Modern cervical imaging assessment. Review of literature on confocal microscopy and digital automated colposcopy

Abstract

Colposcopy is today the gold standard investigation to diagnose cervical intraepithelial neoplasia (CIN) following a modified Pap smear. 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 a wide applicability as an endoscopic imaging technique and already proved useful in cases with cervical lesions. 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.