Efficacy of optical coherence tomography in the triage of women with minor abnormal cervical cytology before colposcopy

Lei Yan; Xiao Xiao; Ling He; Liye Shi; Xue Yang; Jun Zhang; Yongjing Zhang; Chun Fu

doi:10.1371/journal.pone.0282833

Efficacy of optical coherence tomography in the triage of women with minor abnormal cervical cytology before colposcopy

PLoS One. 2023 Mar 13;18(3):e0282833. doi: 10.1371/journal.pone.0282833. eCollection 2023.

Authors

Lei Yan¹, Xiao Xiao¹, Ling He¹, Liye Shi¹, Xue Yang¹, Jun Zhang¹, Yongjing Zhang¹, Chun Fu¹

Affiliation

¹ Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.

Abstract

Objectives: To evaluate the efficacy of Optical Coherence Tomography (OCT) for detecting cervical lesions in women with minor abnormal cytology results (atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL)).

Methods: A prospective study was conducted at gynecologic clinic from Mar 2021 to Sep 2021. The recruited women with cervical cytological findings of ASC-US or LSIL were inspected with OCT before colposcopy-directed cervical biopsy. The diagnostic performance of OCT, alone and in combination with high-risk human papillomavirus (hrHPV) testing were evaluated to detect cervical intraepithelial neoplasia of grade 2 or worse (CIN2+)/CIN3 or worse (CIN3+). The rate of colposcopy referral and the immediate risk of CIN3+ of OCT were calculated.

Results: A total of 349 women with minor abnormal cervical cytology results were enrolled. For detection of CIN2+/CIN3+, the sensitivity and NPV of OCT were lower than those of hrHPV testing (CIN2+: 71.3% vs. 95.4%, 89.0% vs. 91.1%, P < 0.001; CIN3+: 75% vs. 93.8%, 96.5% vs. 95.6%, P < 0.001), but the specificity, accuracy and PPV were higher than those of hrHPV testing (CIN2+: 77.5% vs. 15.6%, 75.9% vs. 35.5%, 51.2% vs. 27.3%, P < 0.001; CIN3+: 69.4% vs. 13.6%, 69.9% vs. 20.9%, 19.8% vs. 9.9%, P < 0.001). OCT combined with hrHPV testing (CIN2+: 80.9%; CIN3+: 72.6%) showed higher specificity than that of OCT alone (P < 0.001). The colposcopy referral rate base on OCT classification was lower than that based on hrHPV testing (34.7% vs. 87.1%, P < 0.001). Patients with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology, the immediate CIN3+ risk in OCT negative cases was less than 4%.

Conclusions: OCT alone or combination with hrHPV testing shows good performance for detecting CIN2+/CIN3+ in patients with ASC-US/LSIL cytology. OCT is an effective method for colposcopy triage in women with hrHPV-positive ASC-US and hrHPV-negative LSIL cytology.

Copyright: © 2023 Yan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atypical Squamous Cells of the Cervix* / pathology
Colposcopy
Early Detection of Cancer / methods
Female
Humans
Papillomaviridae
Papillomavirus Infections*
Pregnancy
Prospective Studies
Tomography, Optical Coherence
Triage / methods
Uterine Cervical Dysplasia*
Uterine Cervical Neoplasms* / diagnostic imaging
Uterine Cervical Neoplasms* / pathology

Associated data

figshare/10.6084/m9.figshare.21586248

Grants and funding

This research was supported by the National Natural Science Foundation Project of China (81771546), Clinical medical technology innovation guidance project of Hunan Provincial Science & Technology Department (2018SK52508 and 2020SK53404), Research Project of Hunan Provincial Health Commission (2021050120344), Construction project of graduate teaching case bank of Central South University(2021ALK47), Research on degree and postgraduate education and teaching reform of Central South University(2021JGB057).The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.