Vol 91, No 5 (2020)
Research paper
Published online: 2020-05-29

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Folate receptor-mediated cervical staining as an adjunct to colposcopy which can improve the diagnostic accuracy of detecting high grade squamous intraepithelial lesions

Wojciech Homola1, Michal Pomorski1, Aleksandra Zimmer1, Pawel Baranski1, Mariusz Zimmer1
Pubmed: 32495929
Ginekol Pol 2020;91(5):247-250.


Objectives: Cervical cancer is rated fourth in terms of incidence and cancer-related mortality in women. Cytology-based
screening programs and colposcopy provided insufficient rates of detecting cervical intraepithelial neoplasia (CIN) prompting
researchers to develop new tools. The aim of this study was to evaluate whether folate receptor-mediated staining is
useful in detecting CIN2+ during gynecological examination with colposcopy.
Material and methods: In total 96 women with abnormal cytology findings were enrolled. The study was conducted on the
Polish population. The diagnostic process consisted of colposcopy, receptor-mediated diagnosis (FRD), and histopathology
examination. All women were subjected to the same diagnostic procedure.
Results: The patient mean age of 96 women was 38 ± 14.5 years. On colposcopy, high-grade lesions were detected in
83 women. The FRD gave positive results in 63 women. Histopathology revealed 1 case of carcinoma plano epithelial akeratodes,
21 cases of high-grade squamous intraepithelial lesions, 13 cases of low-grade squamous intraepithelial lesions. A total
of 61 cases presented no pathology. FRD as an adjunct to colposcopy gave the following test results in detecting CIN2+
lesions: sensitivity — 94.29%, specificity — 46.67%, PPV — 50.77%, NPV — 93.33%, and accuracy — 64.21%. Using both
techniques provided better results than using each of the tests alone.
Conclusions: FRD is a promising test for the diagnosing CIN2+ cervical pathologies because it can increase the probability
of detecting CIN2+ without any additional burden posed on patients. Further studies should be conducted on large and
various populations to complement current evidence.

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  1. Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019; 144(8): 1941–1953.
  2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  3. Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020; 395(10224): 591–603.
  4. Lees BF, Erickson BK, Huh WK. Cervical cancer screening: evidence behind the guidelines. Am J Obstet Gynecol. 2016; 214(4): 438–443.
  5. Kang M, Ha SY, Cho HY, et al. Comparison of papanicolaou smear and human papillomavirus (HPV) test as cervical screening tools: can we rely on HPV test alone as a screening method? An 11-year retrospective experience at a single institution. J Pathol Transl Med. 2020; 54(1): 112–118.
  6. Wojciech R. [The diagnostic value of cytology and colposcopy in women with cervical intraepithelial neoplasia]. Ginekol Pol. 2011; 82(8): 607–611.
  7. Homola W, Fuchs T, Baranski P, et al. Use of electrical impedance spectroscopy as an adjunct to colposcopy in a pathway of cervical intraepithelial neoplasia diagnostics. Ginekol Pol. 2019; 90(11): 628–632.
  8. Hu L, Bell D, Antani S, et al. An Observational Study of Deep Learning and Automated Evaluation of Cervical Images for Cancer Screening. J Natl Cancer Inst. 2019; 111(9): 923–932.
  9. Li K, Cai H, Shen H. Application of FRD Epithelial Tissue Special Staining Solution in Screening of Cervical Lesions. Journal of Guangxi Agricultural and Biological Science. 2016; 7: 1584–1588.
  10. Lewis CM, Smith AK, Kamen BA. Receptor-mediated folate uptake is positively regulated by disruption of the actin cytoskeleton. Cancer Res. 1998; 58(14): 2952–2956.
  11. Carron PMc, Crowley A, O'Shea D, et al. Targeting the Folate Receptor: Improving Efficacy in Inorganic Medicinal Chemistry. Curr Med Chem. 2018; 25(23): 2675–2708.
  12. Parker N, Turk MJo, Westrick E, et al. Folate receptor expression in carcinomas and normal tissues determined by a quantitative radioligand binding assay. Anal Biochem. 2005; 338(2): 284–293.
  13. Liu C, Ding L, Bai L, et al. Folate receptor alpha is associated with cervical carcinogenesis and regulates cervical cancer cells growth by activating ERK1/2/c-Fos/c-Jun. Biochem Biophys Res Commun. 2017; 491(4): 1083–1091.
  14. Lu MH, Hu LY, Du XX, et al. An special epithelial staining agents: folic acid receptor-mediated diagnosis (FRD) effectively and conveniently screen patients with cervical cancer. Int J Clin Exp Med. 2015; 8(5): 7830–7836.
  15. Li D, Chen L, Wang H, et al. Clinical application of a rapid cervical cancer screening method: Folate receptor-mediated staining of cervical neoplastic epithelia. Asia Pac J Clin Oncol. 2017; 13(1): 44–52.
  16. Xiao S, Xie H, Zhu X, et al. Study on the Significance of Folate Receptor-Mediated Staining Solution (FRD) Staining in Screening High Grade Cervical Lesions. Med Sci Monit. 2019; 25: 2792–2801.
  17. Dai Y, Wang L, Li D. Effectiveness of novel folate receptor-mediated staining solution detection (FRD) for cervical cancer screening. Medicine (Baltimore). 2018; 97(34): e11868.
  18. Zhao Y, Li M, Li Y, et al. Evaluation of Folate Receptor-Mediated Cervical Dyeing as a Method for Detection of Cervical Lesions. J Low Genit Tract Dis. 2019; 23(2): 133–137.