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Diagnostic accuracy of colposcopy with dynamic spectral imaging for cytology-negative/high-risk HPV positive (failed test of cure) after large loop excision of the transformation zone (LLETZ) of the cervix: Results of the DySIS colposcopy 1 study.

Abstract After treatment for cervical intraepithelial neoplasia (CIN), in the UK women who are cytology-negative, high-risk (HR) human papilloma virus (HPV) positive are referred to colposcopy. This pilot study assessed the incidence of residual/recurrent CIN and the diagnostic accuracy of colposcopy with dynamic spectral imaging (DSI) mapping in their detection.This was a prospective service evaluation carried out in a UK National Health Service (NHS) colposcopy clinic. All women, referred with negative cytology/HR-HPV positive result following treatment for CIN from March 2013 until November 2014, who were examined with the DSI digital colposcope were included. We excluded 3 cases because of poor-quality imaging from user errors. Everyday clinical practice was followed. Initial colposcopic impression, DSI map indication, and biopsy site selections were recorded. CIN2+ was considered the primary outcome and CIN of any grade a secondary outcome.A total of 105 women were included of which 5 (4.8%) had CIN2+ histology and 24 (22.9%) had CIN1. Pre-DSI map colposcopy suggested normal/low grade in all 5 of the CIN2+ cases and DSI suggested high-grade (HG) CIN in 4 of the 5 cases. Sensitivity of standard colposcopy for CIN2+ was 0%, improving to 80% with the incorporation of the DSI map.The CIN burden in this population is higher than previously expected. Colposcopic identification of HG CIN appears to improve significantly with DSI in this cohort leading to refinement in patient management. A larger, multicentric prospective study (DySIS colposcopy 2) is planned to confirm these initial findings.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29505536
OWN - NLM
STAT- MEDLINE
DCOM- 20180309
LR  - 20180309
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 1
DP  - 2018 Jan
TI  - Diagnostic accuracy of colposcopy with dynamic spectral imaging for
      cytology-negative/high-risk HPV positive (failed test of cure) after large loop
      excision of the transformation zone (LLETZ) of the cervix: Results of the DySIS
      colposcopy 1 study.
PG  - e9560
LID - 10.1097/MD.0000000000009560 [doi]
AB  - After treatment for cervical intraepithelial neoplasia (CIN), in the UK women who
      are cytology-negative, high-risk (HR) human papilloma virus (HPV) positive are
      referred to colposcopy. This pilot study assessed the incidence of
      residual/recurrent CIN and the diagnostic accuracy of colposcopy with dynamic
      spectral imaging (DSI) mapping in their detection.This was a prospective service 
      evaluation carried out in a UK National Health Service (NHS) colposcopy clinic.
      All women, referred with negative cytology/HR-HPV positive result following
      treatment for CIN from March 2013 until November 2014, who were examined with the
      DSI digital colposcope were included. We excluded 3 cases because of poor-quality
      imaging from user errors. Everyday clinical practice was followed. Initial
      colposcopic impression, DSI map indication, and biopsy site selections were
      recorded. CIN2+ was considered the primary outcome and CIN of any grade a
      secondary outcome.A total of 105 women were included of which 5 (4.8%) had CIN2+ 
      histology and 24 (22.9%) had CIN1. Pre-DSI map colposcopy suggested normal/low
      grade in all 5 of the CIN2+ cases and DSI suggested high-grade (HG) CIN in 4 of
      the 5 cases. Sensitivity of standard colposcopy for CIN2+ was 0%, improving to
      80% with the incorporation of the DSI map.The CIN burden in this population is
      higher than previously expected. Colposcopic identification of HG CIN appears to 
      improve significantly with DSI in this cohort leading to refinement in patient
      management. A larger, multicentric prospective study (DySIS colposcopy 2) is
      planned to confirm these initial findings.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Founta, Christina
AU  - Founta C
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
AD  - Department of Gynaecological Oncology, Musgrove Park Hospital, Taunton & Somerset
      NHS Foundation Trust, Taunton.
FAU - Papagiannakis, Emmanouil
AU  - Papagiannakis E
AD  - DYSIS Medical Ltd, Edinburgh, Scotland, UK.
FAU - Ratnavelu, Nithya
AU  - Ratnavelu N
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
FAU - Feusi, Arlene
AU  - Feusi A
AD  - University of Zurich, Zurich, Switzerland.
FAU - Natsis, Stavros
AU  - Natsis S
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
FAU - Bradbury, Melissa
AU  - Bradbury M
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
FAU - Fisher, Ann
AU  - Fisher A
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
FAU - Naik, Raj
AU  - Naik R
AD  - Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital Gateshead,
      Gateshead.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cervical Intraepithelial Neoplasia/*diagnosis/surgery/virology
MH  - Colposcopy/methods/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - Neoplasm Recurrence, Local/*diagnosis/virology
MH  - Papillomaviridae
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Spectrum Analysis
MH  - Uterine Cervical Neoplasms/*diagnosis/surgery/virology
EDAT- 2018/03/06 06:00
MHDA- 2018/03/10 06:00
CRDT- 2018/03/06 06:00
PHST- 2018/03/06 06:00 [entrez]
PHST- 2018/03/06 06:00 [pubmed]
PHST- 2018/03/10 06:00 [medline]
AID - 10.1097/MD.0000000000009560 [doi]
AID - 00005792-201801050-00033 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jan;97(1):e9560. doi: 10.1097/MD.0000000000009560.