International Journal of Gynecology and Obstetrics (2005) 89, 63 — 64
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Optical diagnosis of cervical dysplasia P. F. EscobarT, L. Rojas-Espaillat, J. L. Belinson Department of Gynecology and Obstetrics, Gynecologic Oncology Program, The Cleveland Clinic Foundation, 9500 Euclid Avenue Cleveland, OH 44195, USA Received 18 November 2004; accepted 7 December 2004
Cervical cancer is a major burden to women’s health in developing countries. Worldwide, cancer of the uterine cervix accounts for approximately 470,000 new cases every year, and 233,000 deaths [1]. Many components of comprehensive screening and treatment programs practiced in industrialized nations are not feasible for most developing countries. Moreover, an optimal strategy for a particular low-resource setting may vary from another due to differences in disease prevalence, health care infrastructure, human and financial resources, and local customs. Even a casual look at the quandary cannot help but impress the viewer with the scope and complexity of the problem. In March 2004, the American College of Obstetricians and Gynecologist (ACOG) issued a statement of policy regarding cervical cancer prevention in low-resource setting [2]. In this joint policy statement, a bsingle-visit approachQ incorporating visual inspection of the cervix with acetic acid (VIA), followed by immediate treatment was considered an acceptable and costeffective strategy for cervical cancer prevention.
T Corresponding author. Tel.: +1 216 444 4884. E-mail address:
[email protected] (P.F. Escobar).
In the last decade substantial progress has been made in understanding the origin and pathogenesis of cervical neoplasia. This knowledge, in combination with technologies such as self-sampling devices, optical detection systems, and more recently molecular technologies has allowed physicians and researchers to develop new algorithms to improve the global burden of cervical cancer. To overcome problems such as cost, quality assurance, and impossible recall systems used in the developed world’s conventional screening and treatment programs, various biophotonic methods have been investigated to allow fast, non-invasive evaluation of cervical epithelial abnormalities. Optical coherence tomography (OCT) is an imaging modality that uses harmless, infrared light to create high-resolution, real-time, in vivo images of soft and hard tissues (Fig. 1). The system is based on low-coherence interferometry, which was originally reported in the field of fiber optics [3,4]. It provides structural, rather than chemical, information about the tissue. Using information inherent to the returning photon signals from tissue, early morphological and light-scattering changes can be detected during tumorigenesis. It has the potential to provide a true optical cross-sectional pseudohistologic biopsy [5].
0020-7292/$ - see front matter D 2005 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.12.029
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EP
EP BM
BM ST ST
Figure 1 OCT tomogram and histologic section of normal uterine cervix. Epithelium (EP), Basal Membrane (BM), Stroma (ST).
VIA has consistently demonstrated sensitivity for NCIN II in the 70—80% range. HPV testing has demonstrated sensitivities over 90%. As new rapid tests evolve this and other types of molecular screening will become even more important especially as self-testing technologies improve. An OCT diagnosis of normal versus abnormal may allow even more specific point of care diagnosis and management. If diagnostically comparable to a biopsy, then clearly the ability of OCT to provide a point of service diagnosis would serve a significant advantage. The impact of this technology to the international community is currently under investigation in which multiple algorithms involving OCT in lowresource settings are being evaluated.
References [1] Jansen KU. Vaccines against cervical cancer. Expert Opin Biol Ther 2004 (Nov);4(11):1803 – 9. [2] ACOG Statement of Policy. Cervical cancer prevention in low-resource settings. Obstet Gynecol 2004 (March); 103(3). [3] Youngquist RC, Carr S, Davies DEN. Optical coherence domain reflectometry: a new optical evaluation technique. Opt Lett 1987;12:156 – 60. [4] Takada K, Yokohama I, Chida K, Noda J. New measurement system for fault location in optical waveguide devices based on an interferometric technique. Appl Opt 1987; 26:1603 – 6. [5] Escobar PF, Belinson JL, White A, Shakhova NM, Feldchtein MV, Kareta MV, et al. Diagnostic efficacy of optical coherence tomography in the management of preinvasive and invasive cancer of uterine cervix and vulva. Int J Gynecol Cancer 2004 (May—Jun);14(3):470 – 4.
