A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study

BackgroundSub-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. ObjectiveThe aim of the study was to evaluate the performances of digital sma...

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Main Authors: Urner, Esther, Delavy, Martine, Catarino, Rosa, Viviano, Manuela, Meyer-Hamme, Ulrike, Benski, Anne-Caroline, Jinoro, Jeromine, Heriniainasolo, Josea Lea, Undurraga, Manuela, De Vuyst, Hugo, Combescure, Christophe, Vassilakos, Pierre, Petignat, Patrick
Format: Article
Language:English
Published: JMIR Publications 2017-05-01
Series:JMIR mHealth and uHealth
Online Access:http://mhealth.jmir.org/2017/5/e72/
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spelling doaj-154ba1bbf8d34c0390139858ecee26d12021-05-03T01:40:42ZengJMIR PublicationsJMIR mHealth and uHealth2291-52222017-05-0155e7210.2196/mhealth.6697A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective StudyUrner, EstherDelavy, MartineCatarino, RosaViviano, ManuelaMeyer-Hamme, UlrikeBenski, Anne-CarolineJinoro, JeromineHeriniainasolo, Josea LeaUndurraga, ManuelaDe Vuyst, HugoCombescure, ChristopheVassilakos, PierrePetignat, Patrick BackgroundSub-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. ObjectiveThe 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. MethodsHuman 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. ResultsAltogether, 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). ConclusionSmartphone-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.http://mhealth.jmir.org/2017/5/e72/
collection DOAJ
language English
format Article
sources DOAJ
author Urner, Esther
Delavy, Martine
Catarino, Rosa
Viviano, Manuela
Meyer-Hamme, Ulrike
Benski, Anne-Caroline
Jinoro, Jeromine
Heriniainasolo, Josea Lea
Undurraga, Manuela
De Vuyst, Hugo
Combescure, Christophe
Vassilakos, Pierre
Petignat, Patrick
spellingShingle Urner, Esther
Delavy, Martine
Catarino, Rosa
Viviano, Manuela
Meyer-Hamme, Ulrike
Benski, Anne-Caroline
Jinoro, Jeromine
Heriniainasolo, Josea Lea
Undurraga, Manuela
De Vuyst, Hugo
Combescure, Christophe
Vassilakos, Pierre
Petignat, Patrick
A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
JMIR mHealth and uHealth
author_facet Urner, Esther
Delavy, Martine
Catarino, Rosa
Viviano, Manuela
Meyer-Hamme, Ulrike
Benski, Anne-Caroline
Jinoro, Jeromine
Heriniainasolo, Josea Lea
Undurraga, Manuela
De Vuyst, Hugo
Combescure, Christophe
Vassilakos, Pierre
Petignat, Patrick
author_sort Urner, Esther
title A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
title_short A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
title_full A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
title_fullStr A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
title_full_unstemmed A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
title_sort smartphone-based approach for triage of human papillomavirus-positive sub-saharan african women: a prospective study
publisher JMIR Publications
series JMIR mHealth and uHealth
issn 2291-5222
publishDate 2017-05-01
description BackgroundSub-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. ObjectiveThe 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. MethodsHuman 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. ResultsAltogether, 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). ConclusionSmartphone-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.
url http://mhealth.jmir.org/2017/5/e72/
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