TY  - JOUR
AU  - Urner, Esther
AU  - Delavy, Martine
AU  - Catarino, Rosa
AU  - Viviano, Manuela
AU  - Meyer-Hamme, Ulrike
AU  - Benski, Anne-Caroline
AU  - Jinoro, Jeromine
AU  - Heriniainasolo, Josea Lea
AU  - Undurraga, Manuela
AU  - De Vuyst, Hugo
AU  - Combescure, Christophe
AU  - Vassilakos, Pierre
AU  - Petignat, Patrick
PY  - 2017
DA  - 2017/05/29
TI  - A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
JO  - JMIR Mhealth Uhealth
SP  - e72
VL  - 5
IS  - 5
KW  - cervical cancer
KW  - squamous intraepithelial lesions of the cervix
KW  - HPV
KW  - acetic acid
KW  - lugol’s iodine
KW  - smartphone
KW  - mobile phone
AB  - 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. 
SN  - 2291-5222
UR  - http://mhealth.jmir.org/2017/5/e72/
UR  - https://doi.org/10.2196/mhealth.6697
UR  - http://www.ncbi.nlm.nih.gov/pubmed/28554879
DO  - 10.2196/mhealth.6697
ID  - info:doi/10.2196/mhealth.6697
ER  -