Berit Bargum Booth1,2,3, Lone Kjeld Petersen4,5, Jan Blaakaer4,6, Tonje Johansen7, Henrik Mertz7, Katja Dahl8, Pinar Bor9,10. 1. Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark. berit.booth@auh.rm.dk. 2. Department of Gynecology and Obstetrics, Randers Regional Hospital, Skovlyvej 15, 8390, Randers, Denmark. berit.booth@auh.rm.dk. 3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. berit.booth@auh.rm.dk. 4. Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark. 5. OPEN Open Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark. 6. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 7. Department of Pathology, Randers Regional Hospital, Randers, Denmark. 8. Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark. 9. Department of Gynecology and Obstetrics, Randers Regional Hospital, Skovlyvej 15, 8390, Randers, Denmark. 10. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Abstract
BACKGROUND: Colposcopy serves as a subjective examination of the cervix with low sensitivity to detect cervical intraepithelial dysplasia (CIN) grade 2 or worse (CIN2 +). Dynamic spectral imaging (DSI) colposcopy has been developed to provide an objective element to cervix examinations and has been proven to increase sensitivity of detecting CIN2 + . We aimed to assess the performance of the DSI color map and compared it to histological diagnoses of cervical biopsies in determining the CIN grade present. METHODS: Women were included in a consecutive, prospective manner at Randers Regional Hospital, Denmark. Women were eligible to participate if they were referred for colposcopy due to abnormal cervical smear (threshold: ≥ ASCUS) or follow-up after previously diagnosed CIN. All women had four biopsies taken, one directed by colposcopists alone prior to viewing the DSI color map, one directed by the worst color on the respective DSI color map, and two additional biopsies. All biopsies were analyzed separately. We calculated sensitivity, specificity, positive predictive values, and negative predictive values (NPVs) with 95% confidence intervals (CIs). RESULTS: A total of 800 women were recruited. Of these, 529 (66.1%) were eligible for inclusion. The sensitivity of the DSI color map was found to be 48.1% (95% CI 41.1-55.1) in finding CIN grade 2 or worse (CIN2 +) when compared to the histological diagnosis of the DSI directed biopsy. This was 42.5% (95% CI 36.7-48.5) when compared to the final histological diagnosis of all four cervical biopsies and with an NPV of 53.5% (95% CI 50.5-56.5). CONCLUSION: The worst color indicated by the DSI map might not consistently reflect the true grade of cervical dysplasia present. Thus, even though the DSI color map indicates low-grade changes, colposcopists should still consider taking biopsies from the area as high-grade changes might be present. TRIAL REGISTRATION: NCT04249856, January 31 2020 (retrospectively registered).
BACKGROUND: Colposcopy serves as a subjective examination of the cervix with low sensitivity to detect cervical intraepithelial dysplasia (CIN) grade 2 or worse (CIN2 +). Dynamic spectral imaging (DSI) colposcopy has been developed to provide an objective element to cervix examinations and has been proven to increase sensitivity of detecting CIN2 + . We aimed to assess the performance of the DSI color map and compared it to histological diagnoses of cervical biopsies in determining the CIN grade present. METHODS:Women were included in a consecutive, prospective manner at Randers Regional Hospital, Denmark. Women were eligible to participate if they were referred for colposcopy due to abnormal cervical smear (threshold: ≥ ASCUS) or follow-up after previously diagnosed CIN. All women had four biopsies taken, one directed by colposcopists alone prior to viewing the DSI color map, one directed by the worst color on the respective DSI color map, and two additional biopsies. All biopsies were analyzed separately. We calculated sensitivity, specificity, positive predictive values, and negative predictive values (NPVs) with 95% confidence intervals (CIs). RESULTS: A total of 800 women were recruited. Of these, 529 (66.1%) were eligible for inclusion. The sensitivity of the DSI color map was found to be 48.1% (95% CI 41.1-55.1) in finding CIN grade 2 or worse (CIN2 +) when compared to the histological diagnosis of the DSI directed biopsy. This was 42.5% (95% CI 36.7-48.5) when compared to the final histological diagnosis of all four cervical biopsies and with an NPV of 53.5% (95% CI 50.5-56.5). CONCLUSION: The worst color indicated by the DSI map might not consistently reflect the true grade of cervical dysplasia present. Thus, even though the DSI color map indicates low-grade changes, colposcopists should still consider taking biopsies from the area as high-grade changes might be present. TRIAL REGISTRATION: NCT04249856, January 31 2020 (retrospectively registered).
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