Automated analysis of digital medical images in cervical cancer screening: A systematic review.

Background: Cervical cancer screening programs are poorly implemented in LMICs due to a shortage of specialists and expensive diagnostic infrastructure. To address the barriers of implementation researchers have been developing low-cost portable devices and automating image analysis for decision support.However, as the knowledge base is growing rapidly, progress on the implementation status of novel imaging devices and algorithms in cervical cancer screening has become unclear. The aim of this project was to provide a systematic review summarizing the full range of automated technology systems used in cervical cancer screening. Method: A search on academic databases was conducted and the search results were screened by two independent reviewers. Study selection was based on eligibility in meeting the terms of inclusion and exclusion criteria which were outlined using a Population, Intervention, Comparator and Outcome framework. Results: 17 studies reported algorithms developed with source images from mobile device, viz. Pocket Colposcope, MobileODT EVA Colpo, Smartphone Camera, Smartphone-based Endoscope System, Smartscope, mHRME, and PiHRME. While 56 studies reported algorithms with source images from conventional/commercial acquisition devices. Most interventions were in the feasibility stage of development, undergoing initial clinical validations. Conclusion: Researchers have proven superior prediction performance of computer aided diagnostics (CAD) in colposcopy (>80% accuracies) versus manual analysis (<70.0% accuracies). Furthermore, this review summarized evidence of the algorithms which are being created utilizing portable devices, to circumvent constraints prohibiting wider implementation in LMICs (such as expensive diagnostic infrastructure). However clinical validation of novel devices with CAD is not yet implemented adequately in LMICs.