Evaluating Colposcopy with Dynamic Spectral Imaging During Routine Practice at Five Colposcopy Clinics in Wales: Clinical Performance

Abstract

Background: The diagnostic accuracy of colposcopy is poor for detecting precancerous cervical lesions. Objectives: We assessed the performance of colposcopy for identifying cervical intraepithelial neoplasia grade 2 or worse (CIN2+), before and after including a dynamic spectral imaging (DSI) map that quantifies and maps acetowhitening to assist subsequent biopsy of suspicious lesions. Methods: Four hundred and twenty-five women were examined at a multi-center setting in Wales, of which 393 women were included in the final analysis. Results: For all referrals, the sensitivity of conventional colposcopy for histologically confirmed CIN2+ was 51.5%, the specificity was 92.0%, the positive predictive value was 56.7%, and the negative predictive value (NPV) was 90.4%. With the incorporation of the DSI map in predicting CIN2+, these became 84.8, 61.5, 30.8, and 95.3% respectively. The increase of sensitivity was statistically significant (p < 0.001). For the 236 women having colposcopy after low-grade (LG) cytology, with the incorporation of DSI, the sensitivity for CIN2+ increased from 27.3 to 86.4% (p < 0.001) and the NPV from 92.6 to 97.8%. Conclusions: Colposcopy with DSI results in improved sensitivity to detect CIN2+ and maintains a high NPV for all referrals and especially for those with LG referral cytology.

Accuracy of colposcopy‐directed biopsy vs dynamic spectral imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization: A methodological study

“…These studies reported an increased sensitivity in using DSI from approximately 50% to about 80-85%. 8,12,13,15 However, there is great inter-observer variation 2,3 in the interpretation of the degree of cervical dysplasia between colposcopist, and also poor correlation between colposcopic impression and biopsy histology. 24 Therefore we believe that our approach of comparing the worst histological…”

“…New colposcopy technology is now available and has been suggested to improve the performance of colposcopy. [8][9][10][11][12][13][14][15][16] Dynamic spectral imaging (DSI) digital colposcopy measures the aceto-white changes that may occur after application of acetic acid and suggests sites for biopsy through a color coded map. This new technology may be able to increase the sensitivity of colposcopy from 55% to 86%.…”

“…This new technology may be able to increase the sensitivity of colposcopy from 55% to 86%. 8 The most recent studies from the IMPROVE-COLPO trial indicate a 30% relative increase in the DSI colposcope's ability to find high-grade CIN compared with standard colposcopy alone. 9 However, these studies have a high degree of verification bias, as only one biopsy was taken from the majority of women and some had no biopsies taken at all.…”

Analysis of New Colposcopy Techniques in the Diagnosis and Evolution of SIL/CIN: Comparison of Colposcopy with the DSI System (COLPO-DSI Study)

“…The DSI mapping system (C-DSI) enhances the sensitivity for HSIL/CIN2+ detection, raising it to 86% compared to CC sensitivity [8]. The DSI color-coded mapping system could become an objective tool to assess and select the best sites for biopsy, thus reducing interobserver variability.…”

Options for triage and implications for colposcopists within European HPV-based cervical screening programmes

“…Time and resources may be wasted as a consequence in attempting to improve colposcopic diagnostic performance. Furthermore, the colposcopic identification of HSIL from within the group of women referred with low grade squamous intraepithelial lesion (LSIL) cytology is often difficult with a poor sensitivity in part due to low prevalence of pre-cancerous disease in this group [2]. A Eurogin Roadmap examining triage strategies has stressed the importance of a clear triage strategy of each national screening programme either as a single or as a combination option.…”