Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia without colposcopic tissue information; a step toward automation for low resource settings

Abstract

Abstract. Optical spectroscopy has been proposed as an accurate and low-cost alternative for detection of cervical intraepithelial neoplasia. We previously published an algorithm using optical spectroscopy as an adjunct to colposcopy and found good accuracy (sensitivity ¼ 1.00 [95% confidence interval ðCIÞ ¼ 0.92 to 1.00], specificity ¼ 0.71 [95% CI ¼ 0.62 to 0.79]). Those results used measurements taken by expert colposcopists as well as the colposcopy diagnosis. In this study, we trained and tested an algorithm for the detection of cervical intraepithelial neoplasia (i.e., identifying those patients who had histology reading CIN 2 or worse) that did not include the colposcopic diagnosis. Furthermore, we explored the interaction between spectroscopy and colposcopy, examining the importance of probe placement expertise. The colposcopic diagnosis-independent spectroscopy algorithm had a sensitivity of 0.98 (95% CI ¼ 0.89 to 1.00) and a specificity of 0.62 (95% CI ¼ 0.52 to 0.71). The difference in the partial area under the ROC curves between spectroscopy with and without the colposcopic diagnosis was statistically significant at the patient level (p ¼ 0.05) but not the site level (p ¼ 0.13). The results suggest that the device has high accuracy over a wide range of provider accuracy and hence could plausibly be implemented by providers with limited training.

Detection of cervical intraepithelial neoplasia by using optical coherence tomography in combination with microscopy

“…Several studies have evaluated the use of this combination in vivo reporting a sensitivity of 71% to 100% and a specificity of 50% to 81% for detection of high-grade cervical dysplasia. [31][32][33][34][35] Dynamic spectral imaging analyzes the acetowhitening effect of acetic acid indicating the severity of cervical dysplasia. Balas et al 36 compared the intensity of backscattered light before and after application of acetic acid and generated maps of the cervix to illustrate the areas of maximum alteration in tissue light scattering.…”

Multivariate functional response regression, with application to fluorescence spectroscopy in a cervical pre-cancer study

“…Analytical approaches that extract features by treating curves as vectors (Yamal et al, 2012; Chang et al, 2013) are often considered suboptimal because they fail to take into account the “functional” nature of the curves. Zhu and Cox (2009) and Zhu et al (2010) adopted scalar-on-function regressions to select “important” functional predictors while simultaneously performing classification.…”

Prediction using hierarchical data: Applications for automated detection of cervical cancer

“…A patient was classified as "negative for high-grade CIN" if his/her cervical tissue had a histological grade that indicated low-grade disease or normal (CIN 1, human papilloma virus [HPV]related changes, inflammation, atypia, or normal). The study design has been described in the literature [6][7][8]. Briefly, the patients entered the study in one of two possible categories: patients that never had an abnormal Pap smear (screening patients) and patients who had a history of an abnormal Pap smear (diagnostic patients).…”