TITLE:
Established and Emerging Optical Technologies for the Real-Time Detection of Cervical Neoplasia: A Review
AUTHORS:
Breana Hill, Sylvia F. Lam, Pierre Lane, Calum MacAulay, Leonid Fradkin, Michele Follen
KEYWORDS:
Cervical Cancer Detection, Cervical Cancer Screening, Cervical Cancer Diagnosis, Optical Technologies, Real-Time Diagnosis
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.8 No.13,
December
21,
2017
ABSTRACT: Cervical cancer remains a critically important
problem for women, especially those women in
the developing world where the case-fatality rate is high. There are an estimated 528,000 cases and 266,000 deaths
worldwide. Established screening and detection programs in the developed
world have lowered the mortality from 40/100,000 to 2/100,000 over the last 60
years. The standard of care has been and continues to be: a
screening Papanicolaou smear with or without Human Papilloma Virus (HPV) testing; followed by colposcopy and biopsies and if the smear is abnormal; and
followed by treatment if the biopsies show high grade disease (cervical
intraepithelial neoplasia (CIN) grades 2 and 3 and Carcinoma-in-situ). Low grade
lesions (Pap smears with Atypical Cells of Uncertain Significance
(ASCUS), Low Grade Squamous Intraepithelial Lesions (LGSIL), biopsies showing HPV changes or showing CIN 1); are usually followed for two years and then treated if persistent. Treatment can be
performed with loop excision, LASER, or cryotherapy. Loop excision yields a
specimen which can be reviewed to establish the diagnosis more accurately.
LASER vaporizes the lesion and cryotherapy leads to tissue destruction. Under
long term study; loop excision, LASER, and cryotherapy have the same rate of
cure. The standard of care is expensive and
takes 6 - 12 weeks for the individual patient. During the last twenty years, new technologies that can view the cervix
and even image the cervix with cellular resolution have been developed. These
technologies could lead to a new paradigm in
which diagnosis and treatment occurs at a single visit. These technologies include fluorescence and reflectance
spectroscopy (probe or wide-field,
whole cervix scanning approaches) and fluorescence confocal endomicroscopy
or high resolution micro-endoscopy. Both technologies have received Federal Drug Administration
(FDA) and have been commercialized. Research trials continue to show their remarkable
performance. These technologies are reviewed and clinical trials are summarized.
Emerging technologies are coming along that may compete with those already
approved and include optical coherence
tomography, optical coherence tomography with autofluorescence, diffuse
optical microscopy, and dual mode micro-endoscopy. These technologies are also
reviewed and where available, clinical data is reported. Optical technologies
are ready to diffuse into clinical practice because they will save money and 3
or 4 visits in the developed world and offer the same standard of care to the developing
world where more cervical cancer exists.