Article Text

Download PDFPDF
Study of the Diagnostic Efficacy of Real-Time Optical Coherence Tomography as an Adjunct to Unaided Visual Inspection With Acetic Acid for the Diagnosis of Preinvasive and Invasive Neoplasia of the Uterine Cervix
  1. Na Wulan, MD*,
  2. Nabila Rasool,
  3. Suzanne E. Belinson,
  4. Chun Wang*,
  5. Xuan Rong*,
  6. Wei Zhang*,
  7. YaSha Zhu*,
  8. Bin Yang§,
  9. Nancy J. Tresser,
  10. Mary Mohr,
  11. RuiFang Wu* and
  12. Jerome L. Belinson, MD
  1. *Peking University Shenzhen Hospital, Department of Obstetrics and Gynecology, Shenzhen, China;
  2. Cleveland Clinic Department of Obstetrics and Gynecology, Cleveland, OH;
  3. Northwestern University Department of Preventive Medicine, Chicago, IL;
  4. §Cleveland Clinic Department of Anatomic Pathology; and
  5. Imalux Corporation, Cleveland, OH.
  1. Address correspondence and reprint requests to Na Wulan, MD, Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, 1120 Lianhua Rd, Futian Shenzhen, China. E-mail: wlnaa{at}


Objectives: To determine the sensitivity and specificity of optical coherence tomography (OCT) as an adjunct to unaided visual inspection using acetic acid (VIA) in the detection of cervical intraepithelial neoplasia 2 (CIN 2) in a real-time clinical evaluation.

Background: This clinical study was a prospective cross-sectional comparative trial that screened 1000 patients (aged 30-50 years) in a low-resource setting. Women with abnormal cervical cytology or positive human papillomavirus (HPV) tests were referred for further evaluation including VIA, OCT imaging, colposcopy, and cervical biopsies.

Methods: The VIA diagnoses were coded by quadrant. The OCT was then performed in all VIA-positive areas and at the squamocolumnar junction in all 4 quadrants. All patients were colposcoped; assessed by quadrant with biopsies at 2, 4, 8, and 10 o'clock; all abnormal areas were biopsied; and endocervical curettage was performed. Data were analyzed using generalized estimating equations and logistic regression.

Results: Of the 1000 patients, 175 (17.5%) were HPV positive, 93 (9.3%) had abnormal cervical cytology greater than or equal to atypical squamous cells of undetermined significance, and 211 (21.1%) were either HPV positive or had abnormal cytology. The VIA, OCT, colposcopy, and biopsies were completed on 183 (86.7%) of 211 women. For VIA alone, the sensitivity and specificity in detecting lesions greater than or equal to CIN 2 was 43% and 96%. With the addition of OCT, the sensitivity increases to 62% with a specificity of 80%.

Conclusions: With the addition of OCT, the sensitivity of VIA increased in all analyses for the detection of greater than or equal to CIN II, with a loss in specificity. We hope that the potential of this technology will be realized when a computer algorithm is generated to aid in image interpretation.

  • Cervical intraepithelial neoplasia
  • Optical coherence tomography (OCT)
  • Visual inspection with acetic acid (VIA)

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.