title: Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia without colposcopic tissue information; a step toward automation for low resource settings.
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=1.00 [95% confidence interval (CI)=0.92 to 1.00], specificity=0.71 [95% CI=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=0.89 to 1.00) and a specificity of 0.62 (95% CI=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=0.05) but not the site level (p=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.
authors.affiliation: The University of Texas Health Science Center at Houston, Division of Biostatistics, School of Public Health, 1200 Herman Pressler, RAS W928, Houston, Texas 77030, USA. Jose-Miguel.Yamal@uth.tmc.edu
authors.forename: Jose-Miguel
authors.initials: JM
authors.lastname: Yamal
authors.forename: Getie A
authors.initials: GA
authors.lastname: Zewdie
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Cox
authors.forename: E Neely
authors.initials: EN
authors.lastname: Atkinson
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cantor
authors.forename: Calum
authors.initials: C
authors.lastname: MacAulay
authors.forename: Kalatu
authors.initials: K
authors.lastname: Davies
authors.forename: Isaac
authors.initials: I
authors.lastname: Adewole
authors.forename: Timon P H
authors.initials: TP
authors.lastname: Buys
authors.forename: Michele
authors.initials: M
authors.lastname: Follen
mesh_terms: D000465:Algorithms; D003127:Colposcopy; D005260:Female; D005336:Fiber Optic Technology; D006651:Histocytochemistry; D006801:Humans; D016015:Logistic Models; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013057:Spectrum Analysis / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology