A pilot study of upcycled smartphone-based colposcopy for visual inspection of cervix performed by community healthcare workers in rural Vietnam

Abstract

ObjectiveThis study assessed the feasibility of smartphone-based colposcopy (SBC) for visual inspection of the cervix by community healthcare workers in low-resource areas.MethodsThis was a retrospective study conducted in community villages in rural Vietnam, where 177 participants were enrolled for a cervical cancer screening. Cervical images were obtained by pre-trained community healthcare workers using a portable, upcycled SBC (Samsung Galaxy Note 20). Images were taken before and after the visual inspection after acetic acid (VIA) examination. Captured images were stored on a web server through an Android-based application and later reviewed independently by two experienced gynecologists. Image quality was assessed, and kappa statistics were calculated for the measurement of agreement in VIA findings.ResultsCervical images of 177 women obtained between July and August 2020 were analyzed. The mean age of women was 42 +/- 9.1 years, and 20.3% were postmenopausal. The percentage of adequate visibility of the squamocolumnar junction (SCJ) in the captured images was 83.1%. The kappa value for interobserver reliability was 0.61 for VIA positivity agreement between the two gynecologists. Image clarity was rated as average or above in 77.3%. The reasons for suboptimal clarity were poor focusing (15.3%), inadequate SCJ visibility (18%), and obscuring of the transformation zone due to blood (11.3%), discharge (14.7%), or artifacts such as intrauterine devices or polyps (5.1%).ConclusionUpcycled SBC was feasible when performed by pre-trained healthcare workers in a low-resource setting. VIA findings by SBC showed adequate agreement between two independent assessments, suggesting its potential as a method to aid cervical cancer screening. Upcycled SBC is a feasible method for visual inspection with acetic acid of the cervix performed by community healthcare workers in low-resource settings.