Flexible magnifying endoscopy with narrow band imaging versus colposcopy
for diagnosing uterine cervical neoplasms: a multicenter, prospective,
non-randomized, paired comparison study
Objective To investigate the detection ability of flexible magnifying
endoscopy with narrow band imaging (ME-NBI) for cervical intraepithelial
neoplasia grade two or worse (CIN2+) compared with colposcopy. Design
Multicenter, prospective, non-randomized, paired comparison study.
Setting Three Japanese medical centers. Population Japanese women.
Methods Eligible patients had positive PAP smear test results,
suspicious high-grade CIN in previous colposcopy, or definitive CIN3
diagnosed previously. A gastrointestinal endoscopist examined the cervix
using ME-NBI in an endoscopy room and, subsequently, a gynecologist
blinded to the ME-NBI findings performed colposcopy in a different room.
CIN2+ locations were documented in a scheme immediately after each
examination. Punch biopsy samples were obtained from all areas diagnosed
as CIN2+ with both methods and from one normal area. The reference
standard was the presence of at least one histological diagnosis of
CIN2+ among all biopsy specimens. Main outcome measures The primary
outcome was the detection sensitivity of patients with CIN2+, comparing
ME-NBI and colposcopy. Results We enrolled 88 patients. The detection
sensitivity for patients with CIN2+ was not statistically different
between the two methods (both: 79%, 95% CI: 66%–88%). For
diagnosing CIN2+, ME-NBI tended to show a higher sensitivity than
colposcopy (69% vs. 58%, respectively), while its specificity tended
to be lower vs. colposcopy (55% vs. 70%, respectively). Patients
reported significantly less discomfort and embarrassment with ME-NBI vs.
colposcopy. Conclusion ME-NBI showed comparable sensitivity to
colposcopy for detecting CIN2+ lesions, and ME-NBI was more