Smartphone-Based Visual Inspection with Acetic Acid: An Innovative Tool to Improve Cervical Cancer Screening in Low-Resource Setting

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.

Human Papillomavirus Epidemiology and Prevention: Is There Still a Gender Gap?

“…Interpretation of the results is crucial to determine positivity and negativity to decide on clinical treatment in case of positivity. Since 1990, some countries have used EIA as the primary screening [93]. To assess the squamocolumnar junction, which is the area that has the highest risk of going to dysplasia, the Papanicolau test (Pap test) or the thin-layer liquid-based cytology method is performed [94].…”

The Impact of COVID-19 on Women’s Health in Nepal

“…Particularly, the evolution of smartphone technology has created new possibilities for cervical screening in low-resource settings. Utilizing smartphones as imaging devices during VIA may be the most feasible alternative to enhance the performance of visual inspection with naked eyes, considering the widespread availability and accessibility of smartphones across all demographics [4,20]. Images acquired through these methods can be utilized beyond just human interpretation and telemedicine, to develop AI systems that assist in decision-making and train healthcare workers, such as nurses and paramedics, who perform VIA in LMICs [20,6].…”

“…Utilizing smartphones as imaging devices during VIA may be the most feasible alternative to enhance the performance of visual inspection with naked eyes, considering the widespread availability and accessibility of smartphones across all demographics [4,20]. Images acquired through these methods can be utilized beyond just human interpretation and telemedicine, to develop AI systems that assist in decision-making and train healthcare workers, such as nurses and paramedics, who perform VIA in LMICs [20,6]. In the realm of digital cervicography and colposcopy, there have been efforts to demonstrate how AI models can be leveraged to make decisions regarding VIA outcomes [11,27], to detect various landmarks in the cervix [9] as well as to localize lesions [15].…”

Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini—Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen

“…In low-resource settings, the "see-and-treat" approach, which includes naked eye or digitally enhanced visual inspection with acetic acid (VIA) to detect pre-cancerous lesions and the use of cryotherapy (liquid nitrous oxide ablation) to freeze and destroy pre-cancerous tissue, has been successfully implemented [ 16 ]. However, the quality of VIA depends heavily on provider competence and the test’s sensitivity, which is variable [ 17 – 19 ].…”