Accuracy of optical spectroscopy for the detection of cervical intraepithelial neoplasia without colposcopic tissue information; a step toward automation for low resource settings

Optical spectroscopy has been proposed as an accurate and low-cost alternative for detection of cervical intraepithelial neoplasia. We previously published an algorithm using optical spectroscopy as an adjunct to colpo- scopy and found good accuracy (sensitivity ¼ 1.00 (95% confidence interval ðCI Þ¼ 0.92 to 1.00), specificity ¼ 0.71 (95% CI ¼ 0.62 to 0.79)). Those results used measurements taken by expert colposcopists as well as the col- poscopy diagnosis. In this study, we trained and tested an algorithm for the detection of cervical intraepithelial neoplasia (i.e., identifying those patients who had histology reading CIN 2 or worse) that did not include the colpo- scopic diagnosis. Furthermore, we explored the interaction between spectroscopy and colposcopy, examining the importance of probe placement expertise. The colposcopic diagnosis-independent spectroscopy algorithm had a sensitivity of 0.98 (95% CI ¼ 0.89 to 1.00) and a specificity of 0.62 (95% CI ¼ 0.52 to 0.71). The difference in the partial area under the ROC curves between spectroscopy with and without the colposcopic diagnosis was statistically significant at the patient level (p ¼ 0.05) but not the site level (p ¼ 0.13). The results suggest that the device has high accuracy over a wide range of provider accuracy and hence could plausibly be implemented by providers with limited training. © 2012 Society of Photo-Optical Instrumentation Engineers (SPIE). (DOI: 10.1117/1.JBO.17.4.047002)