The application of magnifying endoscopy in the diagnosis of cervical lesions

The application of magnifying endoscopy in the diagnosis of cervical lesions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The application of magnifying endoscopy in the diagnosis of cervical lesions Qing Li, Jue Wang, Tao Sun, Hongwei Zhang, Limei Chen, Qing Wang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4857318/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to assess the sensitivity and specificity of magnifying endoscopy in the examination of patients with high-risk factors for cervical lesions. Methods Two equally skilled colposcopy specialists examined 59 patients admitted to the Obstetrics and Gynecology Hospital of Fudan University between March 14, 2023, and April 15, 2023. These patients underwent both colposcopy and magnifying endoscopy examinations. Preliminary diagnoses were then made by the two colposcopy specialists using colposcopy and magnifying endoscopy. The sensitivity and specificity of these methods were then evaluated compared to the postoperative pathology diagnosis for a better understanding of their efficacy. Results Colposcopy exhibited sensitivity rates of 23.08% for the diagnosis of normal tissue, 10% for low-grade squamous intraepithelial lesions (LSIL), 90% for high-grade squamous intraepithelial lesions (HSIL), and 84.62% for cervical cancer, with specificity rates of 93.94%, 67.35%, 71.43%, and 100%, respectively. In contrast, magnifying endoscopy demonstrated sensitivity rates of 42.31%, 40%, 90%, and 92.31% for normal tissue, LSIL, HSIL, and cervical cancer, respectively. The corresponding specificity rates for these categories were 87.88%, 77.55%, 83.67%, and 100%. Conclusion Magnifying endoscopy exhibits higher sensitivity and specificity compared to colposcopy in detecting cervical lesions. With the ability to magnify lesions up to 520 times, magnifying endoscopy facilitates precise visualization of cellular-level lesions, as well as associated anatomical features and vascular signals. Biological sciences/Cancer Health sciences/Diseases Health sciences/Diseases/Infectious diseases Health sciences/Diseases/Urogenital diseases magnifying endoscopy cervical lesions sensitivity specificity Figures Figure 1 Figure 2 Background Cervical cancer is one of the most prevalent cancers among women globally, ranking as the second leading cause of cancer-related death in women aged 20 to 39 years [ 1 ] . Although colposcopy-guided cervical biopsy remains the primary method for diagnosing cervical cancer [ 2 ] , conventional colposcopy has limitations in identifying and diagnosing subtle lesions, highlighting the need for advanced technologies in clinical practice. Recent advancements in microscopy technologies [ 3 ] have improved image resolution and vascular visualization, thereby facilitating non-invasive pathological diagnosis. As an emerging imaging technique, magnifying endoscopy shows promise in addressing the limitations of conventional colposcopy. However, few studies have investigated the potential impact of magnifying endoscopy on the diagnosis of cervical cancer. To evaluate its clinical value in diagnosing cervical lesions, magnifying endoscopy was employed and its efficacy was compared with that of conventional colposcopy and biopsy pathology results. Methods Patient Recruitment and Eligibility Criteria: This study included 59 patients who provided consent and underwent colposcopy examinations at the Obstetrics and Gynecology Hospital of Fudan University between March 14, 2023, and April 15, 2023. Eligible women presented with one of the following conditions: a) positive high-risk HPV (types 16/18) testing; b) cervical cytology classified as Atypical Squamous Cells of Undetermined Significance (ASCUS), accompanied by positivity for other high-risk HPV types, or persistent infection with other high-risk HPV types for over one year; c) abnormal cervical cytology, including Low-grade Squamous Intraepithelial Lesion (LSIL), High-grade Squamous Intraepithelial Lesion (HSIL), Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion (ASC-H), Low-grade Squamous Intraepithelial Lesion and Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion (LSIL, ASC-H), Atypical Glandular Cells (AGC), Adenocarcinoma In Situ (AIS), or Squamous Cell Carcinoma (SCC); d) clinical suspicion of cervical malignancy that could not be ruled out. Patients with acute or subacute infections in the lower genital tract, or with wounds, contusions, or active bleeding in the lower genital tract were excluded from the study. Additionally, individuals with a history of previous cervical surgery, pelvic radiation, or hysterectomy, as well as those who were pregnant, were also excluded. Operator and Equipment: Two experienced colposcopists, Dr. Li and Dr. Chen, each performing over 2,000 colposcopic procedures annually and possessing more than five years of expertise in colposcopy, were selected as the primary examiners. Dr. Li received training from Dr. Sun, a skilled endoscopist at a tertiary hospital, to enhance proficiency in utilizing magnifying endoscopy. Dr. Li conducted the initial examination using the endoscope, which was subsequently followed by Dr. Chen's colposcopy examination. The study employed the Olympus Endocytoscopy System (Type: CF-H290ECI), an advanced category of endoscope known as super magnifying endoscope or EC. This system integrates a 520x contact-type optical microscope at the distal end of the endoscope. To ensure stable observation, a prominent soft silicone cap was affixed to the lens, maintaining an optimal focal distance between the lens and the mucosa. This cap minimized potential damage to the mucosa and lesion surfaces while facilitating rapid and precise focusing for image acquisition. Examination Procedure: In a typical colposcopy examination, the participant assumed the lithotomy position for the evaluation of bladder stones and external genitalia. The colposcopist utilized the Olympus Endocytoscopy System, which is equipped with a soft silicone cap at its distal end, and gently dilated the vagina using a speculum to expose the cervix. The cervical mucus was then carefully removed using physiological saline. The endoscope, fitted with the soft silicone cap, was inserted into the vagina for cervical observation under white light, ensuring that at least one image was captured. After the removal of the endoscope, acetic acid was applied to the cervix and vaginal surface. The colposcopist then reinserted the endoscope for repeated observation and image capture after 40 seconds, ensuring the acquisition of at least four images. Following this, the endoscope was removed, and the trial continued with additional examinations and biopsies according to standard colposcopy protocols. Statement of ethics: All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the ethical committee of Obstetrics and Gynecology Hospital of Fudan University (2022 − 202). Written informed consent was obtained from each patient. Statistical Analysis: Statistical analysis was conducted using SPSS version 22.0, with a significance level set at P < 0.05 to indicate statistical significance. Results During the trial, 59 patients underwent colposcopic examinations. The mean age was 39.32 ± 11.68 years. The distribution of cytology results, HPV status, and biopsy pathology diagnoses is presented in Table 1 . Table 1 Distribution of cytology, HPV status, and biopsy pathology diagnosis Cytology n HPV n Pathology n NILM** 19 Type 16+ 18 Normal 26 ASCUS 13 Type 18+ 7 LSIL 10 LSIL 10 Other high risk HPV types+ 35 HSIL 10 ASH-H 6 Moderate and low risk HPV+ 5 SCC 13 HSIL 7 Multiple HPV types + 9 LSIL, ASC-H 1 HPV negative 5 AGC 1 SCC 2 **Negative for Intraepithelial Lesion or Malignancy Colposcopic and endoscopic images Figure 1 presents a comparison of colposcopic and endoscopic images from patients with various pathological types. The endoscopic images exhibited superior resolution and more defined vascular features compared to the colposcopic images. In scenarios where there was an increased risk of missed diagnoses or atypical presentations during colposcopy, endoscopy emerged as a valuable supplementary tool. Diagnostic Performance Figure 2 presents the confusion matrix for the diagnosis using two testing methods. It is evident that both colposcopy and endoscopy exhibit higher detection rates and greater consistency in diagnosing cervical HSIL and cervical cancer. In contrast, both examination tools show lower detection rates and limited consistency in diagnosing cervical inflammation and LSIL. The detailed diagnostic results for each lesion corresponding to colposcopy and endoscopy are provided in Table 2 – 5 . The sensitivity of colposcopy for diagnosing inflammation, LSIL, HSIL, and cervical cancer (Ca) is 23.08%, 10%, 90%, and 84.62%, respectively, with specificities of 93.94%, 67.35%, 71.43%, and 100%, respectively. Conversely, the sensitivity of endoscopy for diagnosing inflammation, LSIL, HSIL, and cervical cancer is 42.31%, 40%, 90%, and 92.31%, respectively, with specificities of 87.88%, 77.55%, 83.67%, and 100%, respectively. Overall, endoscopy demonstrates superior performance compared to colposcopy in detecting cervical lesions. Table 2 Sensitivity and specificity of the two diagnostic methods for normal/inflammation compared to pathological results normal/inflammation Pathological results+ Pathological results- sensitivity specificity Colposcopic results: + 6 2 23.08% 93.94% Colposcopic results: - 20 31 Endoscopic results: + 11 4 42.31% 87.88% Endoscopic results: - 15 29 Table 3 Sensitivity and specificity of the two diagnostic methods for LSIL compared to pathological results LSIL Pathological results+ Pathological results- sensitivity specificity Colposcopic results: + 1 16 10% 67.35% Colposcopic results: - 9 33 Endoscopic results: + 4 11 40% 77.55% Endoscopic results: - 6 38 Table 4 Sensitivity and specificity of the two diagnostic methods for HSIL compared to pathological results HSIL Pathological results+ Pathological results- sensitivity specificity Colposcopic results: + 9 14 90% 71.43% Colposcopic results: - 1 35 Endoscopic results: + 9 8 90% 83.67% Endoscopic results: - 1 41 Table 5 Sensitivity and specificity of the two diagnostic methods for cancer compared to pathological results Cancer Pathological results+ Pathological results- sensitivity specificity Colposcopic results: + 11 0 84.62% 100% Colposcopic results: - 2 46 Endoscopic results: + 12 0 92.31% 100% Endoscopic results: - 1 46 Discussion The endoscopic system has been proven effective in diagnosing cervical glandular cancer. Studies conducted by Kunihisa Uchita [ 3 ] and Noriko Nishiyama [ 5 ] revealed that compared to traditional colposcopy, ME-NBI offered higher sensitivity, specificity, and accuracy in identifying cervical lesions. Additionally, Uchita et. al’s study found thatthe use of endoscopic forceps biopsy can mitigate the trauma caused by the biopsy procedure [ 6 ] . However, the previous studies had a limited number of cases (four studies with 2 [ 7 ] , 10 [ 5 ] , 24 [ 4 ] , 32 [ 6 ] and 88 [ 8 ] cases, respectively). Moreover, endoscopic procedures were complicated and often required referral to specialized endoscopists and endoscopy rooms, which added to patient inconvenience and clinical challenges. In our study, 59 patients indicated for colposcopy underwent sequential examination with both endoscopy and colposcopy by colposcopists with endoscopy training. This approach eliminated the need to change the operation site and made the clinical procedures easier to perform. This study represents the first in China to explore the use of endoscopy for diagnosing cervical lesions, offering new avenues for further research and the application of endoscopic techniques in gynecology. The aim of this study was to assess the sensitivity and specificity of magnifying endoscopy in diagnosing cervical precancerous lesions compared to conventional colposcopy. The results indicated that magnifying endoscopy demonstrated superior sensitivity and specificity for detecting cervical lesions relative to colposcopy. These findings suggest that magnifying endoscopy is more effective in accurately identifying cervical lesions and exhibits a lower rate of false positives, thereby facilitating a more precise diagnosis. Compared with conventional magnifying endoscopes, the EC's enhanced magnification capability allows for cellular-level observation of lesions, contributing to a better assessment of histopathological features. The improved performance of magnifying endoscopy can be attributed to its ability to magnify lesions up to 520 times, enabling detailed visualization of cellular structures, anatomical features, and vascular signals. This enhanced visualization aids in the identification of subtle lesions that may be overlooked by conventional colposcopy. However, it is important to note that this study had a relatively small sample size of 59 patients. Further studies with larger sample sizes are necessary to validate these findings and provide more robust evidence for the clinical application of magnifying endoscopy in diagnosing cervical lesions. In conclusion, this study demonstrates that magnifying endoscopy exhibits superior sensitivity and specificity compared to colposcopy in diagnosing cervical precancerous lesions. The improved accuracy of magnifying endoscopy highlights its potential as a valuable tool in clinical practice for early detection and precise diagnosis of cervical lesions. Further research is warranted to validate these findings and investigate the long-term clinical outcomes associated with the use of magnifying endoscopy in the diagnosis of cervical lesion. Declarations Author Contribution Qing Li is responsible for drafting the article and conducting colposcopy and magnifying endoscopy procedures; Wang Jue is responsible for data analysis, article polishing; Tao Sun is responsible for providing guidance and training on magnifying endoscopy; Hongwei Zhang is responsible for editing and formatting figures and tables; Limei Chen is responsible for colposcopy examinations; Qing Wang is responsible for clinical guidance; Long Sui is responsible for structuring the article and guiding its direction; Keqin Hua is responsible for structuring the article and serves as the corresponding author. Acknowledgements: This study was funded by the Shanghai Municipal Economic and Information Commission project "Shanghai Economic and Information Intelligence 2022 − 592". Data Availability Data is provided as supplementary information files References Siegel, R. L. et al. Cancer statistics, 2023[J]. CA Cancer J. Clin. 73 (1), 17–48 (2023). Perkins, R. B. et al. 2019 ASCCP risk-Based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors[J]. J. Low Genit. Tract. Dis. 24 (2), 102–131 (2020). Guo, J. et al. The value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma[J]. Arch. Gynecol. Obstet. 302 (2), 455–462 (2020). Uchita, K. et al. Characteristic findings of high-grade cervical intraepithelial neoplasia or more on magnifying endoscopy with narrow band imaging[J]. Int. J. Clin. Oncol. 23 (4), 707–714 (2018). Nishiyama, N. et al. Flexible magnifying endoscopy with narrow band imaging for the diagnosis of uterine cervical tumors: A cooperative study among gastrointestinal endoscopists and gynecologists to explore a novel microvascular classification system[J]. Oncol. Lett. 14 (1), 355–362 (2017). Uchita, K. et al. Quality assessment of endoscopic forceps biopsy samples under magnifying narrow band imaging for histological diagnosis of cervical intraepithelial neoplasia: A feasibility study[J]. Diagnostics (Basel) , (2021). 11(2). Kobara, H. et al. Uterine cervical neoplasm diagnosed by flexible magnifying endoscopy with narrow band imaging[J]. Diagnostics (Basel) , 2020,10(11). Kobara, H. et al. Flexible magnifying endoscopy with narrow band imaging for diagnosing uterine cervical neoplasms: a multicenter prospective study[J]. J. Clin. Med. , 10 (20). (2021). Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4857318","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":357274200,"identity":"1896cfa7-896b-4343-9ed0-f086c6280717","order_by":0,"name":"Qing Li","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Li","suffix":""},{"id":357274201,"identity":"3c2f946f-d925-4a9f-9b83-d7b6cee4ed22","order_by":1,"name":"Jue Wang","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jue","middleName":"","lastName":"Wang","suffix":""},{"id":357274202,"identity":"1c34cc4f-d1a3-4749-8ebe-c59bd5467753","order_by":2,"name":"Tao Sun","email":"","orcid":"","institution":"Huadong Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Sun","suffix":""},{"id":357274203,"identity":"4dc126af-4255-48c9-b8cd-65c252d96ee8","order_by":3,"name":"Hongwei Zhang","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Zhang","suffix":""},{"id":357274204,"identity":"9cd0ff9c-b5ad-4a72-ae04-98646dfe37a4","order_by":4,"name":"Limei Chen","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Limei","middleName":"","lastName":"Chen","suffix":""},{"id":357274205,"identity":"b905bd94-c216-423c-a804-a5216ebc1b79","order_by":5,"name":"Qing Wang","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Wang","suffix":""},{"id":357274206,"identity":"dd126d46-252c-497f-add0-8b9ada0f902e","order_by":6,"name":"Long Sui","email":"","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Long","middleName":"","lastName":"Sui","suffix":""},{"id":357274207,"identity":"d62b0e7c-59b1-4f4a-9657-3cbe0adbf564","order_by":7,"name":"Keqin Hua","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAUlEQVRIiWNgGAWjYBACAwYGZiAlwcDYDKQYGxgY+JmZDz8gTYtkO1uaARFaoACkxeA8j4IEPi3mEsmPDT6UWeQxtzM/fPhzh03i5sM8QINqbKJxabGckWacOOOcRDFjM5uxMe+ZtMRth3kPPGA4lpbbgMthNxKMD/O2SSQ2NjOYSTO2HQZq4UswYGw4jEdL+ufDf8Fa2L9J/gRq2dzMYyCBX0uOcTIjWAuPmQQvUMsGZkJazrwpNuw5B9ZSbMzblmY84zAwkBPw+eV4+maJH2V1iRv7j298+LPNRra///DhBx9qbHBqgQA2BgZDFBUJeJVDtcgTVDQKRsEoGAUjFgAA+GFc2Q8AmKAAAAAASUVORK5CYII=","orcid":"","institution":"Obstetrics and Gynecology Hospital of Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Keqin","middleName":"","lastName":"Hua","suffix":""}],"badges":[],"createdAt":"2024-08-04 14:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4857318/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4857318/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66742816,"identity":"ca7dffac-faf9-4cd5-ae94-4d030eeea6bb","added_by":"auto","created_at":"2024-10-16 06:07:20","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78585,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of colposcopic and endoscopic images of patients with different pathological types.\u003c/p\u003e\n\u003cp\u003eA, B: LCT: ASCUS, HPV66+. Pathology: Inflammation. A is a colposcopic image indicating inflammation; B presents an endoscopic image, revealing clear columnar epithelium with granular appearance, suggesting inflammation.\u003c/p\u003e\n\u003cp\u003eC, D: LCT: LSIL, HPV 11+. Pathology: External genital warts. C displays a colposcopic image illustrating cluster-like warts, with an impression of genital warts; D is an endoscopic image showing clear vascular loops, also suggestive of genital warts.\u003c/p\u003e\n\u003cp\u003eE, F: LCT: LSIL, HPV 16+. Pathology: Cervical HSIL. E presents a colposcopic image, showing thin acetowhite epitheliumwith an impression of LSIL. F depicts an endoscopic image illustrating dot-like blood vessels, a peripheral ring-like appearance, acetowhite epithelium, and slight local elevation, suggestive of HSIL.\u003c/p\u003e\n\u003cp\u003eG, H: LCT: HSIL, HPV 31+. Pathology: Invasive cervical squamous cell carcinoma. G is a colposcopic image with an impression of cancer. H displays an endoscopic image demonstrating a cervical mass, atypical blood vessels, and necrotic tissue, supporting the impression of cancer.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4857318/v1/3397f5cb4f3950bde1991e51.jpeg"},{"id":66742818,"identity":"421c6dd2-eb7a-40be-88f1-d37cb3126efb","added_by":"auto","created_at":"2024-10-16 06:07:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163824,"visible":true,"origin":"","legend":"\u003cp\u003eConfusion matrix diagrams for endoscopic and colposcopic diagnoses\u003c/p\u003e\n\u003cp\u003eA: Confusion matrix diagram for endoscopic and colposcopic diagnoses of cervical inflammation. Fisher's exact test, P: 0.054.\u003c/p\u003e\n\u003cp\u003eB: Confusion matrix diagram for endoscopic and colposcopic diagnoses of cervical LSIL.\u003c/p\u003e\n\u003cp\u003eFisher's exact test, P: 1.000.\u003c/p\u003e\n\u003cp\u003eC: Confusion matrix diagram for endoscopic and colposcopic diagnoses of cervical HSIL.\u003c/p\u003e\n\u003cp\u003eD: Confusion matrix diagram for endoscopic and colposcopic diagnoses of cervical cancer. Fisher's exact test, P: 0.154.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4857318/v1/63aadb5041d24fde3471d253.png"},{"id":82820112,"identity":"064fa89d-15af-4f7b-8b3d-03450699695d","added_by":"auto","created_at":"2025-05-15 15:01:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":782293,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4857318/v1/b5951800-7ef9-4c1a-aa65-f32450bcfe26.pdf"},{"id":66742817,"identity":"1fb01611-d427-4daa-8e33-7ad66ff37b22","added_by":"auto","created_at":"2024-10-16 06:07:20","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12578,"visible":true,"origin":"","legend":"","description":"","filename":"data.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4857318/v1/9d40a0bbdacde5d5635136f0.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The application of magnifying endoscopy in the diagnosis of cervical lesions","fulltext":[{"header":"Background","content":"\u003cp\u003eCervical cancer is one of the most prevalent cancers among women globally, ranking as the second leading cause of cancer-related death in women aged 20 to 39 years \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Although colposcopy-guided cervical biopsy remains the primary method for diagnosing cervical cancer\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, conventional colposcopy has limitations in identifying and diagnosing subtle lesions, highlighting the need for advanced technologies in clinical practice. Recent advancements in microscopy technologies\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e have improved image resolution and vascular visualization, thereby facilitating non-invasive pathological diagnosis. As an emerging imaging technique, magnifying endoscopy shows promise in addressing the limitations of conventional colposcopy. However, few studies have investigated the potential impact of magnifying endoscopy on the diagnosis of cervical cancer. To evaluate its clinical value in diagnosing cervical lesions, magnifying endoscopy was employed and its efficacy was compared with that of conventional colposcopy and biopsy pathology results.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Recruitment and Eligibility Criteria:\u003c/h2\u003e \u003cp\u003e This study included 59 patients who provided consent and underwent colposcopy examinations at the Obstetrics and Gynecology Hospital of Fudan University between March 14, 2023, and April 15, 2023. Eligible women presented with one of the following conditions: a) positive high-risk HPV (types 16/18) testing; b) cervical cytology classified as Atypical Squamous Cells of Undetermined Significance (ASCUS), accompanied by positivity for other high-risk HPV types, or persistent infection with other high-risk HPV types for over one year; c) abnormal cervical cytology, including Low-grade Squamous Intraepithelial Lesion (LSIL), High-grade Squamous Intraepithelial Lesion (HSIL), Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion (ASC-H), Low-grade Squamous Intraepithelial Lesion and Atypical Squamous Cells, Cannot Exclude High-grade Squamous Intraepithelial Lesion (LSIL, ASC-H), Atypical Glandular Cells (AGC), Adenocarcinoma In Situ (AIS), or Squamous Cell Carcinoma (SCC); d) clinical suspicion of cervical malignancy that could not be ruled out. Patients with acute or subacute infections in the lower genital tract, or with wounds, contusions, or active bleeding in the lower genital tract were excluded from the study. Additionally, individuals with a history of previous cervical surgery, pelvic radiation, or hysterectomy, as well as those who were pregnant, were also excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eOperator and Equipment:\u003c/h2\u003e \u003cp\u003eTwo experienced colposcopists, Dr. Li and Dr. Chen, each performing over 2,000 colposcopic procedures annually and possessing more than five years of expertise in colposcopy, were selected as the primary examiners. Dr. Li received training from Dr. Sun, a skilled endoscopist at a tertiary hospital, to enhance proficiency in utilizing magnifying endoscopy. Dr. Li conducted the initial examination using the endoscope, which was subsequently followed by Dr. Chen's colposcopy examination. The study employed the Olympus Endocytoscopy System (Type: CF-H290ECI), an advanced category of endoscope known as super magnifying endoscope or EC. This system integrates a 520x contact-type optical microscope at the distal end of the endoscope. To ensure stable observation, a prominent soft silicone cap was affixed to the lens, maintaining an optimal focal distance between the lens and the mucosa. This cap minimized potential damage to the mucosa and lesion surfaces while facilitating rapid and precise focusing for image acquisition.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eExamination Procedure:\u003c/h2\u003e \u003cp\u003e In a typical colposcopy examination, the participant assumed the lithotomy position for the evaluation of bladder stones and external genitalia. The colposcopist utilized the Olympus Endocytoscopy System, which is equipped with a soft silicone cap at its distal end, and gently dilated the vagina using a speculum to expose the cervix. The cervical mucus was then carefully removed using physiological saline. The endoscope, fitted with the soft silicone cap, was inserted into the vagina for cervical observation under white light, ensuring that at least one image was captured. After the removal of the endoscope, acetic acid was applied to the cervix and vaginal surface. The colposcopist then reinserted the endoscope for repeated observation and image capture after 40 seconds, ensuring the acquisition of at least four images. Following this, the endoscope was removed, and the trial continued with additional examinations and biopsies according to standard colposcopy protocols.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatement of ethics:\u003c/h2\u003e \u003cp\u003e All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the ethical committee of Obstetrics and Gynecology Hospital of Fudan University (2022\u0026thinsp;\u0026minus;\u0026thinsp;202). Written informed consent was obtained from each patient.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analysis was conducted using SPSS version 22.0, with a significance level set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 to indicate statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the trial, 59 patients underwent colposcopic examinations. The mean age was 39.32\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68 years. The distribution of cytology results, HPV status, and biopsy pathology diagnoses is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of cytology, HPV status, and biopsy pathology diagnosis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCytology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePathology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNILM**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType 16+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASCUS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType 18+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLSIL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLSIL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther high risk HPV types+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHSIL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASH-H\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate and low risk HPV+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHSIL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultiple HPV types +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLSIL, ASC-H\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHPV negative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAGC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**Negative for Intraepithelial Lesion or Malignancy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eColposcopic and endoscopic images\u003c/strong\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a comparison of colposcopic and endoscopic images from patients with various pathological types. The endoscopic images exhibited superior resolution and more defined vascular features compared to the colposcopic images. In scenarios where there was an increased risk of missed diagnoses or atypical presentations during colposcopy, endoscopy emerged as a valuable supplementary tool.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDiagnostic Performance\u003c/strong\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the confusion matrix for the diagnosis using two testing methods. It is evident that both colposcopy and endoscopy exhibit higher detection rates and greater consistency in diagnosing cervical HSIL and cervical cancer. In contrast, both examination tools show lower detection rates and limited consistency in diagnosing cervical inflammation and LSIL. The detailed diagnostic results for each lesion corresponding to colposcopy and endoscopy are provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The sensitivity of colposcopy for diagnosing inflammation, LSIL, HSIL, and cervical cancer (Ca) is 23.08%, 10%, 90%, and 84.62%, respectively, with specificities of 93.94%, 67.35%, 71.43%, and 100%, respectively. Conversely, the sensitivity of endoscopy for diagnosing inflammation, LSIL, HSIL, and cervical cancer is 42.31%, 40%, 90%, and 92.31%, respectively, with specificities of 87.88%, 77.55%, 83.67%, and 100%, respectively. Overall, endoscopy demonstrates superior performance compared to colposcopy in detecting cervical lesions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity of the two diagnostic methods for normal/inflammation compared to pathological results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003enormal/inflammation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathological results+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathological results-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003especificity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e23.08%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e93.94%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e42.31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e87.88%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity of the two diagnostic methods for LSIL compared to pathological results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eLSIL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathological results+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathological results-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003especificity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e67.35%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e77.55%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity of the two diagnostic methods for HSIL compared to pathological results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eHSIL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathological results+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathological results-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003especificity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e71.43%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e83.67%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity of the two diagnostic methods for cancer compared to pathological results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePathological results+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePathological results-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003especificity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e84.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColposcopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: +\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e92.31%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndoscopic results: -\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe endoscopic system has been proven effective in diagnosing cervical glandular cancer. Studies conducted by Kunihisa Uchita\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e and Noriko Nishiyama\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e revealed that compared to traditional colposcopy, ME-NBI offered higher sensitivity, specificity, and accuracy in identifying cervical lesions. Additionally, Uchita et. al\u0026rsquo;s study found thatthe use of endoscopic forceps biopsy can mitigate the trauma caused by the biopsy procedure\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. However, the previous studies had a limited number of cases (four studies with 2\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, 10\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e, 24\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, 32\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e and 88\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e cases, respectively). Moreover, endoscopic procedures were complicated and often required referral to specialized endoscopists and endoscopy rooms, which added to patient inconvenience and clinical challenges. In our study, 59 patients indicated for colposcopy underwent sequential examination with both endoscopy and colposcopy by colposcopists with endoscopy training. This approach eliminated the need to change the operation site and made the clinical procedures easier to perform. This study represents the first in China to explore the use of endoscopy for diagnosing cervical lesions, offering new avenues for further research and the application of endoscopic techniques in gynecology.\u003c/p\u003e \u003cp\u003eThe aim of this study was to assess the sensitivity and specificity of magnifying endoscopy in diagnosing cervical precancerous lesions compared to conventional colposcopy. The results indicated that magnifying endoscopy demonstrated superior sensitivity and specificity for detecting cervical lesions relative to colposcopy. These findings suggest that magnifying endoscopy is more effective in accurately identifying cervical lesions and exhibits a lower rate of false positives, thereby facilitating a more precise diagnosis. Compared with conventional magnifying endoscopes, the EC's enhanced magnification capability allows for cellular-level observation of lesions, contributing to a better assessment of histopathological features. The improved performance of magnifying endoscopy can be attributed to its ability to magnify lesions up to 520 times, enabling detailed visualization of cellular structures, anatomical features, and vascular signals. This enhanced visualization aids in the identification of subtle lesions that may be overlooked by conventional colposcopy.\u003c/p\u003e \u003cp\u003eHowever, it is important to note that this study had a relatively small sample size of 59 patients. Further studies with larger sample sizes are necessary to validate these findings and provide more robust evidence for the clinical application of magnifying endoscopy in diagnosing cervical lesions.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrates that magnifying endoscopy exhibits superior sensitivity and specificity compared to colposcopy in diagnosing cervical precancerous lesions. The improved accuracy of magnifying endoscopy highlights its potential as a valuable tool in clinical practice for early detection and precise diagnosis of cervical lesions. Further research is warranted to validate these findings and investigate the long-term clinical outcomes associated with the use of magnifying endoscopy in the diagnosis of cervical lesion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eQing Li is responsible for drafting the article and conducting colposcopy and magnifying endoscopy procedures; Wang Jue is responsible for data analysis, article polishing; Tao Sun is responsible for providing guidance and training on magnifying endoscopy; Hongwei Zhang is responsible for editing and formatting figures and tables; Limei Chen is responsible for colposcopy examinations; Qing Wang is responsible for clinical guidance; Long Sui is responsible for structuring the article and guiding its direction; Keqin Hua is responsible for structuring the article and serves as the corresponding author.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e \u003cp\u003eThis study was funded by the Shanghai Municipal Economic and Information Commission project \"Shanghai Economic and Information Intelligence 2022\u0026thinsp;\u0026minus;\u0026thinsp;592\".\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided as supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSiegel, R. L. et al. Cancer statistics, 2023[J]. \u003cem\u003eCA Cancer J. Clin.\u003c/em\u003e \u003cb\u003e73\u003c/b\u003e (1), 17\u0026ndash;48 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerkins, R. B. et al. 2019 ASCCP risk-Based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors[J]. \u003cem\u003eJ. Low Genit. Tract. Dis.\u003c/em\u003e \u003cb\u003e24\u003c/b\u003e (2), 102\u0026ndash;131 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo, J. et al. The value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma[J]. \u003cem\u003eArch. Gynecol. Obstet.\u003c/em\u003e \u003cb\u003e302\u003c/b\u003e (2), 455\u0026ndash;462 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchita, K. et al. Characteristic findings of high-grade cervical intraepithelial neoplasia or more on magnifying endoscopy with narrow band imaging[J]. \u003cem\u003eInt. J. Clin. Oncol.\u003c/em\u003e \u003cb\u003e23\u003c/b\u003e (4), 707\u0026ndash;714 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNishiyama, N. et al. Flexible magnifying endoscopy with narrow band imaging for the diagnosis of uterine cervical tumors: A cooperative study among gastrointestinal endoscopists and gynecologists to explore a novel microvascular classification system[J]. \u003cem\u003eOncol. Lett.\u003c/em\u003e \u003cb\u003e14\u003c/b\u003e (1), 355\u0026ndash;362 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchita, K. et al. Quality assessment of endoscopic forceps biopsy samples under magnifying narrow band imaging for histological diagnosis of cervical intraepithelial neoplasia: A feasibility study[J]. \u003cem\u003eDiagnostics (Basel)\u003c/em\u003e, (2021). 11(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobara, H. et al. Uterine cervical neoplasm diagnosed by flexible magnifying endoscopy with narrow band imaging[J]. \u003cem\u003eDiagnostics (Basel)\u003c/em\u003e, 2020,10(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobara, H. et al. Flexible magnifying endoscopy with narrow band imaging for diagnosing uterine cervical neoplasms: a multicenter prospective study[J]. \u003cem\u003eJ. Clin. Med.\u003c/em\u003e, \u003cb\u003e10\u003c/b\u003e(20). (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"magnifying endoscopy, cervical lesions, sensitivity, specificity","lastPublishedDoi":"10.21203/rs.3.rs-4857318/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4857318/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to assess the sensitivity and specificity of magnifying endoscopy in the examination of patients with high-risk factors for cervical lesions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTwo equally skilled colposcopy specialists examined 59 patients admitted to the Obstetrics and Gynecology Hospital of Fudan University between March 14, 2023, and April 15, 2023. These patients underwent both colposcopy and magnifying endoscopy examinations. Preliminary diagnoses were then made by the two colposcopy specialists using colposcopy and magnifying endoscopy. The sensitivity and specificity of these methods were then evaluated compared to the postoperative pathology diagnosis for a better understanding of their efficacy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eColposcopy exhibited sensitivity rates of 23.08% for the diagnosis of normal tissue, 10% for low-grade squamous intraepithelial lesions (LSIL), 90% for high-grade squamous intraepithelial lesions (HSIL), and 84.62% for cervical cancer, with specificity rates of 93.94%, 67.35%, 71.43%, and 100%, respectively. In contrast, magnifying endoscopy demonstrated sensitivity rates of 42.31%, 40%, 90%, and 92.31% for normal tissue, LSIL, HSIL, and cervical cancer, respectively. The corresponding specificity rates for these categories were 87.88%, 77.55%, 83.67%, and 100%.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMagnifying endoscopy exhibits higher sensitivity and specificity compared to colposcopy in detecting cervical lesions. With the ability to magnify lesions up to 520 times, magnifying endoscopy facilitates precise visualization of cellular-level lesions, as well as associated anatomical features and vascular signals.\u003c/p\u003e","manuscriptTitle":"The application of magnifying endoscopy in the diagnosis of cervical lesions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-16 06:07:15","doi":"10.21203/rs.3.rs-4857318/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9233434f-7d5a-4528-8a5d-fa5729874912","owner":[],"postedDate":"October 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":38006889,"name":"Biological sciences/Cancer"},{"id":38006890,"name":"Health sciences/Diseases"},{"id":38006891,"name":"Health sciences/Diseases/Infectious diseases"},{"id":38006892,"name":"Health sciences/Diseases/Urogenital diseases"}],"tags":[],"updatedAt":"2025-05-15T14:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-16 06:07:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4857318","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4857318","identity":"rs-4857318","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}