PMC5757110_01
(a, b, and c) First examination. (a) Cervical appearance prior to application of acetic acid. (b) Cervical appearance after application of acetic acid. (c) DSI map overlaid on the cervix. Strong acetowhitening signal suggested potential high-grade lesion as identified by the DSI technology (colour legend on the left). The circular annotations are the biopsy sites selected and indicated during the examination; number 1 was identified by the colposcopist; numbers 2 and 3 were marked using the DSI map. (d, e, and f) Follow-up examination. (d) Cervical appearance prior to application of acetic acid. (e) Cervical colposcopic appearances after application of acetic acid. No significant acetowhitening effect is observed. (f) DSI map overlaid on the cervix, confirming the absence of significant changes. Notably, the area that yielded CIN2 at the first visit, now appears normal.
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fig1
One of the biopsy sites was selected based on clinical judgement prior to reviewing the DSI map, and two further were directed by the DSI map (Figure 1(c)). This time, neither the colposcopic impression nor the DSI map suggested any areas suspicious of high-grade disease (Figures 1(d), 1(e), and 1(f)).
Histopathology images from the punch biopsies. (a) Mild atypia (CIN1) in lower third of cervix squamous epithelium with viral cytopathic effect in upper two-thirds (HE x100). (b) Higher magnification (HE x200) of CIN1 showing viral cytopathic effect in upper layers of squamous epithelium and mild atypia in lower third. (c) CIN2, showing almost full thickness epithelial atypia (HE x200).
CRIOG2017-5269279.002.jpg
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fig2
The biopsy which was based on colposcopic impression showed koilocytic changes and CIN1 only, whereas the two biopsies based on the DSI evaluation showed CIN1 and CIN2 (Figure 2).