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Novel Advancements in Colposcopy: Historical Perspectives and a Systematic Review of Future Developments

Adelman, Marisa Rachel MD

Journal of Lower Genital Tract Disease: July 2014 - Volume 18 - Issue 3 - p 246–260
doi: 10.1097/LGT.0b013e3182a72170
Basic Science

Objective: To describe novel innovations and techniques for the detection of high-grade dysplasia.

Materials and Methods: Studies were identified through the PubMed database, spanning the last 10 years. The key words ([“computerized colposcopy” or ”digital colposcopy” or “spectroscopy” or “multispectral digital colposcopy” or “dynamic spectral imaging”, or “electrical impedance spectroscopy” or “confocal endomicroscopy” or “confocal microscopy”or “optical coherence tomography”] and [“cervical dysplasia” or cervical precancer” or “cervix” or “cervical”]) were used. The inclusion criteria were published articles of original research referring to noncolposcopic evaluation of the cervix for the detection of cervical dysplasia. Only English-language articles from the past 10 years were included, in which the technologies were used in vivo, and sensitivities and specificities could be calculated.

Results: The single author reviewed the articles for inclusion. Primary search of the database yielded 59 articles, and secondary cross-reference yielded 12 articles. Thirty-two articles met the inclusion criteria.

Conclusions: An instrument that globally assesses the cervix, such as computer-assisted colposcopy, optical spectroscopy, and dynamic spectral imaging, would provided the most comprehensive estimate of disease and is therefore best suited when treatment is preferred. Electrical impedance spectroscopy, confocal microscopy, and optical coherence tomography provide information at the cellular level to estimate histology and are therefore best suited when deferment of treatment is preferred. If a device is to eventually replace the colposcope, it will likely combine technologies to best meet the needs of the target population, and as such, no single instrument may prove to be universally appropriate. Analyses of false-positive rates, additional colposcopies and biopsies, cost, and absolute life-savings will be important when considering these technologies and are limited thus far.

Optical and ramen spectroscopy offer promise at identifying disease in a treatment paradigm, while confocal microscopy offers promise at excluding disease in a conservative paradigm.

Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT

Reprint requests to: Marisa Rachel Adelman, MD, Department of Obstetrics and Gynecology, University of Utah, 30 N 1900 E, Suite 2B200, Salt Lake City, UT 84132. E-mail: marisa.adelman@hsc.utah.edu

The author has declared that there are no conflicts of interest.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology