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In International journal of cancer ; h5-index 82.0

We examined whether automated visual evaluation (AVE), a deep learning computer application for cervical cancer screening, can be used on cervix images taken by a contemporary smartphone camera. A large number of cervix images acquired by the commercial MobileODT EVA system® were filtered for acceptable visual quality and then 7,587 filtered images from 3,221 women were annotated by a group of gynecologic oncologists (so the gold standard is expert impression, not histopathology). We tested and analyzed on multiple random splits of the images using two deep learning, object detection networks. For all the ROC (receiver operating characteristics) curves, the AUC (area under the curve) values for the discrimination of the most likely precancer cases from least likely cases (most likely controls) were above 0.90. These results showed that AVE can classify cervix images with confidence scores that are strongly associated with expert evaluations of severity for the same images. The results on a small subset of images that have histopathologic diagnoses further supported the capability of AVE for predicting cervical precancer. We examined the associations of AVE severity score with gynecologic oncologist impression at all regions where we had sufficient number of cases and controls, and the influence of a woman's age. The method was found generally resilient to regional variation in the appearance of the cervix. This work suggest that using AVE on smartphones could be a useful adjunct to health-worker visual assessment with acetic acid (VIA), a cervical cancer screening method commonly used in low- and middle-resource settings.

Xue Zhiyun, Novetsky Akiva P, Einstein Mark H, Marcus Jenna Z, Befano Brian, Guo Peng, Demarco Maria, Wentzensen Nicolas, Long L Rodney, Schiffman Mark, Antani Sameer


automated visual evaluation, cervical cancer screening, deep learning, smartphone camera