Is Proflavine Exposure Associated with Disease Progression in Women with Cervical Dysplasia? A Brief Report.

Naitielle Pantano,Katelin Cherry,Brady Hunt,Richard A Schwarz,Adhemar Longatto‐Filho,Philip E Castle,Sonia Parra,Júlio César Possati‐Resende,José Humberto Tavares Guerreiro Fregnani,Kathleen Schmeler,Rebecca Richards‐Kortum

doi:10.1111/php.12976

Abstract

Proflavine is an acridine dye used with high‐resolution microendoscopy for in vivo diagnostic evaluation of cervical epithelial cells. However, there are concerns that even short‐term exposure of cervical tissue to dilute proflavine may increase cervical cancer risk. We performed a retrospective analysis of women referred for colposcopy to Barretos Cancer Hospital comparing the risk of cervical disease progression in those whose cervical tissue was (n = 232) or was not exposed (n = 160) to proflavine. Patients in both groups underwent treatment and follow‐up based on histopathologic results and per the local standards of care. Progression of disease was evaluated by comparing histopathology from the initial visit to the worst subsequent histopathology result from all follow‐up visits. Mean duration of follow‐up was 18.7 and 20.1 months for the proflavine‐exposed and controls groups, respectively. There were no significant differences in disease progression from normal/CIN1 to CIN2/3 or from any initial diagnosis to invasive cancer between the proflavine exposed and control groups overall. Risks of cervical dysplasia progression observed in this study are in agreement with those of the natural history of cervical cancer. Our results suggest that cervical exposure to dilute proflavine does not increase the risk of cervical precancer and cancer.

Highlights

Proflavine is a fluorescent dye that has long been recognized and used as a topical antibacterial agent
We assessed whether proflavine might increase the risk of cervical neoplasia progression when used as a fluorescent contrast agent for in vivo microscopy during colposcopic examination
Our results showed no significant increases in cervical dysplasia progression in women exposed to proflavine when compared to a control group of nonexposed women

Summary

Introduction

Proflavine is a fluorescent dye that has long been recognized and used as a topical antibacterial agent. Acriflavine has been reported as a contrast agent for in vivo confocal laser endomicroscopy in the colon [7,8], stomach [9], duodenum [10], upper gastrointestinal tract [11] and central airway [12]. In these studies, acriflavine was applied topically to the tissue prior to imaging, usually in combination with intravenous fluorescein. The use of proflavine or acriflavine in combination with in vivo microscopy enables real-time assessment of the morphology and distribution of cell nuclei, aiding in the accurate identification of precancerous lesions [16]

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Results

Conclusion