Cervical cytologic abnormalities and negative colposcopy: histologic assessment

Detection of cervical lesions by multivariate analysis of diffuse reflectance spectra: a clinical study

Diffuse reflectance (DR) spectroscopy is a non-invasive, real-time, and cost-effective tool for early detection of malignant changes in squamous epithelial tissues. The present study aims to evaluate the diagnostic power of diffuse reflectance spectroscopy for non-invasive discrimination of cervical lesions in vivo. A clinical trial was carried out on 48 sites in 34 patients by recording DR spectra using a point-monitoring device with white light illumination. The acquired data were analyzed and classified using multivariate statistical analysis based on principal component analysis (PCA) and linear discriminant analysis (LDA). Diagnostic accuracies were validated using random number generators. The receiver operating characteristic (ROC) curves were plotted for evaluating the discriminating power of the proposed statistical technique. An algorithm was developed and used to classify non-diseased (normal) from diseased sites (abnormal) with a sensitivity of 72 % and specificity of 87 %. While low-grade squamous intraepithelial lesion (LSIL) could be discriminated from normal with a sensitivity of 56 % and specificity of 80 %, and high-grade squamous intraepithelial lesion (HSIL) from normal with a sensitivity of 89 % and specificity of 97 %, LSIL could be discriminated from HSIL with 100 % sensitivity and specificity. The areas under the ROC curves were 0.993 (95 % confidence interval (CI) 0.0 to 1) and 1 (95 % CI 1) for the discrimination of HSIL from normal and HSIL from LSIL, respectively. The results of the study show that DR spectroscopy could be used along with multivariate analytical techniques as a non-invasive technique to monitor cervical disease status in real time.

Increased detection of high-grade cervical intraepithelial neoplasia utilizing an optical detection system as an adjunct to colposcopy

OBJECTIVE

To evaluate the impact of using a novel optical detection system (ODS) as an adjunct to colposcopy.

METHODS

A multicenter internally controlled trial designed to evaluate the performance of an ODS system (LUMA MediSpectra, Lexington, MA) used as an adjunct to colposcopy among women referred for the evaluation of an abnormal cervical cytology result was conducted at 7 colposcopy clinics in the United States and enrolled 227 women. After exclusions, 193 women remained in the analysis. The main study outcomes were incremental increases in true positives (CIN 2,3 and cancer, or CIN 2+) and false positives (women with additional cervical biopsies not found to be CIN 2+).

RESULTS

Initial colposcopy identified 41 cases of CIN 2+ for a true positive (TP) rate of 21.2%. Adjunctive use of ODS identified an additional 9 cases of CIN 2+ which corresponds to an incremental ODS TP rate of 4.7% (95% CI 2.2% to 8.7%). Adjunctive use of ODS therefore resulted in a 22.0% (95% CI 6.1% to 37.8%) relative gain in the number of women with CIN 2+ compared to colposcopy alone. The false positive (FP) rate for initial colposcopy was 51.8% (100 of 193 women). An additional 35 subjects had an ODS-directed biopsy that was not diagnosed as CIN 2+, yielding an incremental FP rate of 18.1% (95% CI 13.0% to 24.3%).

CONCLUSIONS

Adjunctive use of ODS with colposcopy provides a significant increase in the detection of CIN 2+ in women referred for the evaluation of abnormal cytology results.

Effective cervical neoplasia detection with a novel optical detection system: A randomized trial

OBJECTIVE

To assess whether the use of a novel optical detection system (ODS) as an adjunct to colposcopy increases the detection of biopsy-confirmed CIN 2,3.

METHODS

This is a multicenter two-arm randomized trial comparing colposcopy alone with colposcopy plus a pre-commercial ODS system that utilizes fluorescence, white light tissue reflectance, and cervical video imaging. Patients were recruited from 13 colposcopy clinics in a variety of practice settings. 2299 women referred for the evaluation of an abnormal cervical cytology were randomized with stratification by cytology; subsequently 113 women were excluded for a variety of reasons. The main study outcomes were differences in true-positive rates (CIN 2,3 and cancer identified) and false-positive rates between the study arms.

RESULTS

The true-positive (TP) rates were 14.4% vs. 11.4% (p=0.035, one-sided) for the combined colposcopy and ODS arm compared to colposcopy-only arm, respectively, in women with either an atypical squamous cell (ASC) or low-grade squamous intraepithelial lesion (LSIL) cytology result. TP rates were similar between the two arms among women referred for the evaluation of HSIL. The 26.5% gain in true-positives observed with the use of ODS and colposcopy among women referred for an ASC or LSIL cytology was achieved with only a fractional increase in number of biopsies obtained per patient (0.30) and a modest increase in false-positive rate (4%). In the combined colposcopy and ODS arm among women with ASC or LSIL, the PPV of biopsies indicated by ODS was 15.0% and the PPV of biopsies indicated by colposcopy was 15.2%. Joint hypothesis testing indicates that ODS and colposcopy provides benefit compared to colposcopy alone among women with ASC or LSIL.

CONCLUSIONS

Combining ODS with colposcopy provides a clinically meaningful increase in the detection of CIN 2,3 in women referred for the evaluation of mildly abnormal cytology results.

Dense acetowhite: a high grade lesion?

To describe the ability of colposcopy in predicting the high grade squamous intraepithelial lesion (SIL) a retrospective, descriptive study was undertaken from January 1, 1993 until November 30, 1995. Agreement between colposcopy and histology results was described in unweighted Kappa. Agreement between colposcopy diagnosis and histology results taken from the dense acetowhitening areas was poor (Kappa 0.5). This agreement will be higher in areas of acetowhite that has an abrupt peeling margin in 72/74 cases. It seems that dense acetowhite areas showed high grade lesions in most of cases observed especially if they had also abrupt peeling margin.