Smartphone use as an alternative to colposcopy in the diagnosis of cervical precancer in rural areas: an overview

Abstract

Main: Evaluate the performance of digital images of smartphone for detecting atypical transformations of the precervical damage.
 Methods:   This was a prospective, descriptive and analytical study which took place over eight months from 1 July 2017 to 28 February 2018, at the CHR in Tchibanga. The use of large images (zoom x2) by smartphone combined with the methods of visual inspection of the uterine collar was the basic technique for this study.
Results:   144 women aged 18-70 were screened; the average age was 34.3 years; the IVA positive rate was 13.2% on-site and 14.6% off-site (k=0.83), while IVL images were 24.3% and 22.2% respectively for both examiners (k=0.86). 23 TAG1 and TAG2 were diagnosed off-site. The off-site performances of IVA image tests were better than on-site at 82.4%, 94.1%, 66.7% and 97.4% respectively for the sensitivity, specificity, VPP and VPN on IVA images; they were 88.2%, 85.6%, 46.9% and 98.1% respectively on IVL images. Anatomopathology has determined a prevalence of 11.8% (n=17) of pre-cancerous damage and 0.7% (n=1) of invasive cancer cases which were referred to ICL via CHUL. Lost views accounted for 5.6%.
Conclusion:   The use of smartphone images combined with visual inspection methods is a simple, low-cost and reproducible technique on a scale. It has shown significant performance in detecting atypical transformations of uterine cancer and its precursors. This technique could be the basis for setting up screening programs suited to remote areas with limits of technical plateau and infrastructure, with the   aim of reducing the high morbidity and mortality associated with this infection.