Multimodal Hyperspectral Imaging for the Noninvasive Diagnosis of Cervical Neoplasia

Abstract

H ealth care professionals encounter multiple dilemmas with the surveillance, diagnosis, and management of women with cervical neoplasia. An imperfect screening test, a lengthy Papanicolaou (Pap) smear collection to notification interval, and a substantial patient noncompliance rate with recommended practices may all adversely impact the screening process [1][2][3][4][5][6][7][8]. Cervical neoplasia is suspected from an abnormal screening Pap smear or positive triage test for oncogenic human papillomavirus (HPV) DNA that is localized and detected by specific epithelial features noted during colposcopic examination of the lower genital tract. The diagnosis is confirmed by histologic results obtained from sampling the ectocervix and endocervical canal, when deemed necessary [9]. When results from these evaluations are considered collectively, optimal management ensues. Most of the tests involve a subjective appraisal that varies considerably and depends on specimen or anatomic variation, as well as evaluator expertise. Thus, diagnoses may be influenced adversely by technical issues and are not made consistently at an expert level; the diagnoses also are not always reproducible. AbstractObjective. To determine the ability of Multimodal Hyperspectral Imaging (MHI) to noninvasively detect, localize and diagnose cervical neoplasia.Materials and Methods. The cervical epithelium was interrogated by MHI using tissue fluorescence and reflectance measurements after the probe was placed on the ectocervix. A Papanicolaou smear was taken, and a colposcopic examination was performed and cervical histologic specimens were collected, when indicated. MHI and Pap smear sensitivity and specificity data were compared with colposcopic and histologic results.Results. Nineteen patients had CIN2 or higher, 30 had CIN1, 34 had benign cellular changes or metaplasia, and 28 were normal by both Pap smear and colposcopic examination. At equal specificity (70%) for both tests, the sensitivity of MHI was 97%, compared to 72% for the Pap smear.Conclusion. MHI detected cervical cancer precursors at a rate greater than that obtained by a simultaneously collected Pap smear.

Clinical optical diagnostics – Status and perspectives

“…3a and b), Barrett's oesophagus [10] and the colon [11] clinical trials have shown an improvement in the relative sensitivity, and better contrast when combining white light endoscopy with autofluorescence and/or reflectance spectroscopy as compared to white light endoscopy alone. Similar conclusions have been reached for cervical tissue diagnosis [15,16]. The commercial instruments here include the FDA-approved LUMA TM Cervical Imaging System (MediSpectra, MA, USA) and the LightTouch system (Norcross, GA, USA).…”

Optical and Opto-Acoustic Interventional Imaging

“…100,116,121 Auto-fluorescence imaging is technically easy to implement during patient screening or surgery and therefore it does not require expensive equipment or complex regulatory approvals. Endoscopic and wide-field auto-fluorescence imaging has been considered for screening oral, 38,83,90,117,161,175 laryngeal, 8,112,220 cervical, 54,84,193 gastric 55,72 and colorectal 88,186 cancer. Lane et al 117 reported a 98 and 100% increase of sensitivity and specificity using autofluorescence imaging in 44 patients screened for oral dysplasia or cancer, while Kraft et al 112 observed a superior performance of autofluorescence (sensitivity 91%, specificity 84%) endoscopy compared to white light (sensitivity 73%, specificity 79%) and even aminolevulinic acid (ALA) induced fluorescence (sensitivity 95%, specificity 62%) endoscopy.…”

Digitized Cervical Images: Problems, Solutions, and Potential Medical Impact

“…A computerized, algorithm-based, automated evaluation colposcopic device could help novice colposcopists identify and sample lesions determined to represent significant neoplasia. Because both use computer-based platforms, the automated image analysis tool easily could interface with fluorescent and reflective spectroscopy units to improve diagnostic accuracy [8][9][10]. Such an image analysis instrument also would help researchers analyze the NCI cervical image archive.…”