%0 Journal Article
%@ 2291-5222
%I JMIR Publications
%V 5
%N 5
%P e72
%T A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
%A Urner,Esther
%A Delavy,Martine
%A Catarino,Rosa
%A Viviano,Manuela
%A Meyer-Hamme,Ulrike
%A Benski,Anne-Caroline
%A Jinoro,Jeromine
%A Heriniainasolo,Josea Lea
%A Undurraga,Manuela
%A De Vuyst,Hugo
%A Combescure,Christophe
%A Vassilakos,Pierre
%A Petignat,Patrick
%+ Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1206, Switzerland, 41 22 372 68 16, martinegilliane@gmail.com
%K cervical cancer
%K squamous intraepithelial lesions of the cervix
%K HPV
%K acetic acid
%K lugol’s iodine
%K smartphone
%K mobile phone
%D 2017
%7 29.05.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
%X 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. 
%M 28554879
%R 10.2196/mhealth.6697
%U http://mhealth.jmir.org/2017/5/e72/
%U https://doi.org/10.2196/mhealth.6697
%U http://www.ncbi.nlm.nih.gov/pubmed/28554879