Page 132 - AIH-2-3

Artificial Intelligence in Health Early detection of CIN/cervicitis using ML

1. Introduction Cervicitis refers to inflammation of the cervical
tissue. This could be asymptomatic or symptomatic,
Cervical cancer is the most common type of cancer affecting including vaginal discharge, bleeding, and irritation, as
women and one of the major public health problems in the well as intermenstrual or postcoital bleeding and lower
world. While it is manageable if detected early, cervical abdominal pain. Cervicitis can be caused by either bacteria
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cancer continues to be a leading cause of cancer-related such as Chlamydia, Gonorrhea, and Trichomoniasis, or
death – particularly in underdeveloped countries – where non-infectious exposure to chemicals, including condoms,
higher mortality rates are often observed among women tampons, and cervical caps. The current diagnosis of
from low socioeconomic backgrounds. According to the cervicitis is the same as for cervical cancer.
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World Cancer Report 2020, India reports one-fifth of the
global burden of cervical cancer, and the disease is the When light falls on tissue, various processes such
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major cause of mortality in countries with a low Human as absorption, reflection, refraction, transmission, and
Development Index. scattering occur. The absorption and scattering properties
of light depend on the tissue’s internal structure, layer
Despite the high mortality rates, cervical cancer is thickness, biochemical constitution, and the wavelength
one of the most preventable types of cancer due to its of the incident light. Therefore, spectroscopy-based
slow progression, the presence of detectable lesions using techniques – such as those utilizing tissue fluorescence,
cytology, and the availability of effective treatments. scattering, and diffuse reflectance (DR) – are effective in
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However, cytology-based Pap smear tests inherently have low identifying the structural, morphological, and biochemical
sensitivity (<50%) and specificity (60 – 70%). Furthermore, changes in cervical tissues during cancer development.
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the accuracy of the diagnosis depends on the expertise and
skill of the gynecologist collecting the exfoliated cervical The hemoglobin (Hb) and oxyhemoglobin (HbO )
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cells. The presence of blood, the absence of squamous- have distinct absorption spectral features in the visible
columnar junction cells, or the clustering of the cells may spectrum, with HbO showing two distinct peaks around
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interfere with the cytology results. These factors contribute 545 nm and 575 nm. However, Hb exhibits a higher molar
to a high number of false negatives or undetected cases of extinction coefficient in the 600 – 650 nm spectral range
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early-stage or low-grade squamous intraepithelial neoplasia compared to HbO 2. This differential absorption cross-
(LSIL) that have a favorable prognosis. section can be utilized to discriminate between normal
and abnormal cervical tissues.
Positive Pap cases are typically referred for conventional
visual inspection with acetic acid method of examination, Studies have been conducted to assess the potential of
and colposcopy-guided biopsies are considered the gold DR spectroscopy in discriminating cervical cancer. The
standard for cervical cancer detection. However, these chromophore Hb has absorption peaks around 280 nm,
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tests are inherently subjective in nature, with the selection 420 nm, 540 nm, and 580 nm. The DR spectrum of
of the most malignant or abnormal site depending on the cervical tissues exhibits changes in the HbO absorption at
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clinician’s expertise. Furthermore, there is a long waiting 542 nm and 577 nm due to a reduction in heme production
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period before pathology results become available for patient during malignant transformation. 10,11 Shaikh et al. cross-
care. Thus, there is a long-felt need for screening tests that validated the DR technique with Raman spectroscopy to
are objective, with improved diagnostic accuracy for the compare the classification accuracy for the detection of
detection of LSILs in real time. Factors including lack of tumor sites in normal patients. In another clinical study,
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awareness, discomfort during the screening procedure, and Prabitha et al. reported an increase in the R545/R575
the need for multiple visits prevent women from periodic image intensity ratio with an increase in the grade of
screening. A non-invasive and low-cost modality that cervical cancer. Similarly, the DR image ratio R545/R575
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provides real-time screening results is essential to make was used in the detection of early-stage malignancies in the
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women come forward for periodic check-ups. This would oral cavity with good diagnostic accuracy.
enable early detection of the disease, leading to a reduction Prasanth et al. 16,17 also utilized DR spectral measurements
in the mortality rates over time. With the introduction of and multispectral imaging techniques to detect gingivitis
vaccines against human papillomavirus (HPV) infection, and periodontitis in patients with gum inflammation.
cervical cancer prevention has undergone dramatic Significant changes in the recorded spectra were observed
changes over the past decade. Although some countries at 545 nm and 575 nm with gingival inflammation, and
have seen a decline in HPV-mediated cervical disease, the DR spectral ratio R620/R575 was found to give a good
widespread implementation of vaccination is limited by correlation with different grades of gingival inflammation.
economic considerations, vaccine availability, and vaccine A sensitivity of 91.6% and a specificity of 93% were
adoption hesitancy among the population. observed in discriminating healthy and mildly inflamed

Volume 2 Issue 3 (2025) 126 doi: 10.36922/aih.8527