Diagnostic comparison of electrical impedance spectroscopy with colposcopy and HPV mRNA‐testing in the prediction of CIN2+ women in Greece

Abstract

Aim To compare the diagnostic parameters of electrical impedance spectroscopy (EIS) via ZedScan, a device that measures spectra to differentiate between normal and abnormal cervical tissues, when used as an adjunct to colposcopies in the diagnosis of HSILs/CIN2+ in Greek women with abnormal referral cytology toward colposcopy alone and HPV mRNA‐testing. Methods This study analyzed 86 women, patients of the Colposcopy and Cervical Pathology Clinic of 2nd Obstetrics and Gynecology Department, Aristotle University of Thessaloniki at Hippokration General Hospital, between January 2022 and September 2022. During the visits, women were subjected to cytology, colposcopy alone and then with EIS/ZedScan and histological sampling. Results Common use of colposcopies and EIS/ZedScan allowed detecting an additional 14 cases of CIN2+ (16.2%) that colposcopy alone failed to report. EIS enhanced the sensitivity of colposcopy from 80.65% to 100% equal with that of HPV‐mRNA test while retaining a high specificity (94.74%) which is much higher than specificity of HPV mRNA‐testing (65.45%). EIS‐assisted colposcopy had the highest value combination of positive and negative predictive values (96.15% and 100%) compared to colposcopy alone (100% and 75%) and HPV mRNA‐testing (72.46% and 100%). Conclusions Colposcopies performed with EIS/ZedScan demonstrated effectiveness in the diagnosing of CIN2+ leading to a significant increase in the number of CIN2+ that would have been missed if only colposcopy was applied especially in women with LSIL referral cytology. EIS/ZedScan seems to possess the ideal diagnostic threshold for sensitivity, specificity, and predictive values for CIN2+ compared to colposcopy alone and HPV mRNA‐testing.

Added value of electrical impedance spectroscopy in adjunction of colposcopy: a prospective cohort study

“…The increased detection of CIN2+ cases by EIS has been reported as most pronounced in women with low-grade cytology13 14 16 17 or with hrHPV positivity without cytological changes 16 18. In our study, additional cases of CIN2+ detected by EIS were also most frequent among low-grade referrals.…”

“…The sensitivity of colposcopy has been suggested to increase with the use of EIS10 13–17 even in women with low probability of high-grade cervical disease and with minor colposcopic changes, as its use is independent of visual findings in colposcopy 12 18 19. The developers of the technology have been involved in most of the published studies.…”

“…In women with persistent hrHPV positivity without cervical cytological changes, EIS has detected additional cases of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with women without EIS examination 18. The benefit of EIS seems to vary depending on the referral cervical cytology, being most useful in terms of finding extra cases of CIN2+ in women with low-grade referral cervical cytology 13 14 16 17. National Institute for Health and Care Excellence guidelines recommend further research on EIS 20…”

Detection of High-Grade CIN by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade CIN on Cytology

“…The use of Zedscan gives quite promising results that allow us to look forward to its complementary use in the future as an adjunct to classic colposcopy. Data from the literature are limited to 5 published studies, as the use of this specific tool began in 2017 17,18,[38][39][40][41][42] . Three of these are from a single location with a small number of patients, and they investigate whether using ZedScan in conjunction with colposcopy improves sensitivity in finding high-grade lesions at the expense of a slight rise in the amount of biopsies.…”

“…Three of these are from a single location with a small number of patients, and they investigate whether using ZedScan in conjunction with colposcopy improves sensitivity in finding high-grade lesions at the expense of a slight rise in the amount of biopsies. 17,38,40 . One study specifically addressed the sensitivity of Zedscan in the detection of lesions associated with HPV infection, which did not show a statistically significant sensitivity of the method for these lesions.…”