1. Smartphone Use for Cervical Cancer Screening in Low-Resource Countries: A Pilot Study Conducted in Madagascar.
- Author
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Catarino R, Vassilakos P, Scaringella S, Undurraga-Malinverno M, Meyer-Hamme U, Ricard-Gauthier D, Matute JC, and Petignat P
- Subjects
- Acetic Acid administration & dosage, Adult, Biopsy methods, Cervix Uteri pathology, Cervix Uteri virology, Colposcopy methods, Early Detection of Cancer methods, Female, Humans, Madagascar, Mass Screening instrumentation, Mass Screening methods, Middle Aged, Papillomaviridae pathogenicity, Papillomavirus Infections diagnosis, Papillomavirus Infections pathology, Pilot Projects, Sensitivity and Specificity, Smartphone, Uterine Cervical Neoplasms virology, Vaginal Smears methods, Uterine Cervical Dysplasia diagnosis, Uterine Cervical Dysplasia pathology, Uterine Cervical Dysplasia virology, Early Detection of Cancer instrumentation, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms pathology
- Abstract
Background: Visual inspection of the cervix after application of 5% acetic acid (VIA) is a screening technique for cervical cancer used widely in low and middle-income countries (LMIC). To improve VIA screening performance, digital images after acid acetic application (D-VIA) are taken. The aim of this study was to evaluate the use of a smartphone for on- and off-site D-VIA diagnosis., Materials and Methods: Women aged 30-65 years, living in the city of Ambanja, Madagascar, were recruited through a cervical cancer screening campaign. Each performed a human papillomavirus (HPV) self-sample as a primary screen. Women testing positive for HPV were referred for VIA followed by D-VIA, cervical biopsy and endocervical curettage according to routine protocol. In addition, the same day, the D-VIA was emailed to a tertiary care center for immediate assessment. Results were scored as either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary center. Each of the three off-site physicians were blinded to the result reported by the one on-site physician and each gave their individual assessment followed by a consensus diagnosis. Statistical analyses were conducted using STATA software., Results: Of the 332 women recruited, 137 (41.2%) were HPV-positive and recalled for VIA triage; compliance with this invitation was 69.3% (n = 95). Cervical intraepithelial neoplasia was detected in 17.7% and 21.7% of digital images by on-site and off-site physicians, respectively. The on-site physician had a sensitivity of 66.7% (95%CI: 30.0-90.3) and a specificity of 85.7% (95%CI: 76.7-91.6); the off-site physician consensus sensitivity was 66.7% (95%CI: 30.0-90.3) with a specificity of 82.3% (95%CI: 72.4-89.1)., Conclusion: This pilot study supports the use of telemedicine for off-site diagnosis of cervical intraepithelial neoplasia, with diagnostic performance similar to those achieved on-site. Further studies need to determine if smartphones can improve cervical cancer screening efficiency in LMIC.
- Published
- 2015
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