Dynamic spectral imaging: improving colposcopy.

PURPOSE: Colposcopy occupies a key role in the prevention of cervical cancer by identifying preinvasive or invasive lesions. However, colposcopy is subjective and is responsible for 52% of screening failures. Dynamic spectral imaging (DSI) is based on the objective, quantitative assessment of the acetowhitening effect. This study compared DSI with colposcopy. EXPERIMENTAL DESIGN: Women referred for colposcopy were examined simultaneously with colposcopy and DSI using a precommercial DySIS model (FPC-03) in an international, multicenter trial. The colposcopy impression and DySIS values were compared with consensus histology reports of biopsies. Subjects were recruited to a training group and subsequently to a test group. Measures were taken to avoid verification bias. RESULTS: The training and test groups comprised 82 and 308 eligible women, respectively. A cutoff value to identify high-grade disease was selected from the results of the training group and data from previous work. Receiver operator curve analysis of the test data showed an area under the curve of 0.844. DySIS detected 62.9% more high-grade cases than colposcopy (57 versus 35, P=0.0001). DySIS exceeded end points approved by the Food and Drug Administration for similar studies, with increments in the true positive rate of 22/308 (7.1%; lower 95% CL, 4.5% versus 2%) and in the false positive rate of 32/308 (10.4%; upper 95% CL, 14.7% versus 15%). CONCLUSIONS: DySIS is more sensitive than colposcopy in detecting high-grade lesions and can provide improved guidance for biopsy. The results are obtained in a user-independent fashion, making it suitable for use by nursing personnel.

Uterine allotranspiantation in the rabbit model using a macrovascular patch technique.

The uterus and its blood supply en bloc were successfully harvested with an aortic-caval macrovascular patch in animal and human cadaveric models. The objective of this study was to assess the technical feasibility of uterine allotransplantation in the rabbit. Six uterine allotransplants were performed. This involved harvesting the uterine allograft with an aortic-caval vascular patch en bloc in the donor. After 1 hour of cold ischemic storage, the uterine allograft was transplanted to the recipient using an aortic-aortal cava-caval end to side anastomosis. Our 6 rabbit recipients surgically survived the procedure. After postmortem and histological analyses in the short term, all of the uteri appeared viable with no evidence of graft vessel thromboses. Postoperative complications included limb paraplegia, pulmonary emboli, and intraperitoneal hemorrhage. The feasibility of uterine allotransplantation using a macrovascular patch, in anatomical and surgical terms, has been proven. Further research will lead to a successful program of fertility restoration.