Cervical cancer screening in low-resource settings: a smartphone image application as an alternative to colposcopy

Figures & data

Figure 1 Study flowchart.

Abbreviations: HPV, human papillomavirus; HR, high risk; VIA, visual inspection after application of acetic acid; VILI, visual inspection after application of Lugol’s iodine.

Figure 2 Device including the gynecological table, smartphone and tripod.

Figure 3 Images’ acquisition flowchart.

Abbreviations: VIA, visual inspection after application of acetic acid; VILI, visual inspection after application of Lugol’s iodine.

Table 1 Pictures fulfilling the four quality criteria of a total of 624 evaluations

	Sharpness n (%)	Focus n (%)	Zoom n (%)	Diagnostic utility n (%)
Rater 1	143 (68.8)	184 (88.5)	149 (71.6)	150 (72.1)
Rater 2	151 (72.6)	166 (79.8)	116 (55.8)	166 (79.8)
Rater 3	191 (91.8)	206 (99.0)	195 (93.8)	206 (99.0)
Total	485 (77.7)	556 (89.1)	460 (73.7)	522 (83.7)

Table 2 Evaluation of photo quality (two or more of the following criteria fulfilled: focus diagnostic utility, sharpness and zoom)

	Good quality photos n (%)	Poor quality photos n (%)
Rater 1	177 (85.1)	31 (14.9)
Rater 2	176 (84.6)	32 (15.4)
Rater 3	206 (99.0)	2 (1.0)
Consensus	194 (93.3)	14 (6.7)

Table 3 Agreement and kappa values between each rater and the consensus

	Obtained agreement (%)	Expected agreement (%)	κ	Standard error	P-value
Rater 1	91.83	80.37	0.58	0.06	<0.001
Rater 2	90.38	79.96	0.52	0.06	<0.001
Rater 3	94.23	92.44	0.23	0.05	<0.001