Department of Biomedical Engineering, Duke University, Durham, NC, USA.
Duke Global Health Institute, Duke University, Durham, NC, USA.
BJOG. 2018 Sep;125(10):1321-1329. doi: 10.1111/1471-0528.15326. Epub 2018 Jul 18.
Our goal was to develop a tele-colposcopy platform for primary-care clinics to improve screening sensitivity and access. Specifically, we developed a low-cost, portable Pocket colposcope and evaluated its performance in a tertiary healthcare centre in Peru.
Images of the cervix were captured with a standard-of-care and Pocket colposcope at la Liga Contra el Cáncer in Lima, Peru.
Two hundred Peruvian women with abnormal cytology and/or human papillomavirus positivity were enrolled.
Images were collected using acetic acid and Lugol's iodine as contrast agents. Biopsies were taken as per standard-of-care procedures.
After passing quality review, images from 129 women were sent to four physicians who provided a diagnosis for each image.
Physician interpretation of images from the two colposcopes agreed 83.1% of the time. The average sensitivity and specificity of physician interpretation compared with pathology was similar for the Pocket (sensitivity = 71.2%, specificity = 57.5%) and standard-of-care (sensitivity = 79.8%, specificity = 56.6%) colposcopes. When compared with a previous study where only acetic acid was applied to the cervix, results indicated that adding Lugol's iodine as a secondary contrast agent improved the percent agreement between colposcopes for all pathological categories by up to 8.9% and the sensitivity and specificity of physician interpretation compared with pathology by over 6.0 and 9.0%, respectively.
The Pocket colposcope performance was similar to that of a standard-of-care colposcope when used to identify precancerous and cancerous lesions using acetic acid and Lugol's iodine during colposcopy examinations in Peru.
The Pocket colposcope performance was similar to that of a standard-of-care colposcope when identifying cervical lesions.
我们旨在开发一种远程阴道镜平台，以提高初级保健诊所的筛查敏感性和可及性。具体而言，我们开发了一种低成本、便携式的 Pocket 阴道镜，并在秘鲁的一家三级保健中心对其性能进行了评估。
在秘鲁利马的 la Liga Contra el Cáncer，使用标准护理和 Pocket 阴道镜拍摄宫颈图像。
共有 200 名患有细胞学异常和/或人乳头瘤病毒阳性的秘鲁女性入组。
使用醋酸和卢戈氏碘作为对比剂采集图像。根据标准护理程序进行活检。
通过质量审查后，将 129 名女性的图像发送给四位医生，每位医生为每张图像提供诊断。
两位医生对两种阴道镜图像的解释有 83.1%的时间是一致的。与病理结果相比，Pocket（敏感性=71.2%，特异性=57.5%）和标准护理（敏感性=79.8%，特异性=56.6%）阴道镜的医生解释的平均敏感性和特异性相似。与仅在宫颈上应用醋酸的先前研究相比，结果表明，添加卢戈氏碘作为二级对比剂，可使所有病理类别中阴道镜之间的百分比一致性提高 8.9%，并使医生解释与病理相比的敏感性和特异性分别提高 6.0%和 9.0%。
在秘鲁，使用 Pocket 阴道镜和醋酸、卢戈氏碘联合进行阴道镜检查时，Pocket 阴道镜的性能与标准护理阴道镜相似，可用于识别癌前病变和癌症病变。
在识别宫颈病变时，Pocket 阴道镜的性能与标准护理阴道镜相似。
