Abstract
The current standard for diagnosing cervical intraepithelial neoplasia (CIN) is colposcopy followed by punch biopsy. We have developed flexible magnifying endoscopy with narrow band imaging (ME-NBI) for the diagnosis of CIN. Here, we investigated the feasibility of targeted endoscopic forceps biopsy (E-Bx) under guidance of ME-NBI for the diagnosis of CIN. We prospectively enrolled 32 consecutive patients with confirmed or suspected high-grade CIN undergoing cervical conization. Next to colposcopy, the same patients underwent ME-NBI just before conization. ME-NBI was performed, and 30 E-Bx samples were taken from lesions suspicious for high-grade CIN and 15 from non-suspicious mucosa. We recalled 82 punch biopsy (P-Bx) specimens taken from lesions suspicious for high-grade CIN under colposcopic examination before enrollment. The proportion of sufficient biopsy samples, which had an entire mucosal layer with subepithelial tissue, for the diagnosis of CIN was evaluated by both methods. Performance of targeted E-Bx for the final diagnosis of at least high-grade CIN was calculated. Seventeen P-Bx specimens were unavailable. The proportion of sufficient samples with E-Bx was 84%, which was similar to that with P-Bx (87%) (p = 0.672). The sensitivity, specificity, and accuracy of ME-NBI using E-Bx was 92%, 81%, and 88%, respectively. In conclusion, ME-NBI-guided E-Bx samples were feasible for histological diagnoses of CIN, and further investigation of its diagnostic accuracy is warranted.
Highlights
magnifying endoscopytechnique (ME)-Narrow band imaging (NBI), magnifying endoscopy with narrow band imaging; CIN, cervical intraepithelial neoplasia; E-Bx, endoscopic forceps biopsy; PV, predictive value. This is believed to be the first study to evaluate the quality of E-Bx samples under MENBI in the histological diagnosis of CIN
The specimen size of the E-Bx samples was significantly smaller than that of P-Bx samples, the sufficiency of biopsy samples to diagnose CIN was similar, and E-Bx under ME-NBI showed promising diagnostic performance for ≥CIN2. Despite their small specimen size, most E-Bx samples contained both the entire epithelial layer and subepithelial tissue; the diagnosis of CIN was possible with E-Bx and P-Bx
E-Bx under ME-NBI could be an acceptable method for diagnosing cervical cancer
Summary
Kunihisa Uchita 1 , Hideki Kobara 2, * , Kenji Yorita 3 , Yuriko Shigehisa 1 , Chihiro Kuroiwa 1 , Noriko Nishiyama 2 , Yohei Takahashi 4 , Yuka Kai 4 , Jun Kunikata 5 , Toshio Shimokawa 6 , Uiko Hanaoka 7 , Kenji Kanenishi 7 , Tsutomu Masaki 2 , Koki Hirano 4 and Noriya Uedo 8.
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