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Validation of a sustainable internationally monitored cervical cancer screening system using a visual smartphone inspection in Kinshasa, Democratic Republic of Congo
  1. Celine Tendobi1,
  2. Margarita Fernandez-Marques2,
  3. Silvia Carlos3,
  4. Marta Amann2,
  5. Milva Ndaye4,
  6. Laetitia Ngoya1,
  7. Gloria Segura2,
  8. Laura Nuñez2,
  9. David Oliver2,
  10. Itz Oiz2,
  11. Marc Tshilanda5,
  12. Dolores Lozano6,
  13. Maria Auba7,
  14. Maria Caparros7,
  15. Gabriel Reina8,
  16. Didier Mbuyi9,
  17. Paula Iglesias-Fernandez2,
  18. Berthe Zinga10,
  19. Matias Jurado11,12 and
  20. Luis Chiva7
  1. 1 Obstetrics and Gynecology, Hospital Monkole, Kinshasa, Congo (the Democratic Republic of the)
  2. 2 University of Navarra - Academic Campus, Pamplona, Spain
  3. 3 Preventive Medicine and Public Health Department, IdiSNA, Navarra Institute for Health Research, Universidad de Navarra, Pamplona, Spain
  4. 4 Medical office Évry the 2 hands, Évry, France
  5. 5 Internal Medicine, Hospital Monkole, Kinshasa, Congo (the Democratic Republic of the)
  6. 6 Pathology, Clinica Universidad de Navarra, Pamplona, Spain
  7. 7 Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
  8. 8 Microbiology, IdiSNA, Navarra Institute for Health Research, Clinica Universidad de Navarra, Pamplona, Spain
  9. 9 Biomedical Research Unit, Hospital Monkole, Kinshasa, Congo (the Democratic Republic of the)
  10. 10 Obstetrics and Gynecology, University of Kinshasa Faculty of Medicine, Kinshasa, Congo (the Democratic Republic of the)
  11. 11 Gynecology, Clinica Universitaria de Navarra, Pamplona, Spain
  12. 12 Universidad de Navarra, Pamplona, Spain
  1. Correspondence to Dr Luis Chiva, Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona 31008, Spain; lchiva{at}


Objective To determine the sensitivity, specificity, and positive and negative predictive values of a cervical cancer screening program based on visual inspection with acetic acid and Lugol’s iodine using a smartphone in a sub-urban area of very low resources in Kinshasa (Democratic Republic of Congo).

Methods This cross-sectional validation study was conducted at Monkole Hospital and it included women between the ages of 25–70 years after announcing a free cervical cancer screening campaign through posters placed in the region of our hospital. Questionnaires collected sociodemographic and behavioral patients characteristics. In the first consultation, we gathered liquid-based cytology samples from every woman. At that time, local health providers performed two combined visual inspection techniques (5% acetic acid and Lugol’s iodine) while a photograph was taken with a smartphone. Two international specialists evaluated the results of the smartphone cervicography. When a visual inspection was considered suspicious, patients were offered immediate cryotherapy. Cytological samples were sent to the Pathology Department of the University of Navarra for cytological assessment and human papillomavirus (HPV) DNA genotyping.

Results A total of 480 women participated in the study. The mean age was 44.6 years (range 25–65). Of all the patients, only 18.7% were infected with HPV (75% had high-risk genotypes). The most frequent high-risk genotype found was 16 (12.2%). The majority (88%) of women had normal cytology. After comparing combined visual inspection results with cytology, we found a sensitivity of 66.0%, a specificity of 87.8%, a positive predictive value of 40.7%, and a negative predictive value of 95.3% for any cytological lesion. The negative predictive value for high-grade lesions was 99.7%.

Conclusions Cervical cancer screening through combined visual inspection, conducted by non-specialized personnel and monitored by experts through smartphones, shows encouraging results, ruling out high-grade cytological lesions in most cases. This combined visual inspection test is a valid and affordable method for screening programs in low-income areas.

  • cervix uteri
  • uterine cervical neoplasms

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • SC and LC are joint senior authors.

  • Twitter @GabReina, @lchiv4

  • CT and MF-M contributed equally.

  • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses, the fidelity of the study to the protocol, and the final approval of the version to be published. LC and SC are both Senior Authors. LC is the corresponding author. LC is the author acting as gurantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.