Deep learning-based image evaluation for cervical precancer screening with a smartphone targeting low resource settings - Engineering approach.

Cervical cancer is the fourth most common cancer among women and still one of the major causes of women's death around the world. Early screening of high grade Cervical Intraepithelial Neoplasia (CIN), precursors to cervical cancer, is vital to efforts aimed at improving survival rate and eventually eliminating cervical cancer. Visual Inspection with Acetic acid (VIA) is an assessment method which can inspect the cervix and potentially detect lesions caused by human papillomavirus (HPV), which is a major cause of cervical cancer. VIA has the potential to be an effective screening method in low resource settings when triaged with HPV test, but it has the drawback that it depends on the subjective evaluation of health workers with varying levels of training. A new deep learning algorithm called Automated Visual Evaluation (AVE) for analyzing cervigram images has been recently reported that can automatically detect cervical precancer better than human experts. In this paper, we address the question of whether mobile phone-based cervical cancer screening is feasible. We consider the capabilities of two key components of a mobile phone platform for cervical cancer screening: (1) the core AVE algorithm and (2) an image quality algorithm. We consider both accuracy and speed in our assessment. We show that the core AVE algorithm, by refactoring to a new deep learning detection framework, can run in ~30 seconds on a low-end smartphone (i.e. Samsung J8), with equivalent accuracy. We developed an image quality algorithm that can localize the cervix and assess image quality in ~1 second on a low-end smartphone, achieving an area under the ROC curve (AUC) of 0.95. Field validation of the mobile phone platform for cervical cancer screening is in progress.

Comparison between self sampling and provider collected samples for Human Papillomavirus (HPV) Deoxyribonucleic acid (DNA) testing in a Nigerian facility.

INTRODUCTION: The multiple visits required for an effective Pap smear screening program is difficult to replicate in many developing countries. This precludes early diagnosis and care for patients with cervical cancer and contributes to its high mortality in these countries. HPV screening has higher specificity and high negative predictive value and has the advantage that materials can be self-collected, which permits the screening of women who for various cultural and religious reasons would be reluctant to come to the clinic to expose themselves for screening. The aim of the study was to assess the degree of agreement between self sampling for HPV DNA with samples collected by a health provider. METHODS: Each respondent selected from women presenting for cervical cancer screening underwent both self- and provider sampling for HPV DNA testing using Hybribio GenoArray. RESULTS: Of the 194 women screened, 12 (6.2%) and 19 (9.8%) had HPV on self sampling and provider col-lected samples respectively. The commonest HPV type seen using both techniques was HPV 58 (2.6%). Multiple HPV genotypes were seen in 1 (0.5%) and 5 cases (2.6%) of provider and self-collected samples respectively. The high risk-HPV detection rate was 7.2% when self sampled and 6.8% when sampled by the provider. There was moderate correlation between both sampling techniques (κ = 0.47, 95% CI: 21.3 - 72.3%, P < 0.05). CONCLUSION: Our study shows moderate correlation between both sampling techniques. Larger multicentre studies will be needed to provide results generalisable to the Nigerian population. Keywords: Pap smear, HPV screening, cervical cancer, sample collection, self-sampling, provider collected, PCR, HPV DNA, Ile-Ife Nigeria.

Comparison of the depth of tissue necrosis between double-freeze and single-freeze nitrous oxide-based cryotherapy.

BACKGROUND: Cryotherapy is one the methods of treating cervical premalignant lesions. It is particularly suitable for low-resource countries because of it is relative cheaper, has low cost of maintenance, ease of use and that does not require electricity which is in short supply in many rural areas of developing countries where the incidence and mortality from cervical cancer is very high. In this study we compared single and double freezing on the cervices of women admitted for hysterectomy for benign conditions using Nitrous-based cryotherapy. MATERIALS AND METHODS: Patients admitted for elective hysterectomy for benign gynaecological conditions were randomized into two arms. The first group had single freeze cryotherapy while the second arm received double freeze cryotherapy. The cervices were examined 24 hours later to determine the depth of tissue necrosis. RESULTS: In this comparative study, the depth of tissue necrosis was deeper with double freeze compared with single freeze. Also in both arms, the depth of necrosis was deeper on anterior lips than on posterior lips of the cervix. CONCLUSION: Double freeze technique achieve more depth of tissue necrosis than single-freeze on both anterior and posterior lips of the cervix.

Age-specific nomograms for follicle stimulating hormone and anti-Mullerian hormone: A pilot study in Ile-Ife, Nigeria.

BACKGROUND: Assessment of ovarian reserve is one of the steps in the management of infertile couples. Follicle Stimulating hormone (FSH) and anti-Müllerian hormone (AMH) are commonly used ovarian reserve markers in Africa. However, there is paucity of age-specific reference values for FSH and AMH among the African population. OBJECTIVE: This study aimed at conducting a pilot study for generation of age-specific nomograms for FSH and AMH among fertile women in Ile-Ife, Nigeria. MATERIALS AND METHODS: A pilot cross-sectional study that involved 65 fertile women within the age range of 18-45 yr were prospectively and consecutively recruited from November 2014 to January 2015. Peripheral blood samples were taken for basal serum FSH and random serum AMH. The samples were processed using enzyme linked immunosorbent (ELISA) assays. RESULTS: Age-specific FSH nomogram showed a gradual increase which became steeper at age 35 yr with an average yearly increase of 0.2 IU/L in basal serum FSH, while age-specific AMH nomogram showed a peak at 25 yr and then; an average yearly decrease of 0.11 ng/ml in random serum AMH from 25 yr. CONCLUSION: The age-specific nomograms generated by this pilot study suggest that AMH may be an earlier marker of reduced ovarian reserve; which if validated by future multicenter population based studies may facilitate counseling of women on their reproductive potentials.

Phyllodes tumor of the breast metastasizing to the vulva.

Phyllodes tumors of the breast are rare breast tumors that resemble fibroadenoma. They are composed of two types of tissues: stromal and glandular tissues. Unlike fibroadenoma, they are commonly found in the third decade of life and they tend to grow more rapidly. Depending on the relative components of the cells and mitotic activity, they are classified into benign, borderline, and malignant. They are usually present as a lump in the breast. Phyllodes tumors are usually managed by wide excision. The excision should be wide enough to ensure a tumor-free margin. Recurrence rate is very high and most recurrences are usually local. Metastasis to the vulva has not been reported.