Can the dynamic spectral imaging (DSI) color map improve colposcopy examination for precancerous cervical lesions? A prospective evaluation of the DSI color map in a multi-biopsy clinical setting

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Background: Colposcopy serves as a subjective examination of the cervix with low sensitivity to detect cervical intraepithelial dysplasia (CIN) grade 2 or worse (CIN2 +). Dynamic spectral imaging (DSI) colposcopy has been developed to provide an objective element to cervix examinations and has been proven to increase sensitivity of detecting CIN2 +. We aimed to assess the performance of the DSI color map and compared it to histological diagnoses of cervical biopsies in determining the CIN grade present. Methods: Women were included in a consecutive, prospective manner at Randers Regional Hospital, Denmark. Women were eligible to participate if they were referred for colposcopy due to abnormal cervical smear (threshold: ≥ ASCUS) or follow-up after previously diagnosed CIN. All women had four biopsies taken, one directed by colposcopists alone prior to viewing the DSI color map, one directed by the worst color on the respective DSI color map, and two additional biopsies. All biopsies were analyzed separately. We calculated sensitivity, specificity, positive predictive values, and negative predictive values (NPVs) with 95% confidence intervals (CIs). Results: A total of 800 women were recruited. Of these, 529 (66.1%) were eligible for inclusion. The sensitivity of the DSI color map was found to be 48.1% (95% CI 41.1–55.1) in finding CIN grade 2 or worse (CIN2 +) when compared to the histological diagnosis of the DSI directed biopsy. This was 42.5% (95% CI 36.7–48.5) when compared to the final histological diagnosis of all four cervical biopsies and with an NPV of 53.5% (95% CI 50.5–56.5). Conclusion: The worst color indicated by the DSI map might not consistently reflect the true grade of cervical dysplasia present. Thus, even though the DSI color map indicates low-grade changes, colposcopists should still consider taking biopsies from the area as high-grade changes might be present. Trial registration: NCT04249856, January 31 2020 (retrospectively registered).

TidsskriftBMC Women's Health
StatusUdgivet - jan. 2021

Bibliografisk note

Funding Information:
The study was supported by the following: Provided salary: Aarhus University. Health Research Foundation of Central Denmark Region. Provided funds to purchase DYSIS disposable specula: Toyota-Fonden, Denmark. Provided funds for operational costs: Danish Doctors Association (lægeforeningen). Fabrikant Einar Willumsens Mindelegat. Direktør Emil C. Hertz og Hustru Inger Hertz' Fond. Eva og Henry Frænkels Mindefond. Ingeniør August Frederik Wedell Erichsens legat. Thora og Viggo Groves Mindelegat. Dagmar Marshalls Fond. Alice og Torben Frimodt Fond. AP Møller Fonden til Lægevidenskabens Fremme. Randers Regional Hospital. Provided funds for the American Society for Colposcopy and Cervical Pathology(ASCCP) comprehensive colposcopy course: Harboefonden. No sponsors had any role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.

Publisher Copyright:
© 2021, The Author(s).

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