Analysis of acetic acid-induced whitening of high-grade squamous intraepithelial lesions

Pogue, Brian W.; Kaufman, Howard; Zelenchuk, Alex; Harper, William; Burke, Gregory C.; Burke, Eschel E.; Harper, Diane M.

doi:10.1117/1.1412850

Cited by 42 publications

(21 citation statements)

References 22 publications

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“…Second, referring facilities only provided cytology to la Liga Contra el Cáncer for 28% of patients; thus, cytology was unknown for a majority of cases in our study. Third, acetic acid was not re-applied immediately prior to imaging with the Pocket colposcope until the last 32 patients (22, 26). Revising the study protocol in future studies to re-apply acetic acid between imaging with the two colposcopes could improve visualization of aceto-whitening.…”

Section: Discussionmentioning

confidence: 99%

Portable Pocket colposcopy performs comparably to standard‐of‐care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru

Mueller

Lam

Dahl

et al. 2018

BJOG

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Section: Discussionmentioning

confidence: 99%

Portable Pocket colposcopy performs comparably to standard‐of‐care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru

Mueller

Lam

Dahl

et al. 2018

BJOG

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“…Reflectance imaging with green wavelength illumination consistently gives best contrast because of hemoglobin absorption39. Alternatively, color reflectance images obtained with white light illumination can be separated into red, green, and blue channels and analyzed to enhance image contrast15, 40. A pilot study of digital reflectance images of the cervix acquired from 29 women showed that an automated image analysis algorithm could identify the presence and spatial extent of high grade precancers with 79% sensitivity and 88% specificity compared to histopathologic analysis 15.…”

Section: In Vivo Optical Imaging Technologiesmentioning

confidence: 99%

“…Imaging the time course of acetowhitening can also improve the ability to discriminate high grade precancer39, 40; a multispectral reflectance imaging study of 123 women found that the increase in light scattering after application of acetic acid was greater and persisted for a longer time in high grade precancers41.…”

Section: In Vivo Optical Imaging Technologiesmentioning

confidence: 99%

Optical imaging for cervical cancer detection: solutions for a continuing global problem

2008

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PrefaceCervical cancer is the leading cause of cancer death for women in developing countries 1 . Optical technologies can improve the accuracy and availability of cervical cancer screening. For example, battery-powered digital cameras can obtain multi-spectral images of the entire cervix highlighting suspicious areas, and high-resolution optical technologies can further interrogate suspicious areas, providing in vivo diagnosis with high sensitivity and specificity. In addition, targeted contrast agents can highlight changes in biomarkers of cervical neoplasia. Such advances should provide a much needed global approach to cervical cancer prevention. Cervical Cancer: A Global ChallengeCervical cancer is the second most common cancer in women worldwide 1 ; more than 80% of cervical cancers occur in the developing world where the least resources exist for management 1 . Most cases of cervical cancer can be prevented through screening programs, such as the Papanicolaou (Pap) smear aimed at detecting precancerous lesions for treatment. In countries in which organized programs have been established, the incidence and mortality of cervical cancer have dramatically reduced 2 . Yet, the necessary resources and infrastructure for screening are not available in many countries; as a result, 274,000 women die each year as a result of this preventable disease 1 .Cervical cancer is caused by chronic infection with high risk types of the human papilloma virus (HPV) 3 . The recent development of vaccines to prevent HPV infection promises to further reduce the incidence of cervical cancer in countries where vaccines are available 4 . However, the significant cost of vaccines and, in some cases, political or logistical barriers, could delay implementation of universal mass vaccination in many developing countries 5 . Furthermore, current vaccines are effective only against high-risk HPV types 16 and 18, which together account for approximately 70% of cervical cancers worldwide 5 . Because the vaccine does not cover all high-risk HPV subtypes, routine cervical cancer screening is still necessary, even for women who have been vaccinated, so cervical cancer screening remains necessary for the foreseeable future. Clinical Approaches to Cervical Cancer ScreeningCurrent screening and diagnosis of cervical precancer is based on optical techniques developed in the early 1900s 2 . As shown in the top row of Fig. 1, an abnormal Pap smear is followed by examination of the cervix using a low-power light microscope (colposcope) to visualize changes in tissue reflectance, which might indicate precancer. For decades, clinical investigators have searched for ways to improve the optical contrast between normal cervix and precancerous lesions. The use of simple agents such as acetic acid and Lugol's iodine, together with the use of a green illumination filter, can highlight suspicious regions. However, because the specificity of visual examination is low, colposcopically abnormal areas are routinely biopsied to confirm the presence of disease 6 . I...

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“…5,6,8,14 Figure 2 also shows that variations in the actual epithelium thickness do not have a strong effect on the reflectance observed. For this reason, the acetowhite effect is typically observed in the 540 to 580 nm region (green region) where hemoglobin provides strong absorption in the stroma; conversely, it is barely observed at wavelengths longer than 600 nm (red region) where hemoglobin absorption is low.…”

Section: Resultsmentioning

confidence: 83%

Reflectance model for acetowhite epithelium

Zonios

2012

J. Biomed. Opt

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Application of low concentration acetic acid solution to various types of human epithelia, in vivo, is a well-established technique for the visual identification of neoplastic and potential precancerous lesions, especially in the cervix. An acetic acid application produces a transient whitening effect associated with the aforementioned lesions (acetowhite effect). In this article, a simple semi-empirical tissue reflectance model is presented, which describes the acetowhite effect in terms of the tissue's optical properties and layered structure. The model successfully describes data available in the literature, explains basic characteristics of the acetowhite effect, and can serve as the basis for the development of more accurate and reliable noninvasive diagnostic methodologies for precancerous epithelial lesions.

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Analysis of acetic acid-induced whitening of high-grade squamous intraepithelial lesions

Cited by 42 publications

References 22 publications

Portable Pocket colposcopy performs comparably to standard‐of‐care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru

Portable Pocket colposcopy performs comparably to standard‐of‐care clinical colposcopy using acetic acid and Lugol's iodine as contrast mediators: an investigational study in Peru

Optical imaging for cervical cancer detection: solutions for a continuing global problem

Reflectance model for acetowhite epithelium

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