title: Dynamic spectral imaging: improving colposcopy.
abstract: OBJECTIVE
  Colposcopy occupies a key role in the prevention of cervical cancer by identifying preinvasive or invasive lesions. However, colposcopy is subjective and is responsible for 52% of screening failures. Dynamic spectral imaging (DSI) is based on the objective, quantitative assessment of the acetowhitening effect. This study compared DSI with colposcopy.
  
  
  METHODS
  Women referred for colposcopy were examined simultaneously with colposcopy and DSI using a precommercial DySIS model (FPC-03) in an international, multicenter trial. The colposcopy impression and DySIS values were compared with consensus histology reports of biopsies. Subjects were recruited to a training group and subsequently to a test group. Measures were taken to avoid verification bias.
  
  
  RESULTS
  The training and test groups comprised 82 and 308 eligible women, respectively. A cutoff value to identify high-grade disease was selected from the results of the training group and data from previous work. Receiver operator curve analysis of the test data showed an area under the curve of 0.844. DySIS detected 62.9% more high-grade cases than colposcopy (57 versus 35, P=0.0001). DySIS exceeded end points approved by the Food and Drug Administration for similar studies, with increments in the true positive rate of 22/308 (7.1%; lower 95% CL, 4.5% versus 2%) and in the false positive rate of 32/308 (10.4%; upper 95% CL, 14.7% versus 15%).
  
  
  CONCLUSIONS
  DySIS is more sensitive than colposcopy in detecting high-grade lesions and can provide improved guidance for biopsy. The results are obtained in a user-independent fashion, making it suitable for use by nursing personnel.
authors.affiliation: Department of Gynaecological Oncology, Hammersmith Hospital, London, United Kingdom. p.soutter@imperial.ac.uk
authors.forename: William P
authors.initials: WP
authors.lastname: Soutter
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Diakomanolis
authors.forename: Deirdre
authors.initials: D
authors.lastname: Lyons
authors.forename: Sadaf
authors.initials: S
authors.lastname: Ghaem-Maghami
authors.forename: Tosin
authors.initials: T
authors.lastname: Ajala
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Haidopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Doumplis
authors.forename: Costas
authors.initials: C
authors.lastname: Kalpaktsoglou
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Sakellaropoulos
authors.forename: Suzan
authors.initials: S
authors.lastname: Soliman
authors.forename: Karen
authors.initials: K
authors.lastname: Perryman
authors.forename: Vicky
authors.initials: V
authors.lastname: Hird
authors.forename: C Hilary
authors.initials: CH
authors.lastname: Buckley
authors.forename: Kitty
authors.initials: K
authors.lastname: Pavlakis
authors.forename: Sofia
authors.initials: S
authors.lastname: Markaki
authors.forename: Roberto
authors.initials: R
authors.lastname: Dina
authors.forename: Vourneen
authors.initials: V
authors.lastname: Healy
authors.forename: Costas
authors.initials: C
authors.lastname: Balas
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D003127:Colposcopy; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*