] [Indexed: 11/17/2022] Open
Abstract
Colposcopy with biopsy is pivotal to cervical cancer prevention programs as it is called to identify the precancerous lesions on patients that screen positive. We present a cervical cancer case from IMPROVE-COLPO, a postmarketing, multicenter, two-arm observational study on US community colposcopy that collects outcomes with the adjunctive Dynamic Spectral Imaging (DSI) in its prospective arm. A 45-year-old woman was seen for suffering of heavy periods. She had cytology of Atypical Squamous Cells of Undetermined Significance (ASC-US) and was Human Papillomavirus (HPV) positive. Her colposcopy did not recognize the underlying condition and opted for no biopsy. The DSI assessment led to a biopsy of a lesion challenging traditional colposcopic templates: small, away from the cervical os, with slow acetowhitening development. Pathology review revealed the presence of invasive squamous carcinoma. In the era of sensitive screening, it is concerning that invasive cancers can challenge colposcopy and that the way to improve colposcopy is to collect multiple biopsies from each patient. The case presented indicates that the adjunctive objective assessment by DSI increases reassurance that observations outside of traditional standard visual templates are not underestimated or ignored.
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Schiffman M, Yu K, Zuna R, Terence Dunn S, Zhang H, Walker J, Gold M, Hyun N, Rydzak G, Katki HA, Wentzensen N. Proof-of-principle study of a novel cervical screening and triage strategy: Computer-analyzed cytology to decide which HPV-positive women are likely to have ≥CIN2. Int J Cancer 2016; 140:718-725. [PMID: 27696414 DOI: 10.1002/ijc.30456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 11/07/2022]
Abstract
A challenge in implementation of sensitive HPV-based screening is limiting unnecessary referrals to colposcopic biopsy. We combined two commonly recommended triage methods: partial HPV typing and "reflex" cytology, evaluating the possibility of automated cytology. This investigation was based on 1,178 exfoliated cervical specimens collected during the enrollment phase of The Study to Understand Cervical Cancer Early Endpoints and Determinants (SUCCEED, Oklahoma City, OK). We chose a colposcopy clinic population to maximize number of outcomes, for this proof-of-principle cross-sectional study. Residual aliquots of PreservCyt were HPV-typed using Linear Array (LA, Roche Molecular Systems, Pleasanton, CA). High-risk HPV typing data and cytologic results (conventional and automated) were used jointly to predict risk of histologically defined ≥CIN2. We developed a novel computer algorithm that uses the same optical scanning features that are generated by the FocalPoint Slide Profiler (BD, Burlington, NC). We used the Least Absolute Shrinkage and Selection Operator (LASSO) method to build the prediction model based on a training dataset (n = 600). In the validation set (n = 578), for triage of all HPV-positive women, a cytologic threshold of ≥ASC-US had a sensitivity of 0.94, and specificity of 0.30, in this colposcopy clinic setting. When we chose a threshold for the severity score (generated by the computer algorithm) that had an equal specificity of 0.30, the sensitivity was 0.91. Automated cytology also matched ≥ASC-US when partial HPV typing was added to the triage strategy, and when we re-defined cases as ≥CIN3. If this strategy works in a prospective screening setting, a totally automated screening and triage technology might be possible.
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Affiliation(s)
- Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kai Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Rosemary Zuna
- Oklahoma University Health Sciences Center, Oklahoma City, OK
| | | | - Han Zhang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Joan Walker
- Oklahoma State Department of Health, Oklahoma City, OK
| | | | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Greg Rydzak
- Information Management Services, Calverton, MD
| | - Hormuzd A Katki
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Garutti P, Cristiani P, Fantin GP, Sopracordevole F, Costa S, Schincaglia P, Ravaioli A, Sassoli de Bianchi P, Naldoni C, Ferretti S, Bucchi L. Interpretation of colposcopy in population-based cervical screening services in north-eastern Italy: an online interregional agreement study. Eur J Obstet Gynecol Reprod Biol 2016; 206:64-69. [PMID: 27639133 DOI: 10.1016/j.ejogrb.2016.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/29/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE An innovative web-based colposcopy quality assurance programme was implemented in population-based cervical screening services in three north-eastern Italian administrative regions with different colposcopists' training background. In this study, the levels of intra- and interregional intercolposcopist diagnostic agreement were evaluated. STUDY DESIGN Of the 158 registered colposcopists, 125 accessed the website of the programme, logged-in, viewed a posted set of 50 digital colpophotographs selected by an expert steering committee, and classified them for the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy. Anonymous data were downloaded and analysed using the crude, or observed, proportion of agreement and the kappa coefficient. RESULTS There were 113 eligible colposcopists. Overall, crude agreement on the colposcopic impression, the visibility of the squamocolumnar junction, and the need for biopsy was 0.72, 0.72, and 0.87, with kappa values of 0.60, 0.36, and 0.69, respectively. The homologous kappa values were 0.61, 0.41, and 0.69 in one region, 0.57, 0.36, and 0.69 in another, and 0.66, 0.38, and 0.74 in the third. Total intra- and interregional agreement were nearly identical, with kappa values of 0.59 and 0.60 for the colposcopic impression, 0.38 and 0.35 for the visibility of the squamocolumnar junction, and 0.69 and 0.69 for the need for biopsy. The width of 95% confidence intervals around the above kappa values was ≤0.01. CONCLUSIONS The levels of agreement varied between moderate and substantial both within and between regions. Regional differences in training background had minor effects. The interpretation of colposcopy is potentially well-reproducible.
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Affiliation(s)
- Paola Garutti
- Department of Obstetrics and Gynaecology, University Hospital, Ferrara, Italy
| | - Paolo Cristiani
- Cervical Cancer Screening Unit, Bologna Health Care District, Bologna, Italy
| | - Gian P Fantin
- Department of Obstetrics and Gynaecology, St. Maria dei Battuti Hospital, Conegliano, Treviso, Italy
| | | | - Silvano Costa
- Department of Obstetrics and Gynaecology, St. Orsola Hospital, Bologna, Italy
| | | | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRST), Meldola, Forlì, Italy
| | | | - Carlo Naldoni
- Department of Health, Emilia-Romagna Region, Bologna, Italy
| | | | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRST), Meldola, Forlì, Italy.
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Castle PE, Aslam S, Behrens C. Cervical Precancer and Cancer Risk by Human Papillomavirus Status and Cytologic Interpretation: Implications for Risk-Based Management. Cancer Epidemiol Biomarkers Prev 2016; 25:1595-1599. [PMID: 27587789 DOI: 10.1158/1055-9965.epi-16-0330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/02/2016] [Accepted: 08/23/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical cancer risks, estimated by using cervical intraepithelial neoplasia grade 3 (CIN3) or more severe diagnoses (≥CIN3) endpoints, have not been quantified for different combinations of results from currently approved screening methods. Understanding these risks will guide optimal patient management. METHODS Women aged ≥25 years (n = 7,823) underwent high-risk human papillomavirus (hrHPV) and liquid-based cytology (LBC) testing. Women with hrHPV-positive results and/or abnormal LBC, plus a random subset of hrHPV and LBC negatives, underwent colposcopy; those without ≥CIN2 at baseline were screened annually by LBC and referred to colposcopy for an abnormal LBC (n = 7,392). One- and 3-year ≥CIN3 risks with 95% confidence intervals (95% CI) were calculated for paired hrHPV and LBC (hrHPV/LBC) results. RESULTS One-year ≥CIN3 risks ranged from 81.27% (95% CI, 66.02%-90.65%) for HPV16 positive/high-grade to 0.33% (95% CI, 0.18%-0.62%) for hrHPV negative/negative for intraepithelial lesion or malignancy (NILM). One-year ≥CIN3 risk for HPV16/NILM (13.95%; 95% CI, 10.98%-17.58%) was greater than low-grade squamous intraepithelial lesion (LSIL; 7.90%; 95% CI, 5.99%-10.37%; P = 0.002) and similar to hrHPV-positive/LSIL (11.45%; 95% CI, 8.61%-15.07%; P = 0.3). Three-year ≥CIN3 risks for HPV16 positive/LSIL and HPV16/atypical squamous cells of undetermined significance was 24.79% (95% CI, 16.44%-35.58%) and 24.36% (95% CI, 15.86%-35.50%), respectively, and 0.72% (95% CI, 0.45%-1.14%) for hrHPV negative/NILM. CONCLUSIONS hrHPV and LBC results stratify cervical cancer risk by more than two orders of magnitude. HPV16-positive women, regardless of the LBC result, warrant immediate colposcopy. Women with concurrent HPV16 and high-grade LBC might consider treatment without a confirmatory biopsy with informed decision-making with their provider. IMPACT These results provide relevant benchmarks for risk-based cervical cancer screening and management. Cancer Epidemiol Biomarkers Prev; 25(12); 1595-9. ©2016 AACR.
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Affiliation(s)
- Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York. .,Global Coalition Against Cervical Cancer, Arlington, Virginia
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Liu AH, Gold MA, Schiffman M, Smith KM, Zuna RE, Dunn ST, Gage JC, Walker JL, Wentzensen N. Comparison of Colposcopic Impression Based on Live Colposcopy and Evaluation of Static Digital Images. J Low Genit Tract Dis 2016; 20:154-61. [PMID: 27015261 PMCID: PMC4808516 DOI: 10.1097/lgt.0000000000000194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the agreement and compare diagnostic accuracy of colposcopic impressions from live colposcopy versus evaluation of static digital images. MATERIALS AND METHODS Live impressions and corresponding static images obtained during colposcopy of 690 women were independently compared. Diagnostic accuracy was calculated for colposcopic impressions from both methods, varying hypothetical thresholds for colposcopically directed cervical biopsies (acetowhitening or worse, low grade or worse, high grade or worse). Stratified analyses investigated the impact of referral cytology, human papillomavirus 16 infection, and age on colposcopic impression. RESULTS Overall agreement between live and static colposcopic visualization was 43.0% (κ = 0.20; 95% CI = 0.14-0.26) over normal, acetowhitening, low-grade, and high-grade impressions. Classification of acetowhitening or worse impressions showed the highest agreement (92.2%; κ = 0.39; 95% CI = 0.21-0.57); both methods achieved more than 95% sensitivity for CIN 2+. Agreement between live and static colposcopic visualization was 69.3% for rating low-grade or worse impressions (κ = 0.23; 95% CI = 0.14-0.33) and 71% when rating high-grade impressions (κ = 0.33; 95% CI = 0.24-0.42). Live colposcopic impressions were more likely to be rated low grade or worse (p < .01; odds ratio = 3.5; 95% CI = 2.4-5.0), yielding higher sensitivity for CIN 2+ at this threshold than static image assessment (95.4% vs 79.8%, p < .01). Overall, colposcopic impressions were more likely rated high grade on live assessment among women referred with high-grade cytology (odds ratio = 3.3; 95% CI = 1.8-6.4), significantly improving the sensitivity for CIN 2+ (66.3% vs 48.5%, p < .01). CONCLUSIONS Colposcopic impressions of acetowhitening or worse are highly sensitive for identifying cervical precancers and reproducible on static image-based pattern recognition.
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Affiliation(s)
- Angela H Liu
- 1Division of Cancer Epidemiology and Genetics, National Cancer Institute; 2Tulsa Cancer Institutes and University of Oklahoma School of Community Medicine; and 3University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Boonlikit S. Performance of the abbreviated Reid colposcopic index in prediction of high-grade lesions. Int J Gynaecol Obstet 2016; 134:41-4. [PMID: 27085982 DOI: 10.1016/j.ijgo.2015.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/30/2015] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of the Reid colposcopic index (RCI) and establish the optimal cutoff value to predict a histology of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). METHODS A retrospective analysis was undertaken of the medical records of women who underwent colposcopy with RCI scoring at a center in Bangkok, Thailand, between 2003 and 2014. Only patients for whom histology reports were available were included. Cases had been scored according to three criteria: margin, color, and vascular pattern. The performance of this three-criterion score (abbreviated RCI) was assessed for sensitivity, specificity, and positive and negative predictive values at every cutoff level. Receiver operation characteristics (ROC) curve analysis was performed to determine the optimal cutoff value to distinguish between women with CIN2+ and others. RESULTS Among 349 included patients, 158 (45.3%) had CIN2+. The most appropriate cutoff score was 3, which had a sensitivity of 72.7%, a specificity of 86.9%, and positive and negative predictive values of 82.1% and 79.4%, respectively. The area under ROC curve was 0.857 (95% confidence interval 0.815-0.898). CONCLUSION The performance of the abbreviated RCI seems satisfactory. The optimal cutoff value was 3.
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Affiliation(s)
- Sathone Boonlikit
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
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Eitan R, Krissi H, Peled Y, Braslavsky D, Binyamin L, Peretz-Davidi Y, Seadia O, Landesman I. The Use of a Novel Optical Algorithm in the Diagnosis of Cervical Pre-Invasive Pathology - A Preliminary Proof of Principal Study. Gynecol Obstet Invest 2016; 81:523-528. [PMID: 26960003 DOI: 10.1159/000444584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a novel optical probe monitoring cervical tissues in real-time and to compare the new imaging technique to actual cervical pathologic findings on resected cone biopsy specimens. METHODS A loop electro-excisional procedure was performed on 15 women with a biopsy diagnosis of dysplasia. The conization specimen was then assessed with the novel optical system and results recorded. The 'normal' and 'abnormal' areas were tested by the optical setup at several points. Extracted parameters were used as the input of the classifier function of a logistic regression algorithm model to assess for system accuracy vs. clinical examination. RESULTS Ninety-seven samples were taken - forty-five samples from 'abnormal zones' and 42 samples from 'normal zones', as defined by the surgeon. The pathologist diagnosed 58 samples as dysplastic and 39 samples as normal. The novel optical method predicted 58 sample points as abnormal and 39 points as normal. The sensitivity of the system was 90% with a specificity of 77%. The probability of correct differentiation of dysplastic cervical tissue from normal cervical tissue was 85%. CONCLUSIONS The optical probe and the algorithms of image processing in combination with the logistic regression algorithm correlated well with pathology results for cervical dysplasia ex-vivo.
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Affiliation(s)
- Ram Eitan
- Gynecologic Oncology Division, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Zong LJ, Zhang YZ, Yang XS, Jiang J, Cui BX, Qiao YB, Li L, Jiang K, Zhang WJ, Kong BH, Shen K. Evaluation of several screening approaches for detection of cervical lesions in rural Shandong, China. Asian Pac J Cancer Prev 2016; 16:1907-12. [PMID: 25773843 DOI: 10.7314/apjcp.2015.16.5.1907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province. MATERIALS AND METHODS A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated. RESULTS The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively. CONCLUSIONS Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.
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Affiliation(s)
- Li-Ju Zong
- Department of Gynecology and Obstetrics, Qilu Hospital of Shandong University, Jinan, People's Republic of China E-mail
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Ghosh I, Mittal S, Banerjee D, Singh P, Dasgupta S, Chatterjee S, Biswas J, Panda C, Basu P. Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. Aust N Z J Obstet Gynaecol 2015; 54:570-5. [PMID: 25476810 DOI: 10.1111/ajo.12282] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This population-based study was conducted to evaluate the performance of colposcopy to assess women with positive visual inspection with acetic acid (VIA) and/or human papillomavirus (HPV) tests. MATERIALS AND METHODS A total of 30,773 women were screened by VIA and oncogenic HPV test. Hybrid capture 2 was used for oncogenic HPV detection. All VIA- and/or HPV-positive women and 8.7% test-negative women had the colposcopy. International Federation of Cervical Pathology & Colposcopy (IFCPC) 2011 nomenclature was used for colposcopic classification of abnormalities. All women with grade 1 or worse lesions had punch biopsies. Biopsies were also obtained from HPV-positive women with normal colposcopy. RESULTS Colposcopy and satisfactory biopsy reports were available for total 2466 women. The overall strength of agreement between colposcopy and histologic classification of cervical neoplasias was poor (kappa = 0.17). Agreement was better when colposcopy was performed on HPV-positive women compared to VIA-positive women. Sensitivity of colposcopy to detect high-grade squamous intraepithelial lesions (HSIL) at referral threshold of grade 1 abnormality was 84.8% after correction of verification bias. Colposcopy was most inaccurate in identifying non-neoplastic conditions often encountered in VIA- and/or HPV-positive women. In 68.8% women with normal histology, colposcopic impression was grade 1 and above. Overestimation of disease severity on colposcopy was more common in VIA-positive women. Colposcopy also underestimated severity of disease in 52.6% of women with HSIL diagnosis on biopsy. CONCLUSIONS Colposcopy performed well in the overall detection of cervical neoplasias, though its capability for accurate categorisation of degree of abnormality was poor.
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Affiliation(s)
- Ishita Ghosh
- Chittaranjan National Cancer Institute, Kolkata, India
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Accuracy of Colposcopically Directed Biopsy: Results from an Online Quality Assurance Programme for Colposcopy in a Population-Based Cervical Screening Setting in Italy. BIOMED RESEARCH INTERNATIONAL 2015; 2015:614035. [PMID: 26180805 PMCID: PMC4477187 DOI: 10.1155/2015/614035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the accuracy of colposcopically directed biopsy in an internet-based colposcopy quality assurance programme in northern Italy. METHODS A web application was made accessible on the website of the regional Administration. Fifty-nine colposcopists out of the registered 65 logged in, viewed a posted set of 50 digital colpophotographs, classified them for colposcopic impression and need for biopsy, and indicated the most appropriate site for biopsy with a left-button mouse click on the image. RESULTS Total biopsy failure rate, comprising both nonbiopsy and incorrect selection of biopsy site, was 0.20 in CIN1, 0.11 in CIN2, 0.09 in CIN3, and 0.02 in carcinoma. Errors in the selection of biopsy site were stable between 0.08 and 0.09 in the three grades of CIN while decreasing to 0.01 in carcinoma. In multivariate analysis, the risk of incorrect selection of biopsy site was 1.97 for CIN2, 2.52 for CIN3, and 0.29 for carcinoma versus CIN1. CONCLUSIONS Although total biopsy failure rate decreased regularly with increasing severity of histological diagnosis, the rate of incorrect selection of biopsy site was stable up to CIN3. In multivariate analysis, CIN2 and CIN3 had an independently increased risk of incorrect selection of biopsy site.
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An online quality assurance program for colposcopy in a population-based cervical screening setting in Italy: results on colposcopic impression. J Low Genit Tract Dis 2015; 18:309-13. [PMID: 24886869 DOI: 10.1097/lgt.0000000000000017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the results of an Internet-based colposcopy quality assurance program from a population-based cervical screening service in a large region of northern Italy. METHODS In 2010 to 2011, a Web application was made accessible on the Web site of the regional administration. Fifty-nine colposcopists of the registered 65 participated. They logged-in, viewed a posted set of 50 high-quality digital colpophotographs selected by an expert committee, and rated them for colposcopic impression using a 4-tier classification (Negative; abnormal, grade 1 [G1]; abnormal, grade 2 [G2]; suspected invasive cancer [Cancer]) derived from the International Federation for Cervical Pathology and Colposcopy 2002 classification. kappa (κ) coefficients for intercolposcopist agreement and colposcopist-committee agreement were calculated. RESULTS Colposcopist-committee agreement was greater than intercolposcopist agreement (overall κ 0.69 vs 0.60, p<.001). The κ values for colposcopist-committee agreement were 0.83 on Negative, 0.53 on G1, 0.66 on G2, and 0.80 on Cancer (all p values for pairwise comparisons<.001, except for Negative vs Cancer [p=.078]). There was no systematic tendency for colposcopists to underestimate or overestimate the colposcopic findings (2-tailed sign test, p=.13). Overall colposcopist-committee agreement was greater among patients 35 years or older (p<.001) and for colposcopists with previous quality assurance experiences (p<.01). Only 0.2% of Negative impressions were formulated for a cervical intraepithelial neoplasia grade 2 or worse. As a parallel finding, the impression of Cancer predicted cervical intraepithelial neoplasia grade 2 or less in 0.5% of cases. The histologic substrates of G1 were dispersed over a large spectrum. CONCLUSIONS The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.
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