Abstract
Visual inspection with acetic acid (VIA) is recommended by the World Health Organization for primary cervical cancer screening or triage of human papillomavirus-positive women living in low-resource settings. Nonetheless, traditional VIA with the naked-eye is associated with large variabilities in the detection of pre-cancer and with a lack of quality control. Digital-VIA (D-VIA), using high definition cameras, allows magnification and zooming on transformation zones and suspicious cervical regions, as well as simultaneously compare native and post-VIA images in real-time. We searched MEDLINE and LILACS between January 2015 and November 2021 for relevant studies conducted in low-resource settings using a smartphone device for D-VIA. The aim of this review was to provide an evaluation on available data for smartphone use in low-resource settings in the context of D-VIA-based cervical cancer screenings. The available results to date show that the quality of D-VIA images is satisfactory and enables CIN1/CIN2+ diagnosis, and that a smartphone is a promising tool for cervical cancer screening monitoring and for on- and off-site supervision, and training. The use of artificial intelligence algorithms could soon allow automated and accurate cervical lesion detection.
Highlights
Articles were excluded from the title, abstract, and/or methodology: (i) if they had not been conducted in a cervical cancer screening context using D-Visual Inspection with Acetic Acid (VIA), (ii) if they did not include the use of smartphones for D-VIA image acquisition, (iii) if the study was not conducted in a low-resource setting or low and middle income countries (LMICs), and (iv) if the study data were not published in full articles
We summarized the articles published on artificial intelligence (AI) according to our research for cervical pre-cancer identification
Comment: accuracy of D-VIA to differentiate between CIN1 and Limitations: low observed prevalence of HPV (6%), small number of CIN2+ (n = 15)
Summary
Organization (WHO) has launched a global program to eliminate cervical cancer, with the following targets: (i) all countries have to achieve 90% vaccination coverage, (ii). 70% of screening coverage, and (iii) 90% access to treatment for cervical pre-cancer or cancer [2]. To reach the second and third WHO targets, towards cervical cancer elimination, women should be screened using high-performance tests between the ages of 5 to 45 years old, coupled with treatment, if required [3]. Visual assessment of the cervix with acetic acid (VIA) has been adopted by the WHO in primary screenings or in the triage of HPV-positive women as an affordable and adapted method in low-resource settings [3]. “nakedeye” VIA assessment remains a highly subjective test with low performance and limited quality control [4]. Limitations were first inherent to the technique itself, but variations of training, mentorship, and supervision may account for the performance difference observed across studies
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