Roblyer Darren, Richards-Kortum Rebecca, Park Sun-Young, Adewole Isaac, Follen Michele
Department of Bioengineering, Rice University, 6100 Main St. Houston, TX 77251-1892, USA.
Gynecol Oncol. 2007 Oct;107(1 Suppl 1):S94-7. doi: 10.1016/j.ygyno.2007.07.042. Epub 2007 Sep 6.
In developed countries, cervical cancer screening programs have been highly successful. In the United States a 70% decrease in the mortality of cervical cancer has occurred since the 1960's largely due to the Papanicolaou test. However, it is not clear how best to translate these advances to developing countries, where cervical cancer remains the leading cause of cancer death for woman. Cytology-based screening, followed by colposcopic detection is expensive and requires extensive laboratory infrastructure and trained personnel, which are often unavailable in low resource settings. Techniques such as visual inspection with acetic acid (VIA) and visual inspection with Lugol's Iodine (VILI) are less expensive and require minimal supplies and infrastructure; however there are concerns that these approaches do not have adequate specificity without extensive provider training and experience. Objective cervical cancer screening techniques which are easy to interpret, provide rapid results, and have both high sensitivity and specificity would be highly beneficial in developing countries. We have developed a multispectral digital colposcope (MDC) which is designed to rapidly image the cervix and is used with automated image analysis algorithms that provide objective delineation of neoplastic areas. In this paper we describe an effort to implement this device in Ibadan, Nigeria, to determine the feasibility of conducting clinical trials using the MDC as an experimental screening device. Our aim was to test the device in a location where it might be most beneficial and to collect data useful for developing new, low-cost, low-maintenance devices. Multiple obstacles limited the success of imaging using the MDC in Nigeria including an unstable supply of electricity and a lack of available spare parts and tools. We conclude that these obstacles must be overcome by robust and simple device designs in order to successfully test an imaging-based screening device in Nigeria or other developing countries.
在发达国家，宫颈癌筛查项目取得了巨大成功。在美国，自20世纪60年代以来，宫颈癌死亡率下降了70%，这主要归功于巴氏涂片检查。然而，目前尚不清楚如何将这些进展最佳地应用于发展中国家，在这些国家，宫颈癌仍是女性癌症死亡的主要原因。基于细胞学的筛查，随后进行阴道镜检测成本高昂，需要广泛的实验室基础设施和训练有素的人员，而在资源匮乏地区往往无法满足这些条件。诸如醋酸目视检查（VIA）和卢戈氏碘液目视检查（VILI）等技术成本较低，所需耗材和基础设施最少；然而，有人担心在没有广泛的提供者培训和经验的情况下，这些方法的特异性不足。客观的宫颈癌筛查技术易于解读、能快速得出结果，且具有高灵敏度和特异性，这将对发展中国家非常有益。我们开发了一种多光谱数字阴道镜（MDC），其设计目的是快速对宫颈进行成像，并与自动图像分析算法配合使用，以客观描绘肿瘤区域。在本文中，我们描述了在尼日利亚伊巴丹实施该设备的努力，以确定将MDC作为实验性筛查设备进行临床试验的可行性。我们的目标是在一个可能最有益的地点测试该设备，并收集有助于开发新型低成本、低维护设备的数据。在尼日利亚，使用MDC进行成像面临多重障碍，包括电力供应不稳定以及缺乏可用的备件和工具。我们得出结论，必须通过坚固且简单的设备设计来克服这些障碍，以便在尼日利亚或其他发展中国家成功测试基于成像的筛查设备。
