Kaufmann Angelika, Founta Christina, Papagiannakis Emmanouil, Naik Raj, Fisher Ann
Northern Gynaecological Oncology Centre, Gateshead NHS Foundation Trust, Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK.
Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
Case Rep Obstet Gynecol. 2017;2017:5269279. doi: 10.1155/2017/5269279. Epub 2017 Dec 25.
Colposcopy is subjective and management of young patients with high-grade disease is challenging, as treatments may impair subsequent pregnancies and adversely affect obstetric outcomes. Conservative management of selected patients is becoming more popular amongst clinicians; however it requires accurate assessment and documentation. Novel adjunctive technologies for colposcopy could improve patient care and help individualize management decisions by introducing standardization, increasing sensitivity, and improving documentation.
A nulliparous 27-year-old woman planning pregnancy underwent colposcopy following high-grade cytology. The colposcopic impression was of low-grade changes, whilst the Dynamic Spectral Imaging (DSI) map of the cervix suggested potential high-grade. A DSI-directed biopsy confirmed CIN2. At follow-up, both colposcopy and DSI were suggestive of low-grade disease only, and image comparison confirmed the absence of previously present acetowhite epithelium areas. Histology of the transformation zone following excisional treatment, as per patient's choice, showed no high-grade changes.
Digital colposcopy with DSI mapping helps standardize colposcopic examinations, increase diagnostic accuracy, and monitor cervical changes over time, improving patient care. When used for longitudinal tracking of disease and when it confirms a negative colposcopy, it can help towards avoiding overtreatment and hence decrease morbidity related to cervical excision.
阴道镜检查具有主观性，对患有高级别疾病的年轻患者进行管理具有挑战性，因为治疗可能会损害后续妊娠并对产科结局产生不利影响。对部分患者进行保守治疗在临床医生中越来越普遍；然而，这需要准确的评估和记录。阴道镜检查的新型辅助技术可以通过引入标准化、提高敏感性和改善记录来改善患者护理，并有助于个性化管理决策。
一名计划怀孕的27岁未育女性在细胞学检查为高级别后接受了阴道镜检查。阴道镜检查印象为低级别改变，而宫颈动态光谱成像（DSI）图提示可能为高级别。DSI引导下的活检证实为CIN2。随访时，阴道镜检查和DSI均仅提示低级别疾病，图像对比证实先前存在的醋酸白上皮区域消失。根据患者选择，切除治疗后转化区的组织学检查显示无高级别改变。
带有DSI成像的数字阴道镜有助于标准化阴道镜检查、提高诊断准确性并随时间监测宫颈变化，从而改善患者护理。当用于疾病的纵向追踪并确认阴道镜检查结果为阴性时，它有助于避免过度治疗，从而降低与宫颈切除相关的发病率。
