Letter to the editor: the value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microin
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CORRESPONDENCE
Letter to the editor: the value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma Hideki Kobara1 · Kunihisa Uchita3 · Noriya Uedo4 · Kenji Kanenishi2 · Tsutomu Masaki1 Received: 22 July 2020 / Accepted: 4 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, We read with great interest the recent published report by Guo demonstrating a novel microendoscopic imaging system in the diagnosis of cervical intraepithelial neoplasms (CIN) [1]. A recent review article found a moderate sensitivity with colposcopy for CIN2 + of 75·1%, and specificity of 71·0% [2]. Thus, microendoscopy has a potential value to improve the diagnostic field of CIN. However, as acetowhite epithelium detected by colposcopy is considered the main finding of CIN, the evaluation for atypical vessels alone by microendoscopy is limited for accurate diagnosis. Currently, flexible magnifying endoscopy with narrow band imaging (ME-NBI) has excellent diagnostic ability for superficial
gastrointestinal neoplasms [3]. Our previous investigation suggested that ME-NBI was also effective for evaluating atypical vessels [4] as well as white epithelium of CIN [5] (Fig. 1). In this method, patients undergo vaginal ME-NBI (gastroscope, GIF-H290Z; Olympus, Tokyo, Japan) in the left lateral decubitus position. We use a balloon (Fuji Systems Corporation; Tokyo, Japan) mounted on the endoscope’s tip to occlude the vaginal orifice, and the cervix and vagina are well visualized. The whole circumference of the cervix is then examined to detect CIN. This novel method may overcome the disadvantages of colposcopy and open new frontiers in diagnosing cervical neoplasms.
* Hideki Kobara [email protected]‑u.ac.jp 1
Department of Gastroenterology and Neurology, Faculty of Medicine Kagawa University, 1750‑1 Ikenobe, Miki, Kita, Kagawa 761‑0793, Japan
2
Department of Gynecology, Faculty of Medicine, Kagawa University, 1750‑1 Ikenobe, Miki, Kita, Kagawa 761‑0793, Japan
3
Department of Gastroenterology, Kochi Red Cross Hospital, 2‑13‑51 Sinhonmachi, Kochi 780‑8562, Japan
4
Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 1‑69, Otemae 3‑chome, Chuo‑ku, Osaka 541‑8567, Japan
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Archives of Gynecology and Obstetrics
Archives of Gynecology and Obstetrics ◂Fig. 1 a Schema showing colposcopy under cusco’s speculum. b Col-
poscopic view with acetowhite epithelium (red arrows). c Schema showing flexible magnifying endoscopy with narrow band imaging (ME-NBI) under balloon occlusion. d White light imaging showing a well-visualized cervix owing to balloon occlusion. E Endoscopic view with NBI showing a thick white epithelium (yellow circle). e ME-NBI image showing a thick white epithelium (yellow circle) and atypical vessels (blue arrows)
Kind regards, Hideki Kobara, MD, Kunihisa Uchita, MD, Noriya Uedo, MD, Kenji Kanenishi, MD, Tsutomu Masaki, MD. Author contributions HK and KU were responsible for the st
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