Abstract
OBJECTIVE: To explore the effectiveness of combining an artificial intelligence (AI) film reading system with a cervical liquid-based ThinPrep cytology test (TCT) in cervical cancer screening. METHODS: A total of 1200 adult women who underwent cervical cancer screening in the Gynecology Department of The Fifth People's Hospital of Jinan from July 2022 to June 2023 were included in the study. All participants underwent TCT followed by both manual and AI examination. The AI examination was performed using an AI film reading system that employed advanced machine learning algorithms and image processing techniques to analyze digital TCT slides. Pathological tissue biopsy was performed on all cases with abnormalities, and the results were used as the gold standard to analyze the effectiveness of the different screening methods. RESULTS: TCT screening results revealed that the average time for manual film reading was shorter than that for the AI film reading system (P<0.001). The AI film reading system significantly detected more lesions than the manual film reading method (P<0.001). The overall compliance rate between AI imaging and manual imaging interpretation was 79.75%, with a corresponding Kappa value of 0.588, indicating moderate agreement between the two methods. The accuracy of the AI screening system for low-grade lesions and inflammation was 87.47%, compared to 79.41% for manual screening (P=0.018). For high-grade cancer lesions, the accuracy rates were 82.54% for AI and 75.90% for manual screening (P=0.241). The AI screening system had a sensitivity of 67.53% (104/154) for detecting high-grade lesions and cancers, higher than the 40.91% (63/154) sensitivity of manual screening. However, the specificity of the AI screening system was 94.07% (349/371), while manual screening had a specificity of 94.61% (351/371). The Youden index for AI screening system was 0.616, significantly higher than the 0.355 for manual screening. CONCLUSION: In TCT screening, the AI screening system outperforms manual screening. The combination of the AI film reading system and TCT may hold significant value in cervical cancer screening, as well as in the early diagnosis and treatment of the disease.