{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T11:54:45Z","timestamp":1793188485261,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,1,4]],"date-time":"2013-01-04T00:00:00Z","timestamp":1357257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine if electrical impedance spectroscopy (<jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content>) improves the diagnostic accuracy of colposcopy when used as an adjunct.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective, comparative, multi\u2010centre clinical study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Three colposcopy clinics: two in <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ngland and one in <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content>reland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women referred with abnormal cytology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In phase 1, <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> was assessed against colposcopic impression and histopathology of the biopsies taken. In phase 2, a probability index and cut\u2010off value for the detection of high\u2010grade cervical intraepithelial neoplasia (<jats:styled-content style=\"fixed-case\">HG<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>, i.e. grade <jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>2+) was derived to indicate sites for biopsy. <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> data collection and analyses were performed in real time and blinded to the clinician. The phase\u20102 data were analysed using different cut\u2010off values to assess performance of <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> as an adjunct.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measure<\/jats:title><jats:p>Histologically confirmed <jats:styled-content style=\"fixed-case\">HG<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content>2+).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 474 women were recruited: 214 were eligible for analysis in phase 1, and 215 were eligible in phase 2. The average age was 33.2\u00a0years (median age 30.3\u00a0years, range 20\u201364\u00a0years) and 48.5% (208\/429) had high\u2010grade cytology. Using the cut\u2010off from phase 1 the accuracy of colposcopic impression to detect <jats:styled-content style=\"fixed-case\">HG<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> when using <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> as an adjunct at the time of examination improved the positive predictive value (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>) from 78.1% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 67.5\u201386.4) to 91.5%. Specificity was also increased from 83.5% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 75.2\u201389.9) to 95.4%, but sensitivity was significantly reduced from 73.6% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 63.0\u201382.5) to 62.1%, and the negative predictive value (<jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content>) was unchanged. The positive likelihood ratio for colposcopic impression alone was 4.46. This increased to 13.5 when <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> was used as an adjunct. The overall accuracy of colposcopy when used with <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> as an adjunct was assessed by varying the cut\u2010off applied to a combined test index. Using a cut\u2010off set to give the same sensitivity as colposcopy in phase 2, <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> increased the <jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content> to detect <jats:styled-content style=\"fixed-case\">HG<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> from 53.5% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 45.0\u201361.8) to 67%, and specificity increased from 38.5% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 29.4\u201348.3) to 65.1%. <jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content> was not significantly increased. Alternatively, applying a cut\u2010off to give the same specificity as colposcopy alone increased <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> sensitivity from 88.5% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 79.9\u201394.4) to 96.6%, and <jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content> from 80.8% (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 67.5\u201390.4) to 93.3%. <jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content> was not significantly increased. The receiver operator characteristic (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) to detect <jats:styled-content style=\"fixed-case\">HG<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CIN<\/jats:styled-content> had an area under the curve (<jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>) of 0.887 (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.840\u20130.934).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> used as an adjunct to colposcopy improves colposcopic performance. The addition of <jats:styled-content style=\"fixed-case\">EIS<\/jats:styled-content> could lead to more appropriate patient management with lower intervention rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12096","type":"journal-article","created":{"date-parts":[[2013,1,4]],"date-time":"2013-01-04T16:30:56Z","timestamp":1357317056000},"page":"400-411","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["Accuracy of detection of high\u2010grade cervical intraepithelial neoplasia using electrical impedance spectroscopy with colposcopy"],"prefix":"10.1111","volume":"120","author":[{"given":"JA","family":"Tidy","sequence":"first","affiliation":[{"name":"Department of Gynaecological Oncology Royal Hallamshire Hospital Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BH","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Sheffield Royal Hallamshire Hospital Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TJ","family":"Healey","sequence":"additional","affiliation":[{"name":"Department of Medical Physics Royal Hallamshire Hospital Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Daayana","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology St Mary's Hospital Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Martin","sequence":"additional","affiliation":[{"name":"ANP Women's Healthcare Tallaght Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Prendiville","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynaecology Coombe Women's Hospital, Tallaght Hospital Royal College of Surgeons in Ireland Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HC","family":"Kitchener","sequence":"additional","affiliation":[{"name":"School of Cancer Studies and Enabling Sciences University of Manchester Manchester Academic Health Science Centre Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,1,4]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"139","volume-title":"Lower Genital Tract Neoplasia","author":"Shafi MI","year":"2003"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2005.10.204"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)09095-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00530.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1438.2006.00651.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/24\/1\/309"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00006-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(03)00413-7"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.065"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2008.07.007"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000295870.67752.b4"},{"key":"e_1_2_7_13_1","volume-title":"NHSCSP, No 20","author":"Colposcopy and Programme Management","year":"2010"},{"key":"e_1_2_7_14_1","unstructured":"NHS Information Centre for Health and Social Care Statistical Bulletin 2010\u201311"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.01065.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2011.02970.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2546"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2009.08.010"},{"key":"e_1_2_7_19_1","unstructured":"WalkerDC.Modelling the electrical properties of cervical epithelium. 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