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Visual inspection with acetic acid (VIA) is recommended by theWorld Health Organization for primary cervical cancer screening or triage of human papillomavirus-positive women living in low-resource settings. Nonetheless, traditional VIA with the naked-eye is associated with large variabilities in the detection of pre-cancer and with a lack of quality control. Digital-VIA (D-VIA), using high definition cameras, allows magnification and zooming on transformation zones and suspicious cervical regions, as well as simultaneously compare native and post-VIA images in real-time. We searched MEDLINE and LILACS between January 2015 and November 2021 for relevant studies conducted in low-resource settings using a smartphone device for D-VIA. The aim of this review was to provide an evaluation on available data for smartphone use in low-resource settings in the context of D-VIA-based cervical cancer screenings. The available results to date show that the quality of D-VIA images is satisfactory and enables CIN1/CIN2+ diagnosis, and that a smartphone is a promising tool for cervical cancer screening monitoring and for on- and off-site supervision, and training. The use of artificial intelligence algorithms could soon allow automated and accurate cervical lesion detection.

Visual inspection with acetic acid (VIA) is one of the methods recommended by the World Health Organization for cervical cancer screening. VIA is simple and low-cost; it, however, presents high subjectivity. We conducted a systematic literature search in PubMed, Google Scholar and Scopus to identify automated algorithms for classifying images taken during VIA as negative (healthy/benign) or precancerous/cancerous. Of the 2608 studies identified, 11 met the inclusion criteria. The algorithm with the highest accuracy in each study was selected, and some of its key features were analyzed. Data analysis and comparison between the algorithms were conducted, in terms of sensitivity and specificity, ranging from 0.22 to 0.93 and 0.67 to 0.95, respectively. The quality and risk of each study were assessed following the QUADAS-2 guidelines. Artificial intelligence-based cervical cancer screening algorithms have the potential to become a key tool for supporting cervical cancer screening, especially in settings where there is a lack of healthcare infrastructure and trained personnel. The presented studies, however, assess their algorithms using small datasets of highly selected images, not reflecting whole screened populations. Large-scale testing in real conditions is required to assess the feasibility of integrating those algorithms in clinical settings.

Screening Papanicolaou test samples has proven to be highly effective in reducing cervical cancer-related mortality. However, the lack of trained cytopathologists hinders its widespread implementation in low-resource settings. Deep learning-based telecytology diagnosis emerges as an appealing alternative, but it requires the collection of large annotated training datasets, which is costly and time-consuming. In this paper, we demonstrate that the abundance of unlabeled images that can be extracted from Pap smear test whole slide images presents a fertile ground for self-supervised learning methods, yielding performance improvements relative to readily available pre-trained models for various downstream tasks. In particular, we propose \textbf{C}ervical \textbf{C}ell \textbf{C}opy-\textbf{P}asting ($\texttt{C}^{3}\texttt{P}$) as an effective augmentation method, which enables knowledge transfer from open-source and labeled single-cell datasets to unlabeled tiles. Not only does $\texttt{C}^{3}\texttt{P}$ outperforms naive transfer from single-cell images, but we also demonstrate its advantageous integration into multiple instance learning methods. Importantly, all our experiments are conducted on our introduced \textit{in-house} dataset comprising liquid-based cytology Pap smear images obtained using low-cost technologies. This aligns with our objective of leveraging deep learning-based telecytology for diagnosis in low-resource settings.

Elisabeth Garcia Vilaplana,1,2 Patrick Petignat,2 Anne-Caroline Benski,2– 4 Adelia Soaroby,4 Jessica Sormani,2 Pierre Vassilakos,2,5 Nicole C Schmidt2,6 1Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Paediatrics, Gynaecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland; 3Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; 4Centre Medical St Damien, Ambanja, Madagascar; 5Geneva Foundation for Medical Education and Research, Geneva, Switzerland; 6Catholic University of Applied Science, Munich, GermanyCorrespondence: Nicole C SchmidtCatholic University of Applied Science, Preysingstraße 95, Munich 81667, GermanyTel +49 89 48092-8499Email nicole.schmidt@ksh-m.deBackground: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system.Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC.Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor

Manuela Viviano,1,* Phuong Lien Tran,1,* Bruno Kenfack,2 Rosa Catarino,1 Mohamed Akaaboune,1,† Liliane Temogne,2 Eveline Tincho Foguem,2 Pierre Vassilakos,3 Patrick Petignat1 1Gynecology Division, Geneva University Hospitals, Geneva, Switzerland; 2Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon; 3Geneva Foundation for Medical Education and Research, Geneva, Switzerland *These authors contributed equally to the work †MA passed away on July 31, 2017 Introduction: Human papillomavirus (HPV) testing is a suitable tool for primary cervical cancer (CC) screening and follow-up in low-resource settings. Vaginal samples taken by women themselves (Self-HPV) are an interesting alternative to physician-performed sampling (Dr-HPV). Our aim was to assess the performance of Self-HPV and Dr-HPV at 6 and 12 months following a CC screening campaign. Methods: This study was carried out at the Dschang District Hospital, Cameroon. Women aged 30–49 years were recruited in a CC screening campaign. HPV-positive women, of whom 2/3 were treated with thermoablation because of abnormal results at baseline screening, were invited to participate in a follow-up study. Self- and Dr-HPV, as well as cytology, were performed at 6 and 12 months. HPV samples were analyzed using the Xpert HPV assay. Sensitivity and specificity for the detection of low-grade squamous intraepithelial lesion or worse and of high-grade squamous intraepithelial lesion or worse were calculated for Self-HPV and Dr-HPV, using cytology as the reference diagnosis. Results: Overall, 188 HPV-positive women were invited to attend follow-up. The obtained follow-up visits’ attendance was 154 (81.9%) and 131 (69.7%) at 6 and 12 months, respectively. While the overall performance of Dr-HPV at 6 months was slightly superior, Self-HPV showed an improved sensitivity for HSIL+ detection at 12 months when compared with

Manuela Viviano,1 Alexia Willame,1 Marie Cohen,1 Anne-Caroline Benski,1 Rosa Catarino,1 Christine Wuillemin,1 Phuong Lien Tran,1 Patrick Petignat,1 Pierre Vassilakos2 1Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland; 2Geneva Foundation for Medical Education and Research, Geneva, Switzerland Objective: Vaginal self-sampling for human papillomavirus (HPV) testing has recently been proposed to optimize cervical cancer screening coverage. The objective of this study was to compare the performance of self-taken samples using flocked and cotton swabs for HPV detection and cellular retrieval.Methods: We recruited women aged 21–65 years, referred to colposcopy at the Division of Gynecology of the Geneva University Hospitals between May and September 2016. Each participant collected 2 vaginal samples: 1 with a cotton swab and 1 with a flocked swab. A 1:1 randomization determined the order in which the 2 samples were taken. The swabs were introduced into a 20 mL PreservCyt® vial. Real-time polymerase chain reaction analysis using the Anyplex™ II HPV HR assay, cytofluorometric analysis and cytological cell counting were performed on each sample.Results: A total of 119 participants were recruited in the study. Their mean ± standard deviation age was 35.1±8.9 years. The HPV prevalence was 29.7% and 38.1% according to the cotton and flocked swab, respectively (p=0.006). The mean number of cells collected per milliliter according to cytofluorometry was 96,726.6 with the cotton swab and 425,544.3 with the flocked swab (p<0.001). The mean number of cells detected at cytological cell count was 13,130.42 using the cotton swab and 17,503.6 using the flocked swab (p<0.001). Conclusion: The flocked swab achieved a greater cellular retrieval and showed an improved performance in HPV detection. Further studies are needed to assess the usability and cost-effectiveness of the 2 self-sampling devices. Key

Manuela Viviano,1 Pierre DeBeaudrap,2 Pierre-Marie Tebeu,3 Jovanny T Fouogue,3 Pierre Vassilakos,4 Patrick Petignat1 1Gynecology Division, Geneva University Hospitals, Geneva, Switzerland; 2Centre Population et Développement – UMR 196, Institute of Research for the Development, University of Paris-Descartes, Paris, France; 3Faculty of Medicine and Biomedical Sciences and Centre Hospitalier Universitaire (CHUY), Yaoundé, Cameroon, Africa; 4Geneva Foundation for Medical Education and Research, Geneva, Switzerland Abstract: Cervical cancer (CC) is a leading cause of cancer-related death and a major public health issue in sub-Saharan Africa. This heavy burden parallels that of the human immunodeficiency virus (HIV) infection, which increases the risk of developing CC. Despite the progressive reduction of HIV prevalence in the past decade, the CC incidence and mortality rates in sub-Saharan Africa remain high. The heterogeneity of the distribution of the two diseases in the African continent, together with the different availability of human and material resources, stands in the way of finding an appropriate screening strategy. The lack of high-quality evidence on the prevention of CC for HIV-positive women, which is necessary for the implementation of efficient screening and treatment strategies, results in the absence of a clearly defined program, which is responsible for the low screening uptake and high mortality rates in sub-Saharan Africa. By taking advantage of the HIV-positive women’s frequent access to health facilities, one way to increase the CC screening coverage rates would be by providing integrated HIV and screening services within the same infrastructure. With the increasing availability of cost-effective methods, screening is becoming more and more available to women who have limited access to health care. Moreover, the introduction of point-of-care technologies for human papillomavirus testing and the s

BACKGROUND: The introduction of ovulation-inducing drugs has raised concern that women exposed to these therapies may be at increased risk of cancer. We assessed the potential association between exposure to fertility drugs and the risk of developing persistent trophoblastic tumour (PTT). METHODS: We conducted a systematic review of the English and non-English language literature using the National Library of Medicine's Medline to identify all observations of patients with hydatidiform mole (HM) after treatment with ovulation-inducers. RESULTS: Fifty-two cases were considered including 26 singleton molar pregnancies and 26 multiple molar pregnancies consisting of an HM and one or more co-existent fetus(es) (HM-and-CF). PTT occurred in 15% of patients with singleton HM and in 42% of patients with HM-and-CF, 15% of whom had a metastasic disease. Of those patients with HM-and-CF, 16 patients delivered at <24 weeks gestation, mostly because of vaginal haemorrhage. Ten patients delivered at ≥24 weeks of gestation, six of whom (25%) had a normal live child. These results are similar to spontaneously conceived pregnancies. CONCLUSIONS: Although women having an HM after therapy with ovulation-inducing drugs seem to have no added risk of PTT, multiple pregnancies are more likely to occur, and the overall risk may be increased

Phuong Lien Tran,1 Bruno Kenfack,2 Eveline Tincho Foguem,3 Manuela Viviano,1 Liliane Temogne,2 Pierre-Marie Tebeu,4 Rosa Catarino,1 Anne-Caroline Benski,1 Pierre Vassilakos,5 Patrick Petignat1 1Division of Gynecology, Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland; 2Department of Biomedical Sciences, University of Dschang, Dschang, Cameroon; 3Department of Gynecology and Obstetrics, District Hospital of Biyem-Assi, Yaoundé, Cameroon; 4Department of Gynecology and Obstetrics, University Centre Hospital, Yaoundé, Cameroon; 5Geneva Foundation for Medical Education and Research, Geneva, Switzerland Introduction: Treating cervical intraepithelial neoplasia (CIN) grades 2 and 3 is the recommended strategy for preventing invasive carcinoma in low- and middle-income countries (LMICs). Our objective was to assess the efficacy of thermoablation in the treatment of CIN2 and CIN3 in a screen-and-treat approach.Methods: Women aged 30–49 years in Dschang, Cameroon, were invited to undergo vaginal sampling for human papillomavirus (HPV), samples being assessed by an Xpert HPV Assay. HPV-positive women underwent visual inspection with acetic acid (VIA) and visual inspection with Lugol’s iodine (VILI), cervical biopsy, and endocervical curettage. Women positive for HPV-16/18/45 or other HPV types with abnormal VIA/VILI were treated by thermoablation on the same day. The primary outcome was persistence of high-grade disease on cytologic examination at 12 months.Results: Of a total of 1,012 recruited women, 188 were HPV-positive, 121 patients required thermoablation, and 99 had a CIN of grade <2, making the overtreatment rate 9.9%. The cure rate for CIN2 and CIN3 at 12 months was 70.6%. Failure (higher risk of persistent disease) was associated with the presence of occult endocervical lesions at baseline diagnosis (adjusted odds ratio [aOR] =128.97 [95% confidence interval [CI], 8.80&ndash

Caroline Gallay,1,* Anne Girardet,1,* Manuela Viviano,2 Rosa Catarino,2 Anne-Caroline Benski,2,3 Phuong Lien Tran,2,4 Christophe Ecabert,5 Jean-Philippe Thiran,5 Pierre Vassilakos,6 Patrick Petignat2 1Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland; 3Department of Gynecology and Obstetrics, Saint Damien Healthcare Centre, Madagascar; 4Department of Gynecology and Obstetrics, Reunion University Hospitals, Reunion Island, France; 5Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; 6Geneva Foundation for Medical Education and Research, Geneva, Switzerland *These authors have contributed equally to the work Background: Visual inspection after application of acetic acid (VIA) and Lugol’s iodine (VILI) is a cervical cancer (CC) screening approach that has recently been adopted in low- and middle-income countries (LMIC). Innovative technologies allow the acquisition of consecutive cervical images of VIA and VILI using a smartphone application. The aim of this study was to evaluate the quality of smartphone images in order to assess the feasibility and usability of a mobile application for CC screening in LMIC.Methods: Between May and November 2015, women aged 30–65 years were recruited in a CC screening campaign in Madagascar. Human papillomavirus-positive women were invited to undergo VIA/VILI assessment. Pictures of their cervix were taken using a Samsung Galaxy S5 with an application called “Exam”, which was designed to obtain high-quality images and to classify them in the following sequence: native, VIA, VILI and posttreatment. Experts in colposcopy were asked to evaluate if the quality of the pictures was sufficient to establish the diagnosis and to assess sharpness, focus and zoom.Results: The application use was simple and intuitive, and 208

Victoria Crofts,1,* Emmanuel Flahault,1,* Pierre-Marie Tebeu,2 Sarah Untiet,3 Gisèle Kengne Fosso,2 Michel Boulvain,3 Pierre Vassilakos,4 Patrick Petignat3 1Faculty of Medicine, University of Geneva, Geneva, Switzerland; 2Department of Gynecology and Obstetrics, University Center Hospital, Yaoundé, Cameroon; 3Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland; 4Geneva Foundation for Medical Education and Research, Geneva, Switzerland *These authors contributed equally to this paper Background: Information about women’s acceptance of new screening methods in Sub-Saharan Africa is limited. The aim of this study was to report on women’s acceptance of human papillomavirus (HPV) self-sampling following an educational intervention on cervical cancer and HPV.Methods: Women were recruited from the city of Tiko and a low-income neighborhood of Yaoundé, both in Cameroon. Written and oral instructions about how to perform an unsupervised HPV self-sample were given to participants, who performed the test in a private room. Acceptability of HPV self-sampling was evaluated by questionnaire. Participants previously screened for cervical cancer by a physician were asked additional questions to assess their personal preferences about HPV self-sampling.Results: A sample of 540 women were prospectively enrolled in the study; median age was 43 years old (range 30–65 years). Participants expressed a high level of acceptance of HPV self-sampling as a screening method following information sessions about cervical cancer and HPV. Most expressed no embarrassment, pain, anxiety, or discomfort (95.6%, 87.8%, 91.3%, and 85.0%, respectively) during the information sessions. Acceptance of the method had no correlation with education, knowledge, age, or socio-professional class. Eighty-six women (16%) had a history of previous screening; they also reported high acceptance of HPV self-sampling.Con

Complete hydatidiform mole and partial hydatidiform mole are two abnormal conceptuses that may be identified by clinical, ultrasonographic, gross morphological, histological, and genetic characteristics. Among all these criteria, the specific diagnosis is generally confirmed only upon histological review. However, an accurate diagnosis based on morphological criteria is difficult and several studies have shown that misclassifications are frequent, even for experienced pathologists. An erroneous diagnosis may imply that women are either not enrolled in an adequate β‐hCG follow‐up with the risk that hydatidiform mole (HM) progresses to choriocarcinoma, or are enrolled in an unnecessary follow‐up. A reliable and complementary method to the pathologic interpretation is a genetic study of the conceptus to eliminate the diagnostic dilemma by distinguishing non‐molar spontaneous abortions from HM and to define the type of HM. The aim of our study was to review the genetic basis of HM and discuss its relevance in the routine management of the disorder

BACKGROUND: The introduction of ovulation-inducing drugs has raised concern that women exposed to these therapies may be at increased risk of cancer. We assessed the potential association between exposure to fertility drugs and the risk of developing persistent trophoblastic tumour (PTT). METHODS: We conducted a systematic review of the English and non-English language literature using the National Library of Medicine's Medline to identify all observations of patients with hydatidiform mole (HM) after treatment with ovulation-inducers. RESULTS: Fifty-two cases were considered including 26 singleton molar pregnancies and 26 multiple molar pregnancies consisting of an HM and one or more co-existent fetus(es) (HM-and-CF). PTT occurred in 15% of patients with singleton HM and in 42% of patients with HM-and-CF, 15% of whom had a metastasic disease. Of those patients with HM-and-CF, 16 patients delivered at <24 weeks gestation, mostly because of vaginal haemorrhage. Ten patients delivered at ≥24 weeks of gestation, six of whom (25%) had a normal live child. These results are similar to spontaneously conceived pregnancies. CONCLUSIONS: Although women having an HM after therapy with ovulation-inducing drugs seem to have no added risk of PTT, multiple pregnancies are more likely to occur, and the overall risk may be increased