Department of Obstetrics and Gynecology, Peking University, Shenzhen Hospital, 1120 Lianhua Rd, Futian Shenzhen, China.
Int J Gynecol Cancer. 2010 Apr;20(3):422-7. doi: 10.1111/IGC.0b013e3181d09fbb.
To determine the sensitivity and specificity of optical coherence tomography (OCT) as an adjunct to unaided visual inspection using acetic acid (VIA) in the detection of cervical intraepithelial neoplasia 2 (CIN 2) in a real-time clinical evaluation.
This clinical study was a prospective cross-sectional comparative trial that screened 1000 patients (aged 30-50 years) in a low-resource setting. Women with abnormal cervical cytology or positive human papillomavirus (HPV) tests were referred for further evaluation including VIA, OCT imaging, colposcopy, and cervical biopsies.
The VIA diagnoses were coded by quadrant. The OCT was then performed in all VIA-positive areas and at the squamocolumnar junction in all 4 quadrants. All patients were colposcoped; assessed by quadrant with biopsies at 2, 4, 8, and 10 o'clock; all abnormal areas were biopsied; and endocervical curettage was performed. Data were analyzed using generalized estimating equations and logistic regression.
Of the 1000 patients, 175 (17.5%) were HPV positive, 93 (9.3%) had abnormal cervical cytology greater than or equal to atypical squamous cells of undetermined significance, and 211 (21.1%) were either HPV positive or had abnormal cytology. The VIA, OCT, colposcopy, and biopsies were completed on 183 (86.7%) of 211 women. For VIA alone, the sensitivity and specificity in detecting lesions greater than or equal to CIN 2 was 43% and 96%. With the addition of OCT, the sensitivity increases to 62% with a specificity of 80%.
With the addition of OCT, the sensitivity of VIA increased in all analyses for the detection of greater than or equal to CIN II, with a loss in specificity. We hope that the potential of this technology will be realized when a computer algorithm is generated to aid in image interpretation.
在实时临床评估中，评估光学相干断层扫描（OCT）作为醋酸（VIA）辅助未受辅助视觉检查在检测宫颈上皮内瘤变 2（CIN 2）中的敏感性和特异性。
本临床研究是一项前瞻性横断面对比试验，在资源匮乏的环境中筛查了 1000 名（30-50 岁）患者。宫颈细胞学异常或人乳头瘤病毒（HPV）检测阳性的妇女被转介进行进一步评估，包括 VIA、OCT 成像、阴道镜检查和宫颈活检。
VIA 诊断按象限编码。然后在所有 VIA 阳性区域以及所有 4 个象限的鳞柱状交界处进行 OCT 检查。所有患者均进行阴道镜检查；按象限进行评估，在 2、4、8 和 10 点钟处进行活检；对所有异常区域进行活检；并进行宫颈搔刮术。使用广义估计方程和逻辑回归分析数据。
在 1000 名患者中，175 名（17.5%）HPV 阳性，93 名（9.3%）宫颈细胞学异常大于或等于非典型鳞状细胞意义不明确，211 名（21.1%）HPV 阳性或宫颈细胞学异常。183 名（86.7%）211 名妇女完成了 VIA、OCT、阴道镜检查和活检。单独使用 VIA，检测大于或等于 CIN 2 的病变的敏感性和特异性分别为 43%和 96%。随着 OCT 的加入，敏感性增加到 62%，特异性为 80%。
在所有分析中，随着 OCT 的加入，VIA 的敏感性增加了，用于检测大于或等于 CIN II 的病变，特异性降低。我们希望当生成用于辅助图像解释的计算机算法时，这项技术的潜力将得到实现。
