Royal Women's Hospital, Parkville, Vic., Australia.
BJOG. 2009 Nov;116(12):1663-70. doi: 10.1111/j.1471-0528.2009.02261.x. Epub 2009 Sep 14.
A high resolution optical imaging device may offer a clinically useful adjunct to colposcopy for the diagnosis and assessment of cervical precancer. This study describes the clinical evaluation of a miniaturised confocal endomicroscope for the quantitative and qualitative assessment of cervical intraepithelial neoplasia (CIN) in vivo.
A descriptive study (n = 25) was performed to assess the usability of confocal endomicroscopy to image the cervix. A prospective study (n = 15) then evaluated the diagnostic accuracy of the technique.
Patients undergoing colposcopy for treatment of CIN1-CIN3 were examined using confocal endomicroscopy.
A 5% solution of acetic acid was used to enhance the colposcopic features of the atypical region. Normal and abnormal regions of the cervix were then imaged following topical application of a fluorescent dye (acriflavine).
Confocal images were analysed to develop a scoring system to grade different levels of CIN. Microscopic features were correlated with histology from biopsy.
Confocal endomicroscopy enabled microscopic imaging of cellular and subcellular structures in vivo at colposcopy. Imaging at increasing depth showed morphological features including dermal papillae, endocervical glands and the squamo-columnar junction. CIN was characterised by an increase in nuclear density, size and cellular atypia. The sensitivity for detection of CIN was 97%. The specificity for predicting the grade of abnormality was 80% for normal-CIN1 and 93% for CIN2-CIN3.
Confocal endomicroscopy is a sensitive imaging tool for detection and assessment of CIN. The technique enables in vivo imaging of cervical histology and the potential for 'see-and-treat' workflows.
高分辨率光学成像设备可为阴道镜检查提供一种临床有用的辅助手段，用于诊断和评估宫颈前癌。本研究描述了一种微型共聚焦内窥镜在体内定量和定性评估宫颈上皮内瘤变（CIN）的临床评估。
进行了一项描述性研究（n=25），以评估共聚焦内窥镜成像宫颈的可用性。然后进行了一项前瞻性研究（n=15），评估该技术的诊断准确性。
接受阴道镜检查以治疗 CIN1-CIN3 的患者接受共聚焦内窥镜检查。
使用 5%的醋酸溶液增强异常区域的阴道镜特征。然后在宫颈表面涂抹荧光染料（吖啶黄素）后，对正常和异常区域进行成像。
共聚焦图像用于开发评分系统，以对不同级别的 CIN 进行分级。显微镜特征与活检的组织学相关。
共聚焦内窥镜使我们能够在阴道镜检查时对活体内的细胞和亚细胞结构进行微观成像。随着深度的增加，成像显示了形态特征，包括真皮乳头、宫颈内腺体和鳞柱状交界。CIN 的特征是核密度、大小和细胞异型性增加。检测 CIN 的灵敏度为 97%。对于正常-CIN1 和 CIN2-CIN3，预测异常程度的特异性分别为 80%和 93%。
共聚焦内窥镜是一种用于检测和评估 CIN 的敏感成像工具。该技术可实现宫颈组织学的体内成像，具有“看到即治疗”的工作流程的潜力。
