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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 24  |  Issue : 1  |  Page : 44-46

Use of mobile camera as a standby for documentation of papanicolaou smear and cervicography: Three case reports


1 Department of Women's Health, Kasturba Health Society's Medical Research Centre, Mumbai, Maharashtra, India
2 Department of Women's Health, Kasturba Health Society's Medical Research Centre; Department of Ob/Gyn, Ayurvidya Prasarak Mandal's Ayurved Hospital, Mumbai, Maharashtra, India
3 Department of Ob/Gyn, Ayurvidya Prasarak Mandal's Ayurved Hospital, Mumbai, Maharashtra, India

Date of Web Publication14-Mar-2019

Correspondence Address:
Ms. Neerja Rastogi
Kasturba Health Society's Medical Research Centre, 17 K. Desai Road, Vile Parle West, Mumbai - 400 056, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_36_18

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  Abstract 


Cervical cancer is more common in countries and regions with poor facilities, and they are often not well equipped with high-end equipment required for diagnosis. By way of this article, we would like to demonstrate with three case reports the use of minimal and available technology for documentation in screening and prevention of cervical cancer in clinics having basic facilities. The mobile camera is commonly available with clinicians/technicians these days. It can be used for capturing pictures of the cervix if colposcope is not available or for clicking microscopic pictures of Papanicolaou smears or histology slides to document abnormalities when inbuilt cameras are not functional or not available.

Keywords: Affordable, cervical cancer, colposcopy, low cost, mobile camera, Papanicolaou smear


How to cite this article:
Rastogi N, Joshi J, Jagtap S, Walwatkar P. Use of mobile camera as a standby for documentation of papanicolaou smear and cervicography: Three case reports. J Mahatma Gandhi Inst Med Sci 2019;24:44-6

How to cite this URL:
Rastogi N, Joshi J, Jagtap S, Walwatkar P. Use of mobile camera as a standby for documentation of papanicolaou smear and cervicography: Three case reports. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2019 Jul 17];24:44-6. Available from: http://www.jmgims.co.in/text.asp?2019/24/1/44/254127




  Introduction Top


We are aware of the progress in developed countries and their screening strategies in choosing the best program with ideal cervical cancer detection techniques.[1] In India, we try to evolve the best methods available locally for early diagnosis, prevention, and research within our limited resources.[2],[3],[4] The use of mobile camera for documentation of abnormal Papanicolaou (Pap) smears has already been reported by us.[5] Here, we are documenting the use of mobile camera both for abnormal  Pap smear More Detailss and cervicography in the absence of a camera attached to a colposcope or a microscope by way of three case reports. The camera used here is the rear camera of Samsung Galaxy Note 5 phone; the specification of the camera is 16 megapixels.


  Case Reports Top


Case 1

A 40-year-old, regularly menstruating woman, gravida three, para two, came for cervical cancer screening to the outpatient department (OPD) with a history of last delivery 15 years ago. She did not have any complaints but gave a history of treated hemorrhoids and previous abnormal Pap smear with low-grade squamous intraepithelial lesion (LSIL), treated in 2010. The speculum examination showed mild cervicitis. After the Pap smear was collected, visual inspection with acetic acid (VIA) and colposcopy revealed mild faint acetowhite areas but no evidence of cervical intraepithelial neoplasia (CIN). Bimanual pelvic examination was normal. Pap smear showed a very large number of small squamous and metaplastic cells with mild hyperchromasia and karyomegaly and was documented by a mobile camera [Figure 1]a. Her colposcopic picture and picture clicked with mobile camera were similar.
Figure 1: (a-c) Documentation with mobile camera for speculum examination, colposcopy, microscopy, and histology when available in three cases. (a) Acetowhite areas documented on colposcopy and mobile camera. Papanicolaou smear showed several squamous cells with increased N/C ratio indicating low-grade squamous intraepithelial lesion. (b) Polyp-like growth from the cervix was documented by mobile camera. Adenocarcinoma confirmed on Papanicolaou smear. (c) Visual inspection with acetic acid suggestive of Grade 2 cervical intraepithelial neoplasia documented by mobile camera. Squamous cell carcinoma confirmed by Papanicolaou smear and cervical biopsy, both clicked with mobile camera

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Case 2

A 50-year-old woman, gravida six, para six, came to the OPD with a history of irregular postmenopausal bleeding for 6 months following amenorrhea of 12 months. She had undergone a pelvic ultrasonography 1 week ago, in which a normal uterus and ovaries with an endometrial thickness of 3 mm were reported. Speculum examination revealed a growth from the cervix with bleeding on touch and was clicked with the mobile camera. On bimanual pelvic examination, the growth from cervix was felt, with a normal-sized uterus and clear fornices. Colposcopy and VIA were not carried out because of the bleeding. Pap smear showed hemorrhagic background with several clusters of columnar cells with hyperchromasia and signet ring-like cells typical of adenocarcinoma [Figure 1]b.

Case 3

A 48-year-old woman, gravida six, para six, came to the OPD with a history of white discharge with itching and burning for 4 years and pain in the lower abdomen for 3 months. Her last delivery was 18 years ago. Speculum examination revealed a large circumoral erosion covering >70% of area. VIA was carried out and showed large irregular erosion. The mobile camera photograph when zoomed showed a fine mosaic pattern in 11 o' clock position and thickened gland openings from 4 to 6 o' clock position and irregular surface suggestive of CIN, but colposcopy could not be done as the patient started bleeding. Bimanual examination revealed a bulky uterus, deviated slightly to the left, and tenderness in fornices. Pap smear showed squamous cells suggestive of high-grade lesion, suspected malignancy, as shown in [Figure 1]c. The patient underwent cervical biopsy from abnormal areas. Histopathology of cervical biopsy when the slides were re-screened in our center showed squamous cell carcinoma as documented using the mobile camera [Figure 1]c. The patient was referred to the Tata Memorial Hospital and underwent loop electrosurgical excision procedure which was reported as squamous cell carcinoma in situ.


  Discussion Top


We have been involved in cervical cancer screening of women at a charitable trust hospital in Mumbai for the past two decades with conventional Pap smears collected with spatula and brush. VIA, colposcopy, and biopsy are used as required. Women with abnormal smears are treated appropriately or referred to a tertiary hospital for further management.

We are also engaged in research in spontaneous or induced regression of CINs, i.e., LSIL, high-grade squamous intraepithelial lesion (HSIL), and treatment of cervicovaginal infections.[6] Low-cost disposables are also used by us to prevent cross infections such as HPV or candida.[7] Due to poor resources, facilities such as a high-quality camera attached to the microscope and a colposcope are not always available to us. Under these circumstances, our team has evolved methods of documenting cervical photographs or microphotographs of Pap smears or biopsy slides with the use of mobile camera with a good capture capacity. The diagnosis is given after screening the complete slides, but documentation is possible from specific diagnostic microscopic fields.

We have, therefore, exemplified this through the above case reports. By maintaining a high quality of collection and screening of Pap smears, we are able to detect early cancer and also prevent it by identifying and treating LSIL or HSIL. We wish to clarify that the technician can focus through the eyepiece the oil immersion field selected by the gynecologic cytologist. The mobile camera is held steadily on the eyepieces to get the best focus. The mobile camera is usually available in any rural or city setting for any situation and is 3–10 times cheaper than a camera attached to the microscope or to a colposcope. First of all, these sophisticated instruments are usually not available for the underprivileged population in which cervical cancer is more common. Second, even if the equipment is available, it may not be functional. Finally, sometimes, it is not possible to subject a patient to colposcopy if the patient starts bleeding. A mobile camera can, therefore, serve as a handy standby tool to help us document our cases at an affordable cost and even in the absence of a separate camera attached to a microscope or a colposcope. Various modifications are open to experimentation, for example, mobile camera on a stand or with a handle or with a fiber-optic cable.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Castle P, Feldman S, Perkins RB. The next generation of cervical cancer screening: Should guidelines focus on best practices for the future or current screening capacity? J Low Genit Tract Dis 2018;22:91-6.  Back to cited text no. 1
    
2.
Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, et al. Effect of VIA screening by primary health workers: Randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014;106:dju009.  Back to cited text no. 2
    
3.
Joshi J, Affandi MZ, Amin P, Vaidya R, Shah R. Persistence of cytologic abnormality after treatment of bacterial, parasitic and fungal infections in older women with low grade squamous intraepithelial lesion. Acta Cytol 2010;54:242-4.  Back to cited text no. 3
    
4.
Chhabra S, Bhavani M, Mahajan N, Bawaskar R. Cervical cancer in Indian rural women: Trends over two decades. J Obstet Gynaecol 2010;30:725-8.  Back to cited text no. 4
    
5.
Paradkar PH, Godse CG, Joshi JV, Vaidya RA, Affandi MZ, Lulla M, et al. Mobile camera photography for quick second opinion for Pap smear screening. J MGIMS 2010;15:41-4.  Back to cited text no. 5
    
6.
Joshi JV, Jagtap SS, Paradkar PH, Walwatkar P, Paradkar HS, Affandi ZM, et al. Cytologic follow up of low-grade squamous intraepithelial lesions in Pap smears after integrated treatment with antimicrobials followed by oral turmeric oil extract. J Ayurveda Integr Med 2016;7:109-12.  Back to cited text no. 6
    
7.
Joshi JV. Methods to substitute expensive disposable materials by cheaper alternatives in poor resource settings. Indian Pract 2016;69:34.  Back to cited text no. 7
    


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