Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Am J Obstet Gynecol. 2019 Sep;221(3):241.e1-241.e6. doi: 10.1016/j.ajog.2019.04.039. Epub 2019 May 7.
Smartphones recently have been applied in the medical setting. However, the literature evaluating the utility of smartphones in gynecologic oncology is limited.
To evaluate the utility of a smartphone in the detection of uterine cervical lesions in patients with abnormal cervical cytology.
Seventy-five women with abnormal cervical cytology were enrolled. Two doctors independently inspected the uterine cervix by using smartphone or colposcopy. Images were captured using acetic acid, and biopsies were taken as standard-of-care procedures. The diagnostic performance of the smartphone for cervical intraepithelial neoplasm 1 or worse and cervical intraepithelial neoplasm 2 or worse were evaluated, and the kappa value was calculated to determine the chance corrected agreement of the histologic diagnoses based on the smartphone and colposcopic findings.
There was a substantial agreement between histologic diagnoses based on the smartphone and colposcopic findings, with a kappa value of 0.67 (95% confidence interval, 0.43-0.90). The sensitivity, specificity, positive predictive value, and negative predictive value of the smartphone in the diagnosis of cervical intraepithelial neoplasm 1 or worse were 0.89 (95% confidence interval, 0.79-0.96), 0.33 (95% confidence interval, 0.08-0.70), 0.91 (95% confidence interval, 0.81-0.97), and 0.30 (95% confidence interval, 0.07-0.65), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value in the diagnosis of cervical intraepithelial neoplasm 2 or worse were 0.92 (95% confidence interval, 0.81-0.98), 0.24 (95% confidence interval, 0.09-0.45), 0.71 (95% confidence interval, 0.58-0.81), and 0.60 (95% confidence interval, 0.26-0.88), respectively.
We found that there was a substantial agreement between the histologic diagnoses based on the smartphone and colposcopic findings. The smartphone seems to be useful and may be an alternative to colposcopy.
智能手机最近已应用于医疗领域。然而，评估智能手机在妇科肿瘤学中的效用的文献有限。
评估智能手机在检测宫颈细胞学异常患者的子宫颈病变中的效用。
共纳入 75 名宫颈细胞学异常的女性。两名医生分别使用智能手机或阴道镜检查子宫颈。使用醋酸溶液采集图像，并作为标准护理程序进行活检。评估智能手机对宫颈上皮内瘤变 1 级或更高级别和宫颈上皮内瘤变 2 级或更高级别的诊断性能，并计算kappa 值以确定基于智能手机和阴道镜检查结果的组织学诊断的机会校正一致性。
基于智能手机和阴道镜检查结果的组织学诊断之间存在高度一致性，kappa 值为 0.67（95%置信区间，0.43-0.90）。智能手机诊断宫颈上皮内瘤变 1 级或更高级别的灵敏度、特异性、阳性预测值和阴性预测值分别为 0.89（95%置信区间，0.79-0.96）、0.33（95%置信区间，0.08-0.70）、0.91（95%置信区间，0.81-0.97）和 0.30（95%置信区间，0.07-0.65）。诊断宫颈上皮内瘤变 2 级或更高级别的灵敏度、特异性、阳性预测值和阴性预测值分别为 0.92（95%置信区间，0.81-0.98）、0.24（95%置信区间，0.09-0.45）、0.71（95%置信区间，0.58-0.81）和 0.60（95%置信区间，0.26-0.88）。
我们发现基于智能手机和阴道镜检查结果的组织学诊断之间存在高度一致。智能手机似乎是有用的，并且可能是阴道镜检查的替代方法。
