Abstract
Simple SummarySeveral studies reveal that digital images taken with a smartphone after a visual inspection with acetic acid (VIA) or Lugol’s iodine (VILI) may be useful for detecting cervical intraepithelial neoplasia. Therefore, smartphones could be useful in the early detection of uterine cervical lesions and an alternative to colposcopy in countries with limited health resources. In this systematic review, we found that the VIA using a smartphone seems to be more sensitive than the VIA, VILI, or VIA/VILI examinations with the naked eye. Therefore, it can improve diagnostic accuracy for the detection of uterine cervical lesions.Little is known regarding the usefulness of the smartphone in the detection of uterine cervical lesions or uterine cervical cancer. Therefore, we evaluated the usefulness of the smartphone in the detection of uterine cervical lesions and measured its diagnostic accuracy by comparing its findings with histological findings. We conducted a systematic review to identify studies on the usefulness of the smartphone in detecting uterine cervical lesions indexed in SCOPUS, MEDLINE/PubMed, Cochrane, OVID, Web of Science, and SciELO until November 2020. The risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A total of 16 studies that evaluated the usefulness of the smartphone in the detection of uterine cervical lesions based on the images clicked after visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), or VIA/VILI combination were included in the study. Five studies estimated diagnostic sensitivity and specificity, nine described diagnostic concordance, and five described the usefulness of mobile technology. Among the five first studies, the sensitivity ranged between 66.7% (95% confidence interval (CI); 30.0–90.3%) and 94.1% (95% CI; 81.6–98.3%), and the specificity ranged between 24.0% (95% CI; 9.0–45.0%) and 85.7% (95% CI; 76.7–91.6%). The risk of bias was low (20%), and the applicability was high. In conclusion, the smartphone images clicked after a VIA were found to be more sensitive than those following the VILI method or the VIA/VILI combination and naked-eye techniques in detecting uterine cervical lesions. Thus, a smartphone may be useful in the detection of uterine cervical lesions; however, its sensitivity and specificity are still limited.
Highlights
Despite advances in the diagnosis of uterine cervical cancer (UCC) and the administration of vaccines against the high-risk human papillomavirus (HPV-16 and 18), UCC remains one of the leading causes of death [1]
Colposcopy is the standard technique used for determining the degree of uterine cervical lesions and high-grade cervical intraepithelial neoplasia (CIN) or abnormal cytology
This difference can probably be explained by the average estimate of the high sensitivity of visual inspection with acetic acid (VIA) versus a low VIA or Lugol’s iodine (VILI) sensitivity, which might result in a decrease in diagnostic sensitivity
Summary
Despite advances in the diagnosis of uterine cervical cancer (UCC) and the administration of vaccines against the high-risk human papillomavirus (HPV-16 and 18), UCC remains one of the leading causes of death [1]. UCC can be prevented by the early detection of cervical intraepithelial neoplasia (CIN) based on a PAP test or the detection of high-risk HPV through a PCR test. Colposcopy is the standard technique used for determining the degree of uterine cervical lesions and high-grade CIN or abnormal cytology. The performance of this procedure varies based on the level of care, experience of the colposcopist, and the type of colposcopy (digital, optical, or video colposcopy). The disadvantage of this procedure is that the colposcope and colposcopists are not always available at primary care facilities
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