Established and Emerging Optical Technologies for the Real-Time Detection of Cervical Neoplasia: A Review

作     者：Breana Hill Sylvia F. Lam Pierre Lane Calum MacAulay Leonid Fradkin Michele Follen 

作者机构：New York Medical College Valhalla NY USA Department of Obstetrics and Gynecology Brookdale Hospital and Medical Center Brooklyn NY USA The British Columbia Cancer Research Centre Vancouver BC Canada 

出 版 物：《Journal of Cancer Therapy》 (癌症治疗（英文）)

年 卷 期：2017年第8卷第13期

页      面：1241-1278页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Cervical Cancer Detection Cervical Cancer Screening Cervical Cancer Diagnosis Optical Technologies Real-Time Diagnosis 

摘      要：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 techno