scholarly journals Quality Assessment of Endoscopic Forceps Biopsy Samples under Magnifying Narrow Band Imaging for Histological Diagnosis of Cervical Intraepithelial Neoplasia: A Feasibility Study

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 360
Author(s):  
Kunihisa Uchita ◽  
Hideki Kobara ◽  
Kenji Yorita ◽  
Yuriko Shigehisa ◽  
Chihiro Kuroiwa ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Intraepithelial Neoplasia ◽  
Final Diagnosis ◽  
Punch Biopsy ◽  
High Grade ◽  
Current Standard ◽  
Forceps Biopsy ◽  
Endoscopic Forceps Biopsy

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.

Cervical intraepithelial neoplasia (CIN) in African women living with HIV: role and effect of rigorous histopathological review by a panel of pathologists in the HARP study endpoint determination

2017 ◽  
Vol 71 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Sylviane Doutre ◽  
Tanvier Omar ◽  
Olga Goumbri-Lompo ◽  
Helen Kelly ◽  
Omar Clavero ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Final Diagnosis ◽  
African Women ◽  
Study Endpoint ◽  
High Grade ◽  
Women Living With Hiv ◽  
Four Quadrant ◽  
Living With Hiv

AIMSTo analyse the effect of the expert end-point committee (EPC) review on histological endpoint classification of cervical intraepithelial neoplasia (CIN).MethodsA cohort of women living with HIV were recruited in Burkina Faso (BF) and South Africa (SA) and followed over 18 months. Four-quadrant cervical biopsies were obtained in women with abnormalities detected by at least one screening test. A central review by a panel of five pathologists was organised at baseline and at endline.ResultsAt baseline the prevalence of high-grade CIN (CIN2+) was 5.1% (28/554) in BF and 23.3% (134/574) in SA by local diagnosis, and 5.8% (32/554) in BF and 22.5% (129/574) in SA by the EPC. At endline the prevalence of CIN2+ was 2.3% (11/483) in BF and 9.4% (47/501) in SA by local diagnosis, and 1.4% (7/483) in BF and 10.2% (51/501) in SA by EPC. The prevalence of borderline CIN1/2 cases was 2.8% (32/1128) and 0.8% (8/984) at baseline and endline. Overall agreement between local diagnosis and final diagnosis for distinguishing CIN2+ from ≤CIN1 was 91.2% (κ=0.82) and 88.9% (κ=0.71) for BF at baseline and endline, and 92.7% (κ=0.79) and 98.7% (κ=0.97) for SA at baseline and endline. Among the CIN1/2 cases, 12 (37.5%) were graded up to CIN2 and 20 (62.5%) were graded down to CIN1 at baseline, and 3 (37.5%) were graded up to CIN2 and 5 (62.5%) were graded down to CIN1 at endline.ConclusionsThis study highlights the importance of a centralised rigorous re-reading with exchange of experiences among pathologists from different settings.

scholarly journals Flexible magnifying endoscopy with narrow band imaging versus colposcopy for diagnosing uterine cervical neoplasms: a multicenter, prospective, non-randomized, paired comparison study

2021 ◽  
Author(s):  
Hideki Kobara ◽  
Kunihisa Uchita ◽  
Noriya Uedo ◽  
Jun Kunikata ◽  
Kenji Yorita ◽  
...  
Keyword(s):  
Pap Smear ◽  
Narrow Band ◽  
Narrow Band Imaging ◽  
Paired Comparison ◽  
Intraepithelial Neoplasia ◽  
Punch Biopsy ◽  
Magnifying Endoscopy ◽  
Detection Sensitivity ◽  
Comparison Study ◽  
Cervical Intraepithelial Neoplasia Grade

Objective To investigate the detection ability of flexible magnifying endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial neoplasia grade two or worse (CIN2+) compared with colposcopy. Design Multicenter, prospective, non-randomized, paired comparison study. Setting Three Japanese medical centers. Population Japanese women. Methods Eligible patients had positive PAP smear test results, suspicious high-grade CIN in previous colposcopy, or definitive CIN3 diagnosed previously. A gastrointestinal endoscopist examined the cervix using ME-NBI in an endoscopy room and, subsequently, a gynecologist blinded to the ME-NBI findings performed colposcopy in a different room. CIN2+ locations were documented in a scheme immediately after each examination. Punch biopsy samples were obtained from all areas diagnosed as CIN2+ with both methods and from one normal area. The reference standard was the presence of at least one histological diagnosis of CIN2+ among all biopsy specimens. Main outcome measures The primary outcome was the detection sensitivity of patients with CIN2+, comparing ME-NBI and colposcopy. Results We enrolled 88 patients. The detection sensitivity for patients with CIN2+ was not statistically different between the two methods (both: 79%, 95% CI: 66%–88%). For diagnosing CIN2+, ME-NBI tended to show a higher sensitivity than colposcopy (69% vs. 58%, respectively), while its specificity tended to be lower vs. colposcopy (55% vs. 70%, respectively). Patients reported significantly less discomfort and embarrassment with ME-NBI vs. colposcopy. Conclusion ME-NBI showed comparable sensitivity to colposcopy for detecting CIN2+ lesions, and ME-NBI was more patient-acceptable.

Endoscopic and Histopathology Characteristics in Patients with Esophageal High-Grade Intraepithelial Neoplasia

2018 ◽  
Vol 36 (5) ◽  
pp. 384-393 ◽  
Author(s):  
Huai-Ming Sang ◽  
Jiu-Liang Cao ◽  
Muhammad Djaleel Soyfoo ◽  
Wei-Ming Zhang ◽  
Jian-Xia Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Curative Resection ◽  
Narrow Band Imaging ◽  
Histological Grade ◽  
Intraepithelial Neoplasia ◽  
Lesion Size ◽  
High Grade ◽  
Independent Risk Factors ◽  
Endoscopic Characteristics ◽  
Endoscopic Forceps Biopsy

Background/Aims: To correlate the endoscopic characteristics with the histopathology of specimens of esophageal high-grade intraepithelial neoplasia obtained by endoscopic submucosal dissection (ESD). Methods: This was a retrospective study developed from January 2010 to December 2015. The study included 169 patients who underwent ESD and were diagnosed with esophageal high-grade intraepithelial neoplasia according to endoscopic forceps biopsy, Lugol staining, endoscopic ultrasonography, computed tomography, and Narrow-Band Imaging. The demographic, endoscopic, and histopathologic characteristics were analyzed. Results: A total of 19 cases (11.2%) had a change in diagnosis after histopathology exam and 16 (9.5%) needed a change in established treatment. An increase in the severity of disease was correlated with a lesion size > 2 cm, less than 4 samples in biopsy, and depressed or excavated patterns (p < 0.05). One hundred forty patients (82.8%) underwent curative resection. Lesions with leukoplakia (p < 0.001) and negative Lugol staining (p = 0.028) were independent risk factor for non-curative resection. Conclusion: This study confirms that lesion size > 2 cm, depressed and excavated patterns, and ≤4 biopsy samples are independent risk factors for histological grade changes compared to pre-endoscopic treatment diagnosis. Similarly, leukoplakia and no Lugol staining of lesions are independent risk factors for non-curative resection.

scholarly journals Expansile Endocervical Crypt Involvement by CIN2 – 3 as a Risk Factor for High Grade Cytology Recurrence After Cold Coagulation Cervical Treatment

2020 ◽  
Vol 80 (09) ◽  
pp. 941-948
Author(s):  
Dimitrios Papoutsis ◽  
Martyn Underwood ◽  
Joanna Williams ◽  
William Parry-Smith ◽  
Jane Panikkar
Keyword(s):  
Multivariate Analysis ◽  
Risk Factor ◽  
Observational Study ◽  
Cervical Intraepithelial Neoplasia ◽  
Secondary Analysis ◽  
Intraepithelial Neoplasia ◽  
Punch Biopsy ◽  
High Grade ◽  
Cold Coagulation

Abstract Introduction To determine whether expansile endocervical crypt involvement (ECI) on pretreatment cervical punch biopsies is a risk factor for high grade cytology recurrence in women following cold coagulation for cervical intraepithelial neoplasia (CIN). Materials and Methods This was a secondary analysis on the results of an observational study of women who had a single cold coagulation cervical treatment between 2001 – 2011 and who were followed up for cytology recurrence. Women with a previous cervical treatment were excluded. Results 559 women were identified with a mean age of 28.7 ± 6.2 years. Expansile and non-expansile ECI were identified in 5.4 and 4.3% of women, respectively. The proportion of women with high grade cytology recurrence was 10% for those with expansile ECI and 2.3% for those without. Multivariate analysis showed that women with expansile ECI when compared to those without, had a four-fold greater risk for high grade cytology recurrence (HR = 4.22; 95% CI: 1.10 – 16.29, p = 0.036). There was no significant association found between non-expansile ECI and overall or high grade cytology recurrence. The increased biopsy depth and the CIN3 grade of pretreatment cervical punch biopsies were significantly associated with greater odds for the detection of expansile ECI. We calculated that the optimal-cut off of pretreatment cervical punch biopsy depth for the detection of expansile ECI was 4 mm (sensitivity: 73.3%; specificity: 55.1%). Conclusions Expansile ECI is a risk factor that increases the likelihood of high grade cytology recurrence following cold coagulation. Deeper pretreatment cervical punch biopsies need to be taken so as not to miss expansile ECI prior to ablative treatment.

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