Diagnostics
Improving detection rates in colposcopy
Amanda Caley provides an insight into the evidence to support the use of technology that could improve detection rates in colposcopy – including the results of an independent study, carried out at East Lancashire Hospitals. The technology uncovered 21 high grade Cervical Interepithelial Neoplasia (CIN) in patients that would have otherwise been missed.
Cervical cancer is the fourth most common cancer in women globally and the 14th
most
common cancer in the UK with 3,200 new cases diagnosed each year. According to WHO, an estimated 570,000 women were diagnosed with cervical cancer worldwide in 2018 and it was responsible for over 300,000 deaths. If diagnosed early enough the disease can be treated, particularly at the pre-cancerous or cervical intra-epithelial neoplasia (CIN) stage. Almost all cervical cancer cases occur in women who have been previously infected with Human Papillomavirus (HPV). HPV is a group of viruses, rather than a single virus. There are more than 100 different types of HPV. It is very common and is spread during sexual intercourse and other types of sexual activity. Some types of HPV do not cause any noticeable symptoms but at least 15 types of HPV are considered high-risk when it comes to cervical cancer. The two highest risks are HPV 16 and HPV 18, which cause the majority of cervical cancers.
High-risk types of HPV are thought to stop the cells working normally, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour. Early detection and treatment are key if numbers are to start decreasing globally. After over a year of effective implementation
of Zillico’s ZedScan diagnostic system within the colposcopy practice across East Lancashire Hospitals (ELH), the findings of initial studies are very encouraging. ZedScan was implemented at ELH in 2020 following an effective pilot in 2019, presented at British Society of Colposcopy Cervical Pathology (BSCCP) 2021. ZedScan helps exclude high-grade disease,
reduce biopsies and the number of follow up visits for patients. Colposcopy is reliant on nonspecific visual indicators, which are highly variable and subjective. Variation in performance for colposcopy is high with average sensitivity to distinguish between low- and high-grade CIN sitting at around 55%. The aims and objectives of the study were
to evaluate the impact of ZedScan one year after full implementation, based on four key outcomes: 1. Diagnosis/exclusion of high-grade disease at the first visit 2. Impact on punch biopsy at the first visit 3. Impact on follow up visits 4. Value added gains as a result of the above
What the study found l Colposcopy without ZedScan adjunct in ELH services would have missed 21 high-grade CIN (6.7%)
l ZedScan diagnosed 6 CIN (10%) among 59 clinical indication referrals (4 CIN1,2 CIN2/3) which would have otherwise been missed.
l 73.5% of the overall cohort were discharged at first visit
l Overall, the use of ZedScan as an adjunct technology implemented within ELH colposcopy services has enhanced the detection of high-grade disease
l ZedScan has also helped reduce and standardise overall biopsy rates to 48% (previously, overall biopsy rates varied between 95% and 40% per clinician). This consistency helps reduce the pressures on histopathology and patient follow ups.
Furthermore, other peer reviewed research published in the European Journal of Obstetrics & Gynecology and Reproductive Biology has shown that the use of ZedScan within the cervical cancer pathway significantly increased the detection of pre-cancer and cancer. The biggest increase was in women referred with low-grade changes – often the most challenging for clinicians to visualise – where ZedScan had more than a 50% increase in high-grade disease detection. Scientists looked at the examinations of 5,257 women by 82 colposcopists in 26 clinics in nine different countries. Research showed that: l HPV vaccination and primary HPV screening
August 2023 I
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