A systematic review of handheld tools in lieu of colposcopy for cervical neoplasia and female genital schistosomiasis

Background Visualization of the lesions in the lower genital tract is the mainstay for diagnosis of the four lesions found in female genital schistosomiasis (FGS), but colposcopes are generally not available in low-resource settings. Objective We sought to review handheld devices that could potentially be used for FGS diagnosis. Search strategy We searched Medline and Embase 2015-2019 for handheld devices used in cervical cancer screening and FGS diagnosis. Selection criteria We excluded studies that did not compare the device to standard-of-care colposcopes or histopathology. Main results and conclusion In 11 studies, four handheld colposcopes, two smartphones, and one compact digital camera were evaluated. Two handheld colposcopes were found to be potentially adequate for FGS diagnosis, namely Gynocular and Mobile ODT. The smartphones and digital camera did not have sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software should be made to support the diagnosis of both FGS and cervical neoplasia. Real-time postgraduate training and quality control should be considered in future studies of handheld colposcopes. For patients from schistosomiasis endemic areas, we recommend that handheld devices are used for FGS. Studies are needed to determine which of the two devices is most adequate for FGS diagnosis in schistosomiasis endemic areas.

Automated summary

Handheld devices have potential for diagnosis in female genital schistosomiasis (FGS), with Gynocular and Mobile ODT identified as potentially adequate for FGS diagnosis. However, smartphones and digital cameras lack sufficient magnification to diagnose grainy sandy patches, one of the FGS lesion types. Customized software is needed to support the diagnosis of both FGS and cervical neoplasia in low-resource settings.