A pilot study of low-cost, high-resolution microendoscopy as a tool for identifying women with cervical precancer.
A pilot study of low-cost, high-resolution microendoscopy as a tool for identifying women with cervical precancer.
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DOI：
10.1158/1940-6207.capr-12-0221
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Richards-Kortum R
中科院分区：
文献类型：
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作者：
Pierce MC;Guan Y;Quinn MK;Zhang X;Zhang WH;Qiao YL;Castle P;Richards-Kortum R
宫颈癌仍然是发展中国家妇女死亡的主要原因之一。在没有资源支持巴氏涂片细胞学检查和阴道镜检查的情况下，使单次就诊的“检查和治疗”方案具有成本效益的方法有可能降低这种可预防疾病的发病率和死亡率。我们在中国山西省开展了一项试点临床研究，以评估一种低成本、高分辨率的显微内窥镜（HRME）成像系统，该系统能够评估体内上皮细胞的形态。除了乙酸目视检查（VIA）和阴道镜检查外，还在174名妇女的子宫颈上的离散部位获得了HRME图像。阴道镜检查69个异常部位中，病理显示高级别病变（CIN2+）的仅有12个。HRME量化核与细胞质的比例可以定义一个特定的阈值，正确地将所有12个位点分类为异常，同时将其余57个病理正常位点中的38个分类为正常。所有活检证实高度病变的患者也检测出高危HPV DNA阳性，并被HRME归类为异常。在其余经阴道镜检查HPV阳性但病理上正常或< CIN2的患者中，只有6/32（18.8%）被HRME分类为异常。宫颈癌筛查的目视检查技术可能会高估癌前病变的患病率，导致不必要的治疗、费用和患者压力。本研究的结果表明，HRME对可疑病变的评估可能有助于排除立即冷冻治疗，从而提高当前观察和治疗方案的效率。
Cervical cancer remains one of the leading causes of death among women in developing countries. Without resources to support Pap smear cytology and colposcopy, cost-effective approaches which enable single-visit “see-and-treat” protocols offer the potential to reduce morbidity and mortality due to this preventable disease. We carried out a pilot clinical study in Shanxi province, China, to evaluate a low-cost, high-resolution microendoscope (HRME) imaging system which enables evaluation of epithelial cell morphology in vivo. HRME images were obtained at discrete sites on the cervix in 174 women, in addition to visual inspection with acetic acid (VIA), and colposcopic examination. Out of 69 sites appearing abnormal on colposcopy, only 12 showed high-grade disease (CIN2+) on pathology. Quantification of the nuclear-to-cytoplasm ratio by HRME enabled an ad hoc threshold to be defined, which correctly classified all 12 sites as abnormal, whilst classifying 38 of the remaining 57 pathology normal sites as normal. All patients with biopsy confirmed high-grade disease also tested positive for high-risk HPV DNA, and were classified as abnormal by HRME. Among the remaining patients who tested positive for HPV but were either normal by colposcopy or showed < CIN2 on pathology, only 6/32 (18.8%) were classified as abnormal by HRME. Visual examination techniques for cervical cancer screening may overestimate the prevalence of precancerous lesions, leading to unnecessary treatment, expense, and patient stress. The results of this study suggest that evaluation of suspicious lesions by HRME may assist in ruling out immediate cryotherapy, thus increasing the efficiency of current see-and-treat programs.