Review al literaturii privind microscopia confocală şi colposcopia digitală automatizată Modern cervical imaging assessment. It is used for cervical image magnification and to guide cervical biopsy. Still, there can be other techniques that could facilitate the diagnosis of cervical neoplastic lesions and cervical cancer. This paper aims to analyze the advantages of modern cervical imaging techniques, namely confocal microscopy and digital automated colposcopy, in detecting and staging cervical neoplasia lesions.
Confocal microscopy has cervical cancer new staging 2019 wide applicability as an endoscopic imaging technique and already proved useful in cases with cervical cervical cancer new staging 2019.
While colposcopy focuses on the macroscopic aspect of the cervical lesions, the advantage of confocal microscopy is that it provides information regarding the microscopic histological changes: architectural changes, increased volume or an increased ratio between the nuclear and cytoplasmic volumes in serial planes tangential to the epithelium, that can be reconfigured 3D.
These changes are routinely diagnosed by histopathological examination of a biopsy specimen; however, the confocal microscopy has the ability to visualize these changes in vivo. This helps the diagnosis process and therapeutic decision by eliminating the time required for biopsy and histopathological examination. However, confocal microscopy is an expensive method, therefore digital colposcopy is more appropriate for the screening and diagnosis process, especially in low-income countries.
In conclusion, confocal microscopy has the potential to become an important diagnostic and staging tool in cervical neoplastic lesions.
The greatest benefit of this method is the ability to visualize in vivo changes that are currently detected by histopathological examination and thus to favorize a faster therapeutic management.
However, because its limited accessibility, colposcopy remains the standard imaging method in the diagnosis of cervical lesions. Keywords confocal microscopy, colposcopy, digital colposcopy, cervical lesions Rezumat Colposcopia reprezintă în prezent standardul de aur în diagnosticarea neoplaziei cervicale intraepiteliale CINdupă un examen Babeş-Papanicolau cu modificări.
Investigaţia este utilizată pentru mărirea imaginii cervicale şi pentru a ghida biopsiile de la nivelul colului uterin.
Totuşi, pot exista şi alte tehnici care să faciliteze diagnosticul leziunilor neoplazice cervicale şi al cancerului de col uterin. Această lucrare urmăreşte să analizeze avantajele tehnicilor cervical cancer new staging 2019 de imagistică de la nivelul colului uterin — şi, anume, microscopia confocală şi colposcopia digitală automatizată — în procesele de detecţie şi stadializare a leziunilor neoplazice şi preneoplazice cervicale.
Microscopia confocală are o aplicabilitate largă ca tehnică imagistică endoscopică şi deja s-a dovedit utilă şi în cazul leziunilor cervicale. În timp ce colposcopia clasică se axează pe aspectul macroscopic al leziunilor cervicale, avantajul microscopiei confocale este acela că furnizează informaţii privind modificările microscopice histologice: modificări arhitecturale, creşterea în volum sau creşterea raportului nucleo-citoplasmatic, în planuri seriate tangenţiale la epiteliu, care pot fi reconstruite 3D.
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Aceste modificări sunt diagnosticate de rutină la examenul histopatologic al piesei de biopsie; totuşi, microscopia confocală are abilitatea de a vizualiza aceste modificări in vivo. Acest aspect facilitează procesul de diagnosticare şi de decizie terapeutică, eliminând timpul necesar biopsierii şi interpretării histopatologice.
Cu toate acestea, microscopia confocală este o metodă costisitoare, prin urmare colposcopia digitală este mai accesibilă în procesele de diagnosticare şi screening, mai ales în ţările în curs de dezvoltare. În concluzie, microscopia confocală are potenţialul de a deveni un instrument de diagnostic şi stadializare important pentru leziunile neoplazice cervicale.
Cel mai mare avantaj al acestei metode este de a vizualiza in vivo modificări care sunt actualmente detectabile doar prin examinare histopatologică şi, astfel, să favorizeze un management terapeutic mai rapid. Cu toate acestea, din cauza accesibilităţii reduse, colposcopia rămâne metoda standard de diagnostic al leziunilor cervicale. Cuvinte cheie microscopie confocală colposcopie colposcopie digital leziuni cervicale Introduction World Health Organization WHO confirms an incidence ofnew cases of cervical cancer diagnosed in and a total ofdeaths in This data classifies cervical cancer as the fourth leading cause of death among female population, representing 6.
In Romania, cervical cancer represents Screening programs have been developed for cervical cancer and nowadays they are cervical cancer new staging 2019 of the best screening cervical cancer new staging 2019 available worldwide.
However, in underdeveloped countries there is no general access to these programs and the mortality rate is very high. An cervical cancer new staging 2019 diagnosis of cervical intraepithelial neoplasia CIN is important, and also the early detection of the cervical cancer, because therapy can cure the disease.
Pap smear, and testing for HPV infection followed by colposcopy and biopsy are the gold standard in the screening and diagnosis of cervical lesions 3. This paper analyzes cervical imaging alternatives to classic colposcopy that have the potential to reduce the number of unnecessary biopsies and eludes the time required for pathology diagnosis that often, especially in developing countries, is a source for lost to follow-up patients.
A modern technique to facilitate the screening process and speed up the diagnosis process would be of great use. Another important aspect for the developing countries is the lack of medical specialists and busy work intervals for practitioners. The new technologies thus enclose more advantages, such as speed and automation. The two methods reviewed in this paper are the confocal endomicroscopy and the digital colposcopy.
They fulfill the requirements necessary for an effective diagnostic test: accurate, safe, fast and convenient for the patient; the see-and-treat method is a principle that specialists try to implement through confocal endomicroscopy and digital colposcopy.
In the cervical cancer new staging 2019 process, from normal to dysplastic and neoplastic cells, certain modifications happen at the cell level, and these alterations might change the optic properties of the cervical cells 5. The confocal microscopy is an optical technique that can identify the optical properties of the cells and classify these lesions as low-risk or high-risk.
Confocal endomicroscopy The confocal microscopy is a high-resolution microscopy currently used for diagnosing stomach lining lesions, lung nodules, pancreatic and biliary strictures, pancreatic cysts, inflammatory diseases or intestinal lesions and urological diseases 6. There was a limited use cervical cancer new staging 2019 confocal microscopy in gynaecology, but in cases of non-invasive cervical cervical cancer new staging 2019, this method demonstrated its diagnostic value 7.
The advantages of confocal microscopy are: obtaining microscopic images in vivo, targeted cervical cancer new staging 2019, accuracy improvement of diagnosis warts on soft skin reducing the time needed for therapy initiation 8,9.
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This can be a new gold standard in underdeveloped countries, where the follow-up is nearly impossible. Avoiding loop excisions in patients without obstetrical history is another advantage of the endomicroscopic assessment warts on skin images the cervix. Literature shows a higher risk of preterm labor for patients who undergo a conization before pregnancy Therefore, cervical integrity is very cervical cancer new staging 2019 cervical cancer new staging 2019 these patients and the use of in vivo histological diagnosis provided by confocal endomicroscopy technique might reduce this obstetrical risk by avoiding unnecessary conizations and loop excisions.
Besides these advantages, this method provides much faster results, in a more comfortable manner for the patient, and permits to establish much faster the proper therapy. The principle of this technique is very simple: instead of a biopsy and histological examination, this method assesses the cervix in real time under the microscope, with a great resolution, down to 1 µm 9, In one of the first cervical applications of this technique, Zhang et al. This method has also the advantage of creating 3D images that can facilitate cervical cancer new staging 2019 biopsy guidance and follow-up the healing process.
The images obtained are tangential on the lesion surface, an approach that cannot be obtained during histopathological examination on routine sectioning, where the section plans are perpendicular to epithelium surface 2. The applicability of confocal microscopy in cervical cancer is suggested by the morphological changes. Intraepithelial cervical lesions are characterized by an increased nucleus volume, size, eccentricity, and an increased nuclei-cytoplasmic ratio.
The gold standard for diagnosing these lesions is biopsy and histopathological examination. Confocal high-resolution microscope can diagnose these changes in vivo, shortening the standard diagnosis process. The nuclear changes are not the only cellular modifications that occur in cervical lesions, but these are the key signs to the in vivo diagnosis, as they are characteristic to high-grade lesions and do not appear in other types of lesions, such as in inflammation.
False positive results due to nuclear crowding in inflammation are avoided by this technique 2, Even small changes of nuclei-cytoplasmic ratio have been noted through the entire depth of the epithelium in dysplastic lesions 2,8.
Tan et al. One of the substances used to stain the nuclei of the epithelium was acriflavine, as a fluorescent contrast agent. However, deep penetration in the epithelium layers was low. On the other hand, the stain was much more evident in high-grade lesions, because of a greater density cervical cancer new staging 2019 the nuclei at superficial levels. These changes were described through the optical endomicroscope and the cases were classified from anthelmintic drugs are cells to CIN3 or cancer.
Other researchers used fluorescein 9injected intravenously to stain the cytoplasmic components, extravascular matrix and the microvascular structures, but not the nuclei 9, Grant et al. Mean nuclear area and the median nuclear eccentricity increase from low-grade to high-grade dysplasia and may be added in the scoring analysis to reduce the number of cervical cancer new staging 2019 positive cases.
Also, prominent vessels were highlighted in some cases with CIN3 or cancer. Digital colposcopy In our opinion, based on data from literature, digital colposcopy has the potential to ease the work of the practitioners in low-income countries as a screening and diagnosis alternative. Sankaranarayanan et al.
However, a professional cervical cancer new staging 2019 specific training is needed to analyze the clinical aspects. Different researchers implemented different strategies to obtain automatic colposcopic images, but the interpretation of these images needed specialists to manually analyze and diagnose them.
Cervicography, with images captured before and after the application of acetic acid, was used by Bomfim-Hyppolito et al. A modern cervical work-flow assessment method would imply real-time images captures seconded by an automatically diagnostic.
There are many studies that tried to demonstrate the importance and benefits of screening and diagnosis methods for cervical preneoplastic and neoplastic lesions by means of optical spectroscopy and digital colposcopy A computer program that can be connected to a cervical images acquisition system and automatically detect the lesion in the image and differentiate normal cervix epithelium from low-grade lesions, high-grade lesions and neoplasia is a revolutionary tool in the cervical cancer screening process, especially in underdeveloped countries.
For example, Li et al.
The detection and diagnosis of these lesions are based on the characteristics of the images, such as the margins of the lesions, the blood vessels and the acetowhite regions. The authors also used special filters to enhance the images and increase the accuracy, for example the green filter that accentuates the vasculature.
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The results of this research were: a sensitivity of Another group a researchers Park et al. Their system had two main steps: the regions with similar optical properties were identified and the regions were classified to determine whether neoplastic tissue was present, all based on color patterns.
Lowers et al.
Conclusions The confocal microscopy technique has many benefits: faster diagnosis, high sensitivity and specificity, it reduces the number of biopsies, precise in vivo delimitation of the affected area, facilitating the biopsy and the loop electrosurgical excision procedure.
It is cervical cancer new staging 2019 reliable non-invasive method to assess the resection margins after loop excision or to verify the efficiency of other therapy during the follow-up process. However, due to the high cost, papilloma a nyelven cervical cancer new staging 2019 is not yet generally available. Therefore, more accessible methods of screening and diagnosis are needed, cervical cancer new staging 2019 in developing countries.
Digital colposcopy with automated diagnosis could improve the screening process for cervical cancer, by reducing the number of specialists required and the therapy implementation timing. In conclusion, these two methods, which are so different but so alike, aim to improve the cervical cancer screening and the diagnosis process, cervical cancer new staging 2019 the period between the first medical interaction and treatment implementation, help diagnose preneoplastic and neoplastic cervical lesions, and decrease mortality.
Conflict of interests: The authors declare no conflict of interests. Bibliografie 1.
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