Quality Assessment of Endoscopic Forceps Biopsy Samples under Magnifying Narrow Band Imaging for Histological Diagnosis of Cervical Intraepithelial Neoplasia: A Feasibility Study

The application of magnifying endoscopy in the diagnosis of cervical lesions

Objective

This study aimed to assess the sensitivity and specificity of magnifying endoscopy in the examination of patients with high-risk factors for cervical lesions.

Methods

Two equally skilled colposcopy specialists examined 59 patients admitted to the Obstetrics and Gynecology Hospital of Fudan University between March 14, 2023, and April 15, 2023. These patients underwent both colposcopy and magnifying endoscopy examinations. Preliminary diagnoses were then made by the two colposcopy specialists using colposcopy and magnifying endoscopy. The sensitivity and specificity of these methods were then evaluated compared to the postoperative pathology diagnosis for a better understanding of their efficacy.

Results

Colposcopy exhibited sensitivity rates of 23.08 % for diagnosing normal tissue, 10 % for low-grade squamous intraepithelial lesions (LSIL), 90 % for high-grade squamous intraepithelial lesions (HSIL), and 84.62 % for cervical cancer, with specificity rates of 93.94 %, 67.35 %, 71.43 %, and 100 %, respectively. In contrast, magnifying endoscopy demonstrated sensitivity rates of 42.31 %, 40 %, 90 %, and 92.31 % for normal tissue, LSIL, HSIL, and cervical cancer, respectively. The corresponding specificity rates for these categories were 87.88 %, 77.55 %, 83.67 %, and 100 %.

Conclusion

Magnifying endoscopy exhibits higher sensitivity and specificity compared to colposcopy in detecting cervical lesions. With the ability to magnify lesions up to 520 times, magnifying endoscopy facilitates precise visualization of cellular-level lesions, as well as associated anatomical features and vascular signals.

Pneumovaginoscopy-assisted radical hysterectomy for early-stage cervical cancer: a novel bidirectional approach for tumor spillage prevention and R0 resection

OBJECTIVE

This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach.

METHODS

This retrospective observational cohort study examined the operative outcomes and prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage.

RESULTS

Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3). The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO2 gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]). The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2-122) months, and no recurrence occurred.

CONCLUSION

PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy.

Flexible Magnifying Endoscopy with Narrow Band Imaging for Diagnosing Uterine Cervical Neoplasms: A Multicenter Prospective Study

We aimed to investigate the diagnostic ability of magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This was a multicenter prospective study. Eligible patients had positive Pap smear results or follow-up high-grade cytology or CIN3 diagnosed in referring hospitals. Patients underwent ME-NBI by a gastrointestinal endoscopist, followed by colposcopy by a gynecologist. One lesion with the worst finding was considered the main lesion. Punch biopsies were collected from all indicated areas and one normal area. The reference standard was the highest histological grade among all biopsy specimens. The primary endpoint was the detection rate of patients with CIN2+ in the main lesion. The secondary endpoints were diagnostic ability for CIN2+ lesions and patients’ acceptability. We enrolled 88 patients. The detection rate of ME-NBI for patients with CIN2+ was 79% (95% CI: 66–88%; p = 1.000), which was comparable to that of colposcopy (79%; p = 1.000). For diagnosing CIN2+ lesions, ME-NBI showed a better sensitivity than colposcopy (87% vs. 74%, respectively; p = 0.302) but a lower specificity (50% vs. 68%, respectively; p = 0.210). Patients graded ME-NBI as having significantly less discomfort and involving less embarrassment than colposcopy. ME-NBI did not show a higher detection ability than colposcopy for patients with CIN2+, whereas it did show a better patient acceptability.