Use of Smartphones for the Detection of Uterine Cervical Cancer: A Systematic Review

SIMPLE SUMMARY: Several 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. ABSTRACT: 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.