目的:探讨光学相干显微镜(OCM)的成像特征及其高分辨率图像在识别宫颈管病变(ECLs)中的应用价值。这是宫颈癌筛查计划中的临床难题。
方法:总共,通过用超高分辨率OCM系统扫描宫颈管病变获得520张OCM图像(来自73例患者的204份标本)。观察并总结了ECL的OCM形态特征,然后3名研究人员对宫颈管病变的OCM图像进行了诊断测试。准确性,灵敏度,特异性,正预测值,负预测值,每个参数的95%置信区间,并计算了研究者间的一致性(κ)。
结果:正常宫颈内膜,囊肿,鳞状上皮化生,涉及腺体的高级别鳞状上皮内病变,浸润性癌具有明显的OCM特征,与相应的H&E组织学切片相关。准确性,灵敏度,3名研究人员的特异性为90.6%,89.3%(95%CI,86.5%-91.7%)和91.6%(95%CI,89.2%-93.5%),分别。阳性预测值为90.1%(95%CI,87.3%-92.4%),阴性预测值为90.9%(95%CI,88.5%-92.9%),几乎完全一致(κ=0.874)。
结论:OCM系统在宫颈管病变中的应用是可行的,有助于提高宫颈癌筛查计划中隐匿性ECLs的检测。本研究为OCM在体内宫颈管病变中的进一步研究奠定了基础,这也对预测超出目前可能的病理评估有潜在的影响,也许是全球。
OBJECTIVE: To investigate optical coherence microscopy (OCM) imaging features and the application value of these high-resolution images for identifying endocervical canal lesions (ECLs), which is a clinical dilemma in cervical cancer screening programs.
METHODS: In total, 520 OCM images were obtained by scanning the cervical canal lesions with an ultra-high-resolution OCM system (204 specimens from 73 patients). The OCM morphologic characteristics of ECLs were observed and summarized, and then 3 researchers performed a diagnostic test of OCM images of cervical canal lesions. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, 95% confidence interval of each parameter, and interinvestigator agreement (κ) were calculated.
RESULTS: Normal endocervix, cysts, squamous metaplasia, high-grade squamous intraepithelial lesions involving glands, and invasive carcinoma had distinct OCM characteristics, which correlated well with corresponding H&E histologic sections. The accuracy, sensitivity, and specificity of the 3 researchers were 90.6%, 89.3% (95% CI, 86.5%-91.7%) and 91.6% (95% CI, 89.2%-93.5%), respectively. The positive predictive value was 90.1% (95% CI, 87.3%-92.4%), and the negative predictive value was 90.9% (95% CI, 88.5%-92.9%), with almost perfect agreement (κ = 0.874).
CONCLUSIONS: The application of the OCM system in cervical canal lesions is feasible and could help improve detection of occult ECLs in cervical cancer screening programs. This study lays the foundation for further research on OCM in cervical canal lesions in vivo, which also has a potential impact on projecting pathologic evaluation beyond what is currently possible, perhaps globally.