A real time optoelectronic device as an adjunct to the Pap smear for cervical screening: A multicenter evaluation

Clinical evaluation of a real-time optoelectronic device in cervical cancer screening

OBJECTIVE

Early screening and intervention are crucial for the prevention and treatment of cervical cancer. TruScreen is a real-time, intelligent, pathological diagnostic technology designed for cervical cancer screening. The aim of this study was to evaluate the clinical value of TruScreen in screening for cervical lesions.

STUDY DESIGN

A total of 458 women aged between 25 and 65 years were recruited to receive cervical cancer screening, including human papillomavirus (HPV) testing, cytological testing using the ThinPrep cytology test (TCT), and TruScreen from December 2018 to January 2020. The clinical performance of TruScreen, alone and in combination with HPV testing, was evaluated to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+ or CIN3+).

RESULTS

For detection of CIN2+, the sensitivity and specificity of TruScreen were 83.78% and 78.86%, respectively. The specificity of TruScreen was significantly higher than those of HPV testing (50.59%, P < 0.001) and TCT (55.58%, P < 0.001). In high-risk HPV-positive women, the specificity of HPV testing combined with TruScreen was significantly higher than that of HPV testing combined with TCT (50% vs 39.9%, P = 0.004). The sensitivity of HPV testing combined with TruScreen was comparable to that of HPV testing combined with TCT (93.94% vs 87.88%, P = 0.625). Similar patterns were also observed for CIN3+ cases.

CONCLUSION

TruScreen has the potential for screening high-grade cervical precancerous lesions and may replace cytological tests as a cervical cancer screening method in China to avoid subjectivity in the interpretation of cytological tests and requirements by pathologists.

Evaluation of a real-time optoelectronic method in the diagnostics of CIN over four years of observations

Cervical cancer is considered to be particularly amenable to prevention and highly treatable in its early stages. The real-time optoelectronic method of cervix examination seemed to be very promising in the detection of cervical squamous intraepithelial lesions and demonstrated relatively good efficacy. Although this method was introduced into clinics almost 10 years ago, it has not found its place in diagnostic schemes. At the moment, cytological smears and HPV detection with genotyping are still essential. TruScreen seems to be a slightly forgotten test. The aim of the study was to evaluate the efficacy and accuracy of TruScreen in detecting cervical pathology: CIN and cervical cancer confirmed with a histopathological diagnosis in comparison with other methods–cytology and colposcopy over four years of observations. The study was conducted on 130 women with abnormal Pap smear results. We can conclude that a real-time optoelectronic method like TruScreen can be useful as an effective initial cervical cancer screening in developing countries, possibly in combination with other methods. The combination of cytology and TruScreen examination may help clinicians to take decision about the next diagnostics steps (e.g. colposcopy) and contribute to better primary screening for cervical cancer.

The advent of human papillomavirus detection for cervical screening

PURPOSE OF REVIEW

This review updates progress in the human papillomavirus (HPV)-based revolution in cervical screening and vaccination predicted to eventually eliminate cervical cancer.

RECENT FINDINGS

HPV PCR, patented by the author in 1987, has recently begun to replace cytology for primary cervical screening. I highlight the findings from large randomized clinical trials that have brought about this change, and progress with implementation. Australia was the first to introduce a national, publicly-funded HPV PCR-based program of primary screening, on 1 December 2017. The United Kingdom is set to follow, as are other countries. The widespread preference of self-sampling by under-screened women in particular will increase the effectiveness of population screening when using HPV tests. Coupled with improved vaccination now that more effective (nonavalent) HPV vaccines are being introduced, recent modeling predicts that cervical cancer will be markedly reduced, or even eliminated, in coming decades.

SUMMARY

The recent or pending change to more accurate cervical screening by HPV detection using PCR in various countries means less frequent screening for women. Women with an aversion to having their sample collected by a physician can collect their sample themselves, either at the doctor's rooms or at home, the sample then being mailed to the testing laboratory.

The diagnostic accuracy of a real-time optoelectronic device in cervical cancer screening: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

This study aimed to assess the diagnostic accuracy of a real-time optoelectronic device (TruScreen) for uterine cervical cancer screening.

METHODS

On the basis of Preferred Reporting Items for Systematic Reviews and Meta-analyses (the PRISMA statement) we performed this systematic review and meta-analysis. We searched PubMed, EMBASE, the Cochrane Library, CNKI, CBM, and WanFang Data using medical subject headings (MeSH) and text words. Title/abstract screening, full text check, data extraction, and methodological quality assessment (with the QUADAS-2 tool) were performed by 2 reviewers independently. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), the summary receiver operator characteristic curve, and the area under the curve (AUC) were analyzed with Meta-DiSc software. Statistical heterogeneity was evaluated by Cochran's Q test and I, meta-regression was conducted based on patient type, and the possibility of publication bias was evaluated using Deeks funnel plot in Stata software.

RESULTS

Of 293 publications, nine met our inclusion criteria. These studies included a total of 2730 patients and 567 cervical intraepithelial neoplasias. The pooled test characteristics for the TruScreen were as follows: sensitivity 76% (95% CI, 73-80%), specificity 69% (95% CI, 67%-71%), PLR 2.30 (95% CI, 1.59-3.33), and NLR 0.34 (95% CI, 0.23-0.51). The corresponding pooled DOR was 7.03 (95% CI, 3.40-14.55). The AUC was 0.7859 (Q = 0.7236).

CONCLUSION

The diagnostic accuracy of the TruScreen device is moderately good. The study findings are based on Chinese studies only and could not be generalized to other populations.

Advances in the imaging and detection of cervical intra-epithelial neoplasia

Screening for preinvasive disease of the cervix, and detecting and mapping the lesions for treatment, are fundamental to programs for the prevention of cervical cancer. These will become even more important in women vaccinated against humanpapilloma viruses 16 and 18. Biophysical imaging technologies have considerable potential advantages in both screening for and mapping the lesions. This review describes the technologies that seem to have the greatest promise.