title: The performance of Dynamic Spectral Imaging colposcopy depends on indication for referrals.
abstract: OBJECTIVE. A previous study has shown that Dynamic Spectral Imaging (DSI) colposcopy increases the sensitivity of the colposcopic examination in women referred with abnormal cytology. In this study we have reanalyzed the performance of DSI and conventional colposcopy for new referral conditions and for low-grade cytology referrals versus high-grade cytology referrals. METHOD. Data from a previous validation trial was used to assess the performance of DSI in different cytology groups:Women referred with BMD (borderline and mild dyskaryosis) cytology and women referred with NBMD cytology either hrHPV positive or negative were separately analyzed. Furthermore, we tried to assess the clinical performance by appropriate filtering of patients to replicate two different referral strategies. RESULTS. The sensitivity of DSI and conventional colposcopy to detect CIN2+ lesions in women referred with BMD cytology is 82% and 44% respectively (p= 0.001) and in the NBMD group 77% and 64% respectively (p= 0.24). If the two techniques are combined the sensitivity is 85%.When the conditions of new screening strategies are applied DSI colposcopy has a higher sensitivity to detect CIN2+ than conventional colposcopy. Findings are similar when CIN3+ is used as a threshold. CONCLUSION. We found that in most cases DSI colposcopy has a higher sensitivity than conventional colposcopy, even when referral criteria are changed. Unlike conventional colposcopy, the sensitivity of colposcopy with DSI in low-grade cytology referrals was found similar to the sensitivity in high-grade cytology referrals. This suggests that a baseline colposcopy sensitivity may be possible with the adjunctive use of the DSI map, irrespective of referral cytology.
authors.affiliation: Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: ja.louwers@vumc.nl.
authors.forename: J A
authors.initials: JA
authors.lastname: Louwers
authors.affiliation: Division of Women and Baby, Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Zaal
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kocken
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Berkhof
authors.affiliation: DySIS Medical Ltd, Alba Campus, Livingston, United Kingdom.
authors.forename: E
authors.initials: E
authors.lastname: Papagiannakis
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: P J F
authors.initials: PJ
authors.lastname: Snijders
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: C J L M
authors.initials: CJ
authors.lastname: Meijer
authors.affiliation: Division of Women and Baby, Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R H M
authors.initials: RH
authors.lastname: Verheijen
mesh_terms: D019342:Acetic Acid; D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D061848:Optical Imaging / Q000379:methods*; D027383:Papillomaviridae / Q000302:isolation & purification; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000821:virology
chemical_list: D019342:Acetic Acid
keywords: CIN; Cervix uteri; Colposcopy; Dynamic Spectral Imaging; Premalignant lesion; Sensitivity and specificity