Abstract
Cervical cancer incidence and mortality rates remain high in medically underserved areas. In this study, we present a low-cost (<$5,000), portable and user-friendly confocal microendoscope, and we report on its clinical use to image precancerous lesions in the cervix. The confocal microendoscope employs digital apertures on a digital light projector and a CMOS sensor to implement line-scanning confocal imaging. Leveraging its versatile programmability, we describe an automated aperture alignment algorithm to ensure clinical ease-of-use and to facilitate technology dissemination in low-resource settings. Imaging performance is then evaluated in ex vivo and in vivo pilot studies; results demonstrate that the confocal microendoscope can enhance visualization of nuclear morphology, contributing to significantly improved recognition of clinically important features for detection of cervical precancer.
Highlights
Cervical cancer imposes an enormous burden on healthcare worldwide
Parra et al showed that the specificity of the high-resolution microendoscope (HRME) for detecting precancerous lesions was higher than that of colposcopy in 174 women enrolled in a range of clinical settings, suggesting that 21% fewer unnecessary
In site A, the squamous epithelium was characterized by evenly spaced nuclei embedded in heterogeneous background, which could be from non-specific staining of keratin in the ectocervix
Summary
Cervical cancer imposes an enormous burden on healthcare worldwide. Despite the effectiveness of screening programs in several high-income countries, cervical cancer has the second highest incidence and mortality rates among women in lower Human Development Index (HDI) areas [1,2,3]. Parra et al showed that the specificity of the HRME for detecting precancerous lesions (grade 2 or higher cervical intraepithelial neoplasia [CIN2 + ]) was higher than that of colposcopy in 174 women enrolled in a range of clinical settings, suggesting that 21% fewer unnecessary biopsies could be spared with in vivo microscopic imaging at the point-of-care [12] In another prospective randomized trial involving 200 women with abnormal Papanicolaou tests in rural Brazil, Hunt et al showed that women referred to mobile vans equipped with HRMEs were more likely to complete diagnostic follow-up compared with those referred to central hospitals (87% vs 64%) [11]
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