Elsevier

Academic Radiology

Volume 9, Issue 5, May 2002, Pages 504-512
Academic Radiology

Original Investigations
Near Real-Time Confocal Microscopy of Amelanotic Tissue: Detection of Dysplasia in ex Vivo Cervical Tissue

https://doi.org/10.1016/S1076-6332(03)80326-4Get rights and content

Abstract

Rationale and Objectives

The authors performed this study to determine whether images of ex vivo tissue obtained with a near real-time confocal microscope can be used to differentiate between normal and dysplastic tissue.

Materials and Methods

Biopsy specimens of colposcopically normal and abnormal cervical tissue were obtained from 19 patients and imaged at various depths with a confocal microscope. Nuclear morphologic features were extracted from the confocal images; in addition, a group of reviewers examined the images and attempted to identify whether the specimen contained high-grade dysplasia. Results of both analyses were compared with the histopathologic findings of the same specimens provided by a board-certified pathologist with expertise in gynecologic pathology.

Results

The morphologic feature measurements compared well with the findings at pathologic examination. The use of the nuclear-cytoplasmic ratio to determine the presence of dysplasia resulted in a sensitivity of 100% and a specificity of 91%. The untrained reviewers had an average sensitivity of 95% and an average specificity of 69% in the determination of dysplasia.

Conclusion

The results indicate the clinical potential of in vivo confocal imaging in the detection of dysplasia.

Section snippets

Patients

Cervical biopsy specimens were obtained from 25 patients at the colposcopy clinics of the University of Texas M.D. Anderson Cancer Center, Herman Hospital, and Lyndon Baines Johnson Hospital in Houston, Tex. The patients had been referred to these clinics (a) because they were suspected of having dysplasia owing to abnormal findings at cervical cytologic examination or (b) for removal of the cervical tissue with the loop electrical excision procedure owing to a previous diagnosis of dysplasia.

Results

Figure 2 shows images of colposcopically normal and abnormal biopsy specimens obtained in one patient at various depths. The cell nuclei can be seen on all of the confocal images, and the cell outlines can be seen around most cells of the normal specimen. The nuclear density of the abnormal specimen is clearly increased compared with that of the normal specimen. The area of individual nuclei on the images of the abnormal specimen is also greater than that of the normal specimen. These

Discussion

Our results show that both quantitative analysis of confocal images and qualitative review by untrained observers can yield high sensitivity and specificity compared with histopathologic diagnosis. Analysis of nuclear feature measurements indicated that the nuclear-cytoplasmic ratio appears to be the most important feature for detecting dysplasia on confocal images in which the image plane is parallel to the tissue surface. The penetration depth at which images with clear intracellular features

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Supported by National Institutes of Health grant RO1 CA 82880-01.

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