{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T20:46:46Z","timestamp":1790196406785,"version":"4.1.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T00:00:00Z","timestamp":1585094400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T00:00:00Z","timestamp":1585094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12905-020-00902-0","type":"journal-article","created":{"date-parts":[[2020,3,25]],"date-time":"2020-03-25T07:03:07Z","timestamp":1585119787000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology"],"prefix":"10.1186","volume":"20","author":[{"given":"Ali","family":"Naqvi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niti","family":"Manglik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Dudrey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Perry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuber D.","family":"Mulla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4359-5951","authenticated-orcid":false,"given":"Jorge L.","family":"Cervantes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,25]]},"reference":[{"issue":"2","key":"902_CR1","first-page":"216","volume":"98","author":"M Sarwar","year":"2013","unstructured":"Sarwar M, Soomro T. Impact of Smartphone\u2019s on society. Eur J Sci Res. 2013;98(2):216\u201326.","journal-title":"Eur J Sci Res"},{"key":"902_CR2","unstructured":"Kubaczyk D. Photographic lens manufacturing and production technologies. Boston: Massachusetts Institute of Technology; 2011."},{"issue":"6","key":"902_CR3","doi-asserted-by":"publisher","first-page":"e98781","DOI":"10.1371\/journal.pone.0098781","volume":"9","author":"JS Cybulski","year":"2014","unstructured":"Cybulski JS, Clements J, Prakash M. Foldscope: origami-based paper microscope. PLoS One. 2014;9(6):e98781. https:\/\/doi.org\/10.1371\/journal.pone.0098781 PubMed PMID: 24940755; PubMed Central PMCID: PMC4062392.","journal-title":"PLoS One"},{"key":"902_CR4","volume-title":"Cervical cancer","author":"WHO","year":"2019","unstructured":"WHO. Cervical cancer. 2019 [cited 2019]. Available from: https:\/\/www.who.int\/cancer\/prevention\/diagnosis-screening\/cervical-cancer\/en\/."},{"key":"902_CR5","unstructured":"Guzman K. BolivianExpress; 2016. http:\/\/www.bolivianexpress.org\/blog\/posts\/cervical-cancer-in-rural-bolivia."},{"key":"902_CR6","volume-title":"The ABCs of cervical cancer prevention in remote locations PLOS BLOGS: PLOS","author":"J Collins","year":"2017","unstructured":"Collins J, Shannon G. The ABCs of cervical cancer prevention in remote locations PLOS BLOGS: PLOS; 2017 [cited 2019]. Available from: https:\/\/blogs.plos.org\/globalhealth\/2017\/09\/the-abcs-of-cervical-cancer-prevention-in-remote-locations\/."},{"issue":"1","key":"902_CR7","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s13012-018-0718-9","volume":"13","author":"LG Johnson","year":"2018","unstructured":"Johnson LG, Armstrong A, Joyce CM, Teitelman AM, Buttenheim AM. Implementation strategies to improve cervical cancer prevention in sub-Saharan Africa: a systematic review. Implement Sci. 2018;13(1):28. https:\/\/doi.org\/10.1186\/s13012-018-0718-9 PubMed PMID: 29426344; PubMed Central PMCID: PMC5807829.","journal-title":"Implement Sci"},{"key":"902_CR8","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.anndiagpath.2018.12.001","volume":"38","author":"AF Nicol","year":"2019","unstructured":"Nicol AF, de Andrade CV, Gomes SC Jr, Brusadelli MG, Lodin HM, Wells SI, et al. The distribution of novel biomarkers in carcinoma-in-situ, microinvasive, and squamous cell carcinoma of the uterine cervix. Ann Diagn Pathol. 2019;38:115\u201322. https:\/\/doi.org\/10.1016\/j.anndiagpath.2018.12.001 PubMed PMID: 30579259.","journal-title":"Ann Diagn Pathol"},{"issue":"7","key":"902_CR9","doi-asserted-by":"publisher","first-page":"e0005550","DOI":"10.1371\/journal.pntd.0005550","volume":"11","author":"J Rajchgot","year":"2017","unstructured":"Rajchgot J, Coulibaly JT, Keiser J, Utzinger J, Lo NC, Mondry MK, et al. Mobile-phone and handheld microscopy for neglected tropical diseases. PLoS Negl Trop Dis. 2017;11(7):e0005550. https:\/\/doi.org\/10.1371\/journal.pntd.0005550 PubMed PMID: 28683127; PubMed Central PMCID: PMC5499985.","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"902_CR10","first-page":"141","volume":"63","author":"J Moya-Salazar","year":"2016","unstructured":"Moya-Salazar J, Bruno M, Rojas-Zumaran V, Prakash M. Implementation of the Foldoscope as a device for cervical cancer diagnosis: a verification and evaluation study. Revista Latinoamericana de Patologia Clinica y Medicine de Laboratorio. 2016;63(3):141\u20137.","journal-title":"Revista Latinoamericana de Patologia Clinica y Medicine de Laboratorio"},{"key":"902_CR11","volume-title":"Abnormal cervical cancer screening test results","author":"Gynecologists ACoOa","year":"2018","unstructured":"Gynecologists ACoOa. Abnormal cervical cancer screening test results 2018. Available from: https:\/\/www.acog.org\/Patients\/FAQs\/Abnormal-Cervical-Cancer-Screening-Test-Results."},{"key":"902_CR12","volume-title":"Epidemiology beyond the basics","author":"M Szklo","year":"2000","unstructured":"Szklo M, Nieto F. Epidemiology beyond the basics. Gaithersburg: Aspen Publishers Inc.; 2000."},{"key":"902_CR13","volume-title":"Classification assessment methods. Appl Computing and Informatics","author":"A Tharwat","year":"2018","unstructured":"Tharwat A. Classification assessment methods. Appl Computing and Informatics; 2018."},{"issue":"6","key":"902_CR14","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.4269\/ajtmh.14-0741","volume":"92","author":"RK Ephraim","year":"2015","unstructured":"Ephraim RK, Duah E, Cybulski JS, Prakash M, D\u2019Ambrosio MV, Fletcher DA, et al. Diagnosis of Schistosoma haematobium infection with a mobile phone-mounted Foldscope and a reversed-lens CellScope in Ghana. Am J Trop Med Hyg. 2015;92(6):1253\u20136. https:\/\/doi.org\/10.4269\/ajtmh.14-0741 PubMed PMID: 25918211; PubMed Central PMCID: PMC4458833.","journal-title":"Am J Trop Med Hyg"},{"key":"902_CR15","doi-asserted-by":"publisher","first-page":"j2813","DOI":"10.1136\/bmj.j2813","volume":"357","author":"JG Elmore","year":"2017","unstructured":"Elmore JG, Barnhill RL, Elder DE, Longton GM, Pepe MS, Reisch LM, et al. Pathologists\u2019 diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study. BMJ. 2017;357:j2813. https:\/\/doi.org\/10.1136\/bmj.j2813 PubMed PMID: 28659278; PubMed Central PMCID: PMC5485913 at www.icmje.org\/coi_disclosure.pdf. All authors had financial support from the National Cancer Institute for the submitted work. RLB reports a financial relationship with Myriad Genetics outside of the submitted work, and GML reports grants from Fred Hutchinson Cancer Research Center during the conduct of the study.","journal-title":"BMJ"},{"issue":"5","key":"902_CR16","first-page":"265","volume":"26","author":"A Mohan","year":"2015","unstructured":"Mohan A. Foldoscope: An innovative microscope. Natl Med J India. 2015;26(5):265.","journal-title":"Natl Med J India"}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-020-00902-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12905-020-00902-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-020-00902-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,25]],"date-time":"2021-03-25T00:07:22Z","timestamp":1616630842000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcwomenshealth.biomedcentral.com\/articles\/10.1186\/s12905-020-00902-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,25]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["902"],"URL":"https:\/\/doi.org\/10.1186\/s12905-020-00902-0","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,25]]},"assertion":[{"value":"11 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Institutional Review Board exemption was obtained from the Institutional Review Board for the Protection of Human Subjects at TTUHSC El Paso to utilize the de-identified cervical cytology samples, as it was deemed unnecessary according to national regulations (IRB# E19046). Data was anonymized. Being IRB exempt no administrative permission and \u2018consent to participate\u2019 were required.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"60"}}