Discussion
CIN
DYSPLASTIC, INVASIVE CERVICAL CANCER, CIN, CERVICAL CANCER, CAVITY
Colposcopy, as the current gold standard, plays a vital role in evaluating cervical abnormalities. It has significantly contributed to cervical cancer screening, diagnosis, and decision-making processes. By providing enhanced visualization of the cervix, colposcopy, combined with VIA and iodine staining, enables the identification of subtle changes and abnormalities. It facilitates targeted biopsy of suspicious areas and provides visual guidance during treatment procedures, leading to improved accuracy of diagnosis and treatment. Through early detection and evaluation of CIN, colposcopy plays a critical role in preventing the progression to invasive cervical cancer. However, it is important to acknowledge that the accuracy and interpretation of colposcopic findings can vary among practitioners. Generally, the highest accuracy is achieved by highly experienced colposcopists, which presents a challenge for ensuring universal access to quality healthcare services. While colposcopy demonstrates good sensitivity, it exhibits only moderate specificity. This often results in frequent and burdensome biopsy procedures for patients [In recent years, several groups have investigated spectroscopic technologies just like fluorescence spectra and reflectance spectra [Several research groups have explored the feasibility of employing a hyperspectral approach to differentiate between normal and dysplastic cervical tissue, by investigating the spectral signatures of cervical tissue across a range of wavelengths [Despite recent successes in tissue differentiation using HSI, the clinical application and further research in this field face limitations. Current challenges include the bulky setup and high costs of experimental HSI systems, as well as the time-consuming nature of data acquisition and processing. The availability of medically approved HSI systems that could be easily applied for evaluating the technology remains limited. These factors impede the broader adoption and exploration of HSI in medical settings. To overcome these limitations, we acquired hyperspectral cubes using the TIVITAThe primary objective of the current investigation was to assess the feasibility of utilizing the TIVITABesides the promising results of this study, it involves several limitations based on the technical issues described above and the performed data analysis. In the clinical setup it is not practical to externalize the cervix uteri by lateral sutures to enable accessibility for HSI. HSI sensors must be able to enter the vaginal cavity to achieve high-resolution HSI images. The extraction of HSI spectra by hand based on the information of colposcopy and VIA lacks reproducibility and may be a source of bias. The statistical comparisons on mean values using two-way ANOVA and Šidák’s multiple comparison test may entail overperformance of the results. In future, the clustering of hyperpixel information by machine learning algorithms could be an interesting strategy to illustrate HSI-based differences in tissue composition. Further limitations of this proof-of-principle study include the small sample size of 41 patients and the uneven distribution of included CIN lesions. Large-scale confirmatory clinical trials involving diverse patient populations, along with the integration of advanced image analysis techniques as well as machine learning algorithms and neuronal networks, will be crucial to optimize the clinical utility of HSI in the detection and management of cervical abnormalities. Further confirmatory prospective clinical studies are under development to verify the results of this study with second generation HSI devises overcoming the above described technical limitations.