Phoblap Thamawoot, Temtanakitpaisan Amornrat, Aue-Angkul Apiwat, Kleebkaow Pilaiwan, Chumworathayi Bandit, Luanratanakorn Sanguanchoke, Itarat Yuwadee
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Obstet Gynecol Sci. 2022 Sep;65(5):451-458. doi: 10.5468/ogs.22092. Epub 2022 Jul 28.
To evaluate the performance of "Smartscopy" in diagnosing preinvasive cervical lesions among patients with abnormal cervical cancer screening results obtained during the coronavirus disease 2019 (COVID-19) pandemic.
This diagnostic study enrolled non-pregnant women with abnormal cervical cancer screening results obtained at the colposcopy clinic at Srinagarind Hospital (Khon Kaen, Thailand) between September 2020 and March 2021. Two colposcopists independently evaluated the uterine cervix using a smartphone and colposcopy. Cervical biopsies and endocervical curettage were performed in accordance with standard procedures. The diagnostic performance of a smartphone in detecting low-grade squamous intraepithelial lesions or worse plus (LSIL+) and high-grade squamous intraepithelial lesions plus (HSIL+) was assessed.
In total, 247 patients were included. There was high agreement between the two colposcopists (κ=0.88; 95% confidence interval [CI], 0.82-0.93). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the smartphone to detect LSIL+ were 96.6% (95% CI, 91.6-99.1), 12.9% (95% CI, 8.06-19.2), 46.2% (95% CI, 39.7-52.4), 83.3% (95% CI, 62.6-95.3), and 0.49% (95% CI, 0.43-0.55), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of smartscopy in diagnosing HSIL+ were 67.6% (95% CI, 55.2- 78.5), 85.4% (95% CI, 79.9-90.0), 60.5% (95% CI, 48.6-71.6), 88.9% (95% CI, 83.7-92.9), and 81.0% (95% CI, 0.75-0.85), respectively.
Smartscopy demonstrated a remarkable correlation with colposcopy and a high diagnostic performance value for the detection of preinvasive cervical lesions. Therefore, smartscopy may be an alternative tool for detecting abnormal cervical lesions in low to medium medical resource settings. Smartscopy may be applied in telemedicine during the COVID-19 pandemic.
评估“智能阴道镜检查”在诊断2019冠状病毒病（COVID-19）大流行期间宫颈癌筛查结果异常的患者中宫颈上皮内瘤变的性能。
这项诊断性研究纳入了2020年9月至2021年3月期间在泰国孔敬市诗里拉医院阴道镜诊所获得宫颈癌筛查结果异常的非孕妇。两名阴道镜检查医师分别使用智能手机和阴道镜对子宫颈进行评估。按照标准程序进行宫颈活检和宫颈管刮除术。评估智能手机检测低级别鳞状上皮内病变或更高级别病变加（LSIL+）以及高级别鳞状上皮内病变加（HSIL+）的诊断性能。
总共纳入了247例患者。两名阴道镜检查医师之间具有高度一致性（κ=0.88；95%置信区间[CI]，0.82-0.93）。智能手机检测LSIL+的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为96.6%（95%CI，91.6-99.1）、12.9%（95%CI，8.06-19.2）、46.2%（95%CI，39.7-52.4）、83.3%（95%CI，62.6-95.3）和49.0%（95%CI，43.0-55.0）。智能阴道镜检查诊断HSIL+的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为67.6%（95%CI，55.2-78.5）、85.4%（95%CI，79.9-90.0）、60.5%（95%CI，48.6-71.6）、88.9%（95%CI，83.7-92.9）和81.0%（95%CI，75.0-85.0）。
智能阴道镜检查与阴道镜检查显示出显著相关性，并且在检测宫颈上皮内瘤变方面具有较高的诊断性能价值。因此，智能阴道镜检查可能是在中低医疗资源环境中检测宫颈异常病变的一种替代工具。在COVID-19大流行期间，智能阴道镜检查可应用于远程医疗。
