Abstract
Purpose
Cervical cancer is still one of the main causes of death in females. Conventional diagnostic tools such as colposcopy are still unsatisfactory, so accurate diagnostic tools for cervical diseases are needed. Therefore, the purpose of this study was to perform a clinical study to evaluate the value of microendoscopic imaging systems in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma (MIC).
Methods
Totally 106 patients ranging in age from 23 to 67 years were recruited. All patients had abnormal thin-layer cytology (TCT) results (≥ low-grade squamous intraepithelial lesions) and high-risk human papillomavirus (HPV) positivity. Each patient was first subjected to ordinary colposcopy, followed by microendoscopy and biopsy. All results of the colposcopy and microendoscopy images were compared to the histopathological diagnosis.
Results
Characteristics of pathological blood vessels were easily distinguished by microendoscopy compared with ordinary colposcopy. The diagnostic agreement rate of microendoscopy with the pathological diagnosis was higher (95.3%) than that of ordinary colposcopy (37.7%) (weighted kappa = 0.863, P < .01). When diagnosing HSIL and more advanced disease, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the microendoscopic diagnosis were significantly higher than those of ordinary colposcopy (97.6 and 38.1%), (95.5 and 63.6%), (98.8 and 80.0%), (91.3 and 21.2%) and (97.7 and 43.4%), respectively.
Conclusion
This study shows that microendoscopy has important value in the diagnosis of cervical lesions which can provide real-time diagnosis in vivo without staining, particularly for lesions that are not sensitive to acetic acid staining.
Similar content being viewed by others
References
Jiang X, Tang H, Chen T (2018) Epidemiology of gynecologic cancers in China. J Gynecol Oncol 29(1):e7
Wanqing C, Rongshou Z, Siwei Z, Ping Z, Guanglin L, Lingyou W, Jie H (2009) Report of incidence and mortality in China cancer registries. Chin J Cancer Res 24(3):171–180
Chen WQ, Zheng RS, Zhang SW, Li N, Zhao P, Li GL, Wu LY, He J (2008) Report of incidence and mortality in china cancer registries. Chin J Cancer Res 24(3):171–180. https://doi.org/10.1007/s11670-012-0171-2
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424
Sankaranarayanan R, Nessa A, Esmy PO, Dangou J-M (2012) Visual inspection methods for cervical cancer prevention. Best Pract Res Clin Obstet Gynaecol 26(2):221–232
Sankaranarayanan R, Esmy PO, Rajkumar R, Muwonge R, Swaminathan R, Shanthakumari S, Fayette JM, Cherian J (2007) Effect of visual screening on cervical cancer incidence and mortality in Tamil Nadu, India: a cluster-randomised trial. The Lancet 370(9585):398–406
Sarian L, Derchain S, Naud P, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Eržen M, Serpa-Hammes L, Matos J (2005) Evaluation of visual inspection with acetic acid (VIA), Lugol's iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America: this report refers to partial results from the LAMS (Latin AMerican Screening) study. J Med Screen 12(3):142–149
Zeng X, Zhang X, Li C, Wang X, Jerwick J, Xu T, Ning Y, Wang Y, Zhang L, Zhang Z (2018) Ultrahigh-resolution optical coherence microscopy accurately classifies precancerous and cancerous human cervix free of labeling. Theranostics 8(11):3099
Liu Z, Belinson SE, Li J, Yang B, Wulan N, Tresser NJ, Wang C, Mohr M, Zhang L, Zhou Y (2010) Diagnostic efficacy of real-time optical coherence tomography in the management of preinvasive and invasive neoplasia of the uterine cervix. Int J Gynecol Cancer 20(2):283–287
Jacob B, James B, Peter BS, Frank G, Hope H, Michael M, Myriam P, Walter P, Peter R, Mario S (2012) 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 120(1):166–172
Uchita K, Kanenishi K, Hirano K, Kobara H, Nishiyama N, Kawada A, Fujihara S, Ibuki E, Haba R, Takahashi Y (2018) Characteristic findings of high-grade cervical intraepithelial neoplasia or more on magnifying endoscopy with narrow band imaging. Int J Clin Oncol 23(4):707–714
Quinn MK, Bubi TC, Pierce MC, Kayembe MK, Ramogola-Masire D, Richards-Kortum R (2012) High-resolution microendoscopy for the detection of cervical neoplasia in low-resource settings. PloS one 7(9):e44924
Nishiyama N, Kanenishi K, Mori H, Kobara H, Fujihara S, Chiyo T, Kobayashi N, Matsunaga T, Ayaki M, Yachida T (2017) Flexible magnifying endoscopy with narrow band imaging for the diagnosis of uterine cervical tumors: a cooperative study among gastrointestinal endoscopists and gynecologists to explore a novel microvascular classification system. Oncol Lett 14(1):355–362
Arbyn M, Sankaranarayanan R, Muwonge R, Keita N, Dolo A, Mbalawa CG, Nouhou H, Sakande B, Wesley R, Somanathan T, Sharma A, Shastri S, Basu P (2008) Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer 123(1):153–160. https://doi.org/10.1002/ijc.23489
Sankaranarayanan R, Basu P, Wesley RS, Mahe C, Keita N, Mbalawa CC, Sharma R, Dolo A, Shastri SS, Nacoulma M, Nayama M, Somanathan T, Lucas E, Muwonge R, Frappart L, Parkin DM (2004) Accuracy of visual screening for cervical neoplasia: results from an IARC multicentre study in India and Africa. Int J Cancer 110(6):907–913. https://doi.org/10.1002/ijc.20190
Sankaranarayanan R, Shastri SS, Basu P, Mahé C, Mandal R, Amin G, Roy C, Muwonge R, Goswami S, Das P (2004) The role of low-level magnification in visual inspection with acetic acid for the early detection of cervical neoplasia. Cancer Detect Prev 28(5):345–351
Sankaranarayanan R, Thara S, Sharma A, Roy C, Shastri S, Mahe C, Muwonge R, Fontaniere B, Multicentre Study Group on Cervical Cancer Early Detection in I (2004) Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen 11(2):77–84. https://doi.org/10.1258/096914104774061056
Sankaranarayanan R, Wesley R, Thara S, Dhakad N, Chandralekha B, Sebastian P, Chithrathara K, Parkin DM, Nair MK (2003) Test characteristics of visual inspection with 4% acetic acid (VIA) and Lugol's iodine (VILI) in cervical cancer screening in Kerala India. Int J Cancer 106(3):404–408. https://doi.org/10.1002/ijc.11245
Sankaranarayanan R, Wesley RS (2003) A practical manual on visual screening for cervical neoplasia, vol 41. Diamond Pocket Books (P) Ltd, New Delhi
Funding
This work was supported by National Natural Science Foundation of China (Grant NO. 81771529), Shanghai Science and Technology Development Foundation (Grant NO. 17441902500), Shanghai Hospital Development Center Foundation (Grant NO. 16CR3089B), Fundamental Research Funds for the Central Universities (Grant NO. 22120190241 and 22120190214), National Natural Science Foundation of China (Grant NO. 81974414).
Author information
Authors and Affiliations
Contributions
JG: study design, data collection, data analysis, writing.; LF: study design, data analysis, Writing; JZ and LL: microendoscopy diagnosis; QZ, ML and YR: clinical data collection; HL and JX: colposcopy diagnosis; NL and HW: microendoscopy research and development; HZ: the design of the study, the implementation of clinical treatment, article guidance and modification, statistical guidance and modification, Pathological diagnosis; ZH: the design of the study, the implementation of clinical treatment, article guidance and modification, statistical guidance and modification, Colposcopy diagnosis, Microendoscopy diagnosis; FL: the design of the study, the implementation of clinical treatment, article guidance and modification, statistical guidance and modification, Colposcopy diagnosis, Microendoscopy diagnosis.
Corresponding authors
Ethics declarations
Conflict of interest
Junhan Guo, Le Fu, Junwei Zhao, Lei Lei, Qin Zhan, Min Liu,Yetian Ruan, Hui Li, Jin Xu, Huiting Zhu, Zhiqiang Han and Fang Li have no conflicts of interest or financial ties to disclose.
Ethical approval
This study was approved by the the Ethics Committee of the Affiliated Hospital of Tongji University with protocol number KS1690, registered into the ClinicalTrials.gov registry with ID NCT02955667.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Guo, J., Fu, L., Zhao, J. et al. The value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma. Arch Gynecol Obstet 302, 455–462 (2020). https://doi.org/10.1007/s00404-020-05565-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-020-05565-8