Flexible Magnifying Endoscopy with Narrow Band Imaging for Diagnosing Uterine Cervical Neoplasms: A Multicenter Prospective Study.

Hideki Kobara,Kenji Kanenishi,Yumiko Kiyohara,Kenji Yorita,Jun Kunikata,Noriko Nishiyama,Koki Hirano,Tsutomu Masaki,Shoji Kamiura,Chihiro Kuroiwa,Kunihisa Uchita,Noriya Uedo,Yohei Takahashi,Noriko Matsuura,Naoya Tada,Yuriko Shigehisa,Yuka Kai,Uiko Hanaoka

doi:10.3390/jcm10204753

Abstract

We aimed to investigate the diagnostic ability of magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade 2 or worse (CIN2+). This was a multicenter prospective study. Eligible patients had positive Pap smear results or follow-up high-grade cytology or CIN3 diagnosed in referring hospitals. Patients underwent ME-NBI by a gastrointestinal endoscopist, followed by colposcopy by a gynecologist. One lesion with the worst finding was considered the main lesion. Punch biopsies were collected from all indicated areas and one normal area. The reference standard was the highest histological grade among all biopsy specimens. The primary endpoint was the detection rate of patients with CIN2+ in the main lesion. The secondary endpoints were diagnostic ability for CIN2+ lesions and patients’ acceptability. We enrolled 88 patients. The detection rate of ME-NBI for patients with CIN2+ was 79% (95% CI: 66–88%; p = 1.000), which was comparable to that of colposcopy (79%; p = 1.000). For diagnosing CIN2+ lesions, ME-NBI showed a better sensitivity than colposcopy (87% vs. 74%, respectively; p = 0.302) but a lower specificity (50% vs. 68%, respectively; p = 0.210). Patients graded ME-NBI as having significantly less discomfort and involving less embarrassment than colposcopy. ME-NBI did not show a higher detection ability than colposcopy for patients with CIN2+, whereas it did show a better patient acceptability.

Highlights

Uterine cervical cancer is caused by human papillomavirus (HPV) infection, and proper screening programs promise cancer detection at an early stage
The aim of this study was to examine the diagnostic ability of magnifying endoscopy with narrow band imaging (ME-NBI) for diagnosing CIN compared with that of colposcopy
The case report forms for ME-NBI and colposcopy were faxed to the Department of Clinical Research Support Center, Faculty of Medicine, Kagawa University on the day of the examination

Summary

Introduction

Uterine cervical cancer is caused by human papillomavirus (HPV) infection, and proper screening programs promise cancer detection at an early stage. The World Health Organization is establishing a strategy to achieve a one-third reduction in premature mortality from cervical cancer by 2030 [1]. The strategy emphasizes the importance of triple intervention targets constituting increased HPV vaccination rates, screening rates, and treatment of preinvasive and invasive lesions for cervical cancer. In many screening programs, HPV testing has been adopted as the first triage, followed by colposcopy [2]. Traditional screening constitutes cytological examination (Pap smear) followed by colposcopy. In both methods, colposcopy is important for identifying lesions with CIN grade 2 or worse (CIN2+) and for treatment decision making

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