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. 2020 Mar 25;20(1):60.
doi: 10.1186/s12905-020-00902-0.

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology

Ali Naqvi  1 , Niti Manglik  1   2 , Ellen Dudrey  1   2 , Cynthia Perry  1 , Zuber D Mulla  3 , Jorge L Cervantes  4
Affiliations

Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology

Ali Naqvi et al. BMC Womens Health. .

Abstract

Background: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology.

Methods: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity.

Results: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal.

Conclusions: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

Keywords: Accuracy; Agreement; Cervical cytology; Foldscope; Smart phone.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The Foldscope. Assembled paper-based Foldscope (top left). Foldscope phone coupler taped onto a smart phone (top right). Placing the slide within the slide holding apparatus (lower left). Foldscope ball lens comparison with a penny, ball lens is a 2.2 mm borosilicate lens (bottom right)
Fig. 2
Fig. 2
Region of Interest (ROI) images of cervical cytology slides obtained using a Foldscope (left) and a conventional microscope (right)
See this image and copyright information in PMC

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