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Smartphone Use for Cervical Cancer Screening in Low-Resource Countries: A Pilot Study Conducted in Madagascar
- Source :
- PLoS ONE, PLoS ONE, Vol 10, Iss 7, p e0134309 (2015), PLOS ONE, Vol. 10, No 7 (2015) P. e0134309
- Publication Year :
- 2015
-
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.
- Subjects :
- Biopsy
lcsh:Medicine
Uterine Cervical Neoplasms
Pilot Projects
Cervix Uteri
Acetic Acid/administration & dosage
Cancer screening
Mass Screening/instrumentation/methods
Mass Screening
lcsh:Science
Papillomaviridae
Early Detection of Cancer
Acetic Acid
Cervical cancer
Colposcopy
Multidisciplinary
ddc:618
medicine.diagnostic_test
Middle Aged
Cervical Intraepithelial Neoplasia/diagnosis/pathology/virology
Biopsy/methods
Visual inspection
medicine.anatomical_structure
Female
Smartphone
Research Article
Adult
medicine.medical_specialty
Low resource
Cervical intraepithelial neoplasia
Sensitivity and Specificity
Cervix Uteri/pathology/virology
Colposcopy/methods
medicine
Madagascar
Humans
Medical physics
Papillomaviridae/pathogenicity
Cervix
Mass screening
Gynecology
Vaginal Smears
Papillomavirus Infections/diagnosis/pathology
business.industry
Early Detection of Cancer/instrumentation/methods
Uterine Cervical Neoplasms/diagnosis/pathology/virology
lcsh:R
Papillomavirus Infections
medicine.disease
Uterine Cervical Dysplasia
Vaginal Smears/methods
lcsh:Q
business
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 10
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....8e8fbc9831f7c5b5e086df1235e3381b