5-aminolevulinic-acid-based fluorescence spectroscopy and conventional colposcopy for in vivo detection of cervical pre-malignancy.

Abstract

BACKGROUND:

Sensitized fluorescence diagnostics are based on selective accumulation of photosensitizer in the tissue where carcinogenesis has started. The present study compared topical 5-aminolevulinic acid (5-ALA)-based fluorescence spectroscopy (FS) in vivo with conventional colposcopy for cervical intraepithelial neoplasia (CIN) detection.

METHODS:

We enrolled 48 patients who were referred for colposcopy because of high-grade changes in cervical cytology. Every inspected cervix was divided in to quadrants, and there were 174 quadrants included in the study. Each patient had a cytological smear, colposcopy, FS and histopathological analysis. For FS, 3% 5-ALA cream was used topically and after an average 135 min incubation, fluorescence spectra were recorded from the cervix in vivo. FS and colposcopy results were correlated with histopathology.

RESULTS:

All spectra were evaluated by a ratio of the protoporphyrin IX fluorescence intensity at 634 nm and autofluorescence intensity at 510 nm. For proper grouping of low-risk and high-risk cases, a threshold of 3.87 was calculated. Data per quadrant showed that FS had higher sensitivity than colposcopy (71.7% vs 67.4%) but specificity was greater for colposcopy (86.6% vs 75.6%). Combination of the methods showed higher sensitivity (88.0% vs 67.4%) but reduced specificity (88.0% and 69.5%), but it had the highest number of correctly identified high-risk changes and the highest (79.3%) accuracy. Data for each patient showed FS sensitivity of 91.2%, which was greater than for colposcopy (88.2%). Higher overdiagnosis resulted in decreased specificity for fluorescence methodology-71.4% versus 78.6% for colposcopy. In both cases, accuracy was 85.4% and effectiveness was >80%, which means that both methods can be used to determine high-risk cervical intraepithelial neoplasia. The diagnostic sensitivity of 97.1% for this complementary diagnosis indicates that it could be the best choice for detection of high-risk changes.

CONCLUSIONS:

5-ALA-based FS is an objective method, requiring short-term administration for appropriate fluorescence measurements. FS is a promising diagnostic tool with similar accuracy as colposcopy but with the potential advantage of providing objective results.

• Authors: Rasa Vansevičiūtė, Jonas Venius, Olga Žukovskaja, Daiva Kanopienė, Simona Letautienė, Ričardas Rotomskis
• Journal: BMC women's health (BMC Womens Health) Vol. 15 Pg. 35 (Apr 17 2015) ISSN: 1472-6874 [Electronic] England
• PMID: 25887444 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Photosensitizing Agents
• Aminolevulinic Acid

Topics

• Adult
• Aminolevulinic Acid (pharmacology)
• Colposcopy (methods)
• Early Detection of Cancer (methods)
• Female
• Humans
• Middle Aged
• Photosensitizing Agents (pharmacology)
• Reproducibility of Results
• Sensitivity and Specificity
• Spectrometry, Fluorescence (methods)
• Vaginal Smears (methods)
• Uterine Cervical Dysplasia (diagnosis)