Use of Smartphones as Adjuvant Tools for Cervical Cancer Screening in Low-Resource Settings
Use of Smartphones as Adjuvant Tools for Cervical Cancer Screening in Low-Resource Settings
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DOI：
10.1097/lgt.0000000000000136
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发表时间：
2015-10-01
影响因子：
3.7
通讯作者：
Petignat, Patrick
中科院分区：
文献类型：
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作者：
Ricard-Gauthier, Dominique;Wisniak, Anna;Petignat, Patrick
目的我们的目的是评估智能手机数字图像作为醋酸（VIA）和卢戈碘（VILI）常规目视检查方法的辅助手段检测2级或更差的宫颈上皮内瘤变（CIN 2+）的可行性和性能，方法对300例宫颈癌患者进行HPV初筛，并与组织病理学检查进行比较。收集的阴道标本然后邀请人乳头瘤病毒阳性的妇女进行VIA和VILI，这被解释为（i）非病理性，（ii）病理性或（iii）不确定性。进行宫颈涂片、宫颈内刷检和宫颈活检。用智能手机拍摄子宫颈的数字图像，并由经验丰富的医疗保健提供者进行异地评估。以组织病理学诊断为判断标准，比较宫颈癌诊断的敏感性和特异性。总的来说，7例CIN 2+（8.0%）使用活检标本诊断。现场医生获得的灵敏度为28.6%（95%置信区间[95% CI]，3.7-71），特异性为87.2%（95% CI，77.7- 93.7）。非现场医生获得的灵敏度范围为42.9%（95% CI，9.9-81.6; p = 1）和85.7%（95% CI，42.1-99.6; p = .13），特异性在48.1%（95% CI，36.5- 59.7; p < .001）和79.2%（95% CI，68.5-87.6; p = .10）之间。观察者之间的比较未达到显著性。观察者评估95.6%的所有图像为非常好或可接受的interpretation purpose.Conclusion智能手机图像可能是一个有用的辅助传统的VIA和VILI的CIN 2+的检测和改善宫颈癌筛查在低资源设置。
Objectives Our aim was to evaluate the feasibility and performance of smartphone digital images for the detection of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) as an adjunct to a conventional visual inspection approach with acetic acid (VIA) and Lugol's iodine (VILI), in comparison with detection by histopathologic examination.Methods Three hundred women were primarily screened for human papillomavirus (HPV) using self-collected vaginal specimens. Human papillomavirus-positive women were then invited for VIA and VILI, which were interpreted as (i) nonpathological, (ii) pathological or, (iii) inconclusive. Cervical smearing, endocervical brushing, and cervical biopsies were performed. Digital images of the cervix were taken with a smartphone and evaluated offsite by experienced health care providers. Sensitivity and specificity for CIN2+ were compared between on-site and off-site observers, using histopathological diagnosis as the criterion standard.Results Eighty-eight HPV-positive women were screened for cervical cancer. Overall, 7 cases of CIN2+ (8.0%) were diagnosed using biopsy specimens. The on-site physician obtained a sensitivity of 28.6% (95% confidence interval [95% CI], 3.7-71) and a specificity of 87.2% (95% CI, 77.7- 93.7). The off-site physicians obtained a sensitivity ranging between 42.9% (95% CI, 9.9-81.6; p = 1) and 85.7% (95% CI, 42.1-99.6; p = .13) and a specificity between 48.1% (95% CI, 36.5- 59.7; p < .001) and 79.2% (95% CI, 68.5-87.6; p = .10). Comparison between observers did not reach significance. Observers assessed 95.6% of all images as very good or acceptable for interpretation purpose.Conclusion Smartphone images may be a useful adjunct to conventional VIA and VILI for the detection of CIN2+ and improve cervical cancer screening in low-resource settings.