@Article{info:doi/10.2196/mhealth.6697,
author="Urner, Esther
and Delavy, Martine
and Catarino, Rosa
and Viviano, Manuela
and Meyer-Hamme, Ulrike
and Benski, Anne-Caroline
and Jinoro, Jeromine
and Heriniainasolo, Josea Lea
and Undurraga, Manuela
and De Vuyst, Hugo
and Combescure, Christophe
and Vassilakos, Pierre
and Petignat, Patrick",
title="A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="May",
day="29",
volume="5",
number="5",
pages="e72",
keywords="cervical cancer; squamous intraepithelial lesions of the cervix; HPV; acetic acid; lugol's iodine; smartphone; mobile phone",
abstract="Background: Sub-Saharan African countries are marked by a high incidence of cervical cancer. Madagascar ranks 11th among the countries with the highest cervical cancer incidence worldwide. Objective: The aim of the study was to evaluate the performances of digital smartphone-based visual inspection with acetic acid (D-VIA) and Lugol's iodine (D-VILI) for diagnosing cervical precancer and cancer. Methods: Human papillomavirus (HPV)-positive women recruited through a cervical screening campaign had D-VIA and D-VILI examinations with endocervical curettage (ECC) and cervical biopsy. Three images were captured for each woman (native, D-VIA, D-VILI) using a smartphone camera. The images were randomly coded and distributed on 2 online databases (Google Forms). The D-VIA form included native and D-VIA images, and the D-VILI form included native and D-VILI images. Pathological cases were defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Physicians rated the images as non-pathological or pathological. Using the ECC and cervical biopsy results as references, the sensitivity and specificity of D-VIA and D-VILI examinations for each and all physicians were calculated. Results: Altogether, 15 clinicians assessed 240 images. Sensitivity was higher for the D-VIA interpretations (94.1{\%}; 95{\%} CI 81.6-98.3) than for the D-VILI interpretations (78.8{\%}; 95{\%} CI 54.1-92.1; P=.009). In contrast, the specificity was higher for the D-VILI interpretations (56.4{\%}; 95{\%} CI 38.3-72.9) than for the D-VIA interpretations (50.4{\%}; 95{\%} CI 35.9-64.8; P=.005). Conclusion: Smartphone-based image for triage of HPV-positive women is more accurate for detecting CIN2+ lesions with D-VIA than D-VILI, although with a small loss of specificity. ",
issn="2291-5222",
doi="10.2196/mhealth.6697",
url="http://mhealth.jmir.org/2017/5/e72/",
url="https://doi.org/10.2196/mhealth.6697",
url="http://www.ncbi.nlm.nih.gov/pubmed/28554879"
}