China has the considerable disease burden of cervical cancer, with the mortality and morbidity of cervical cancer showing an increasing and younger trend. Facing to the critical situation of cervical cancer control, it is urgent to explore the new methods that suitable for different resource areas for the early detection and treatment of cervical cancer. Recently, great progress has been made in the field of AI image classification, and scientists have developed many algorithms to identify cervical lesions and conducted corresponding studies on their accuracy. Here, by reviewing the papers published at home and aboard, which studied the applications value of AI in cervical cytology screening, colposcopy examination, diagnosis and treatment of cervical cancer, we summarized and discussed the current progress and challenges for AI's application in the area of cervical cancer control, in order to provide solid evidence for the future use of AI in improving human health.
The results of cervical cancer containment have demonstrated regional differences in China, which may be due to various socioeconomic and cultural developments across regions. Understanding cervical cancer screening results in various regions is of a great significance for developing effective cervical cancer prevention strategies.
To perform a comparative analysis of the results of two yearly cervical cancer screening (2019 and 2020) in urban areas of Shihezi, Xinjiang, to estimate the changes in high-risk human papillomavirus (hrHPV) infection and cervical lesion detection rate in women.
A retrospective design was used. Participants were 46 994 women from Shihezi urban areas who underwent initial cervical cancer screening with an HPV test〔underwent once either between December 2018 and December 2019 (the 2019 yearly screening) or between January and June 2020 (the 2020 yearly screening) 〕 in Shihezi Maternal and Child Health Hospital, Shihezi People's Hospital, and First Affiliated Hospital, School of Medicine, Shihezi University during December 2018 to June 2020. Data of the screening results, including HPV infection rate and subtypes, Thinprep cytologic test results, and pathological diagnosis of cervical biopsy samples taken during a colposcopy were collected, and those of the 2019 yearly screening were compared with those of 2020 yearly screening.
There were 18 378, and 28 616 attendees for 2019, and 2020 yearly screenings, respectively, and 44 746 of them finally completed the screening. The completion rate of cervical cancer screening in 2020 was higher than that in 2019 〔97.07% (27 779/28 616) vs (16 967/18 378) 〕 (P<0.05) . A total of 5 992 cases (12.75%) were detected with HPV infection, among them, the prevalence of HPV 16 and HPV 18 was 18.55% (1 112/5 992) , and that of other HPV subtypes was 81.45% (4 880/5 992) . The prevalence of HPV infections in participants of 2020 yearly screening〔11.09% (3 176/28 616) 〕was lower than that in participants of 2019 yearly screening〔15.32% (2 816/18 378) 〕 (P<0.05) . The prevalence of single-type HPV infections in participants of 2019 yearly screening was higher than that in participants of 2020 yearly screening 〔11.38% (2 092/18 378) vs 7.45% (2 674/28 616) 〕 (P<0.05) . The prevalence of multi-type HPV infections in participants of 2019 yearly screening was higher than that in participants of 2020 yearly screening〔3.94% (724/18 378) vs 1.75% (502/28 616) 〕 (P<0.05) . The prevalence of HPV was 10.37% (909/8 767) , 12.22% (1 916/15 677) , 13.71% (2 500/18 234) and 15.45% (667/4 316) , respectively, in four age groups of participants (30-39, 40-49, 50-59, and 60-65) in these two yearly screenings totally, showing an increase with age (P<0.05) . The prevalence of HPV showed a decrease in 30-39-year-old participants, so did it in 40-49-year-old, 50-59-year-old, and 60-65-year-old participants of 2020 yearly screening (P<0.05) . The top 5 prevalent single HPV subtypes found in 2019 yearly screening were HPV 52 (20.84%) , HPV 16 (14.48%) , HPV 53 (8.56%) , HPV 51 (7.93%) , and HPV 39/68 (7.60%) , while those found in 2020 yearly screening were HPV 52 (15.07%) , HPV 16 (12.64%) , HPV 58 (12.30%) , HPV 53 (10.25%) and HPV 66 (4.75%) . HPV 18 ranked as the 11th most prevalent single HPV subtype in both two screenings. The proportion of patients with pathological diagnosis of inflammation/condyloma and LSIL in cervical cancer screening in 2020 was lower than that in 2019 (P<0.05) . The 30-39-year-old participants of the 2020 yearly screening had lower prevalence of inflammation/condyloma detected by colposcopy than did those of the 2019 yearly screening (47.83% vs 74.36%) (P<0.05) . The 50-59-year-old participants of the 2020 yearly screening had lower prevalence of inflammation / condyloma detected by colposcopy than did those of the 2019 yearly screening (65.50% vs 77.22%) (P<0.05) . The 30-39-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected low-grade squamous intraepithelial lesion (LSIL) than did those of 2019 yearly screening (31.30% vs 5.13%) (P<0.05) . The 40-49-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected LSIL than did those of 2019 yearly screening (27.06% vs 16.07%) (P<0.05) . The 50-59-year-old participants of 2020 yearly screening had higher prevalence of colposcopy-detected LSIL than did those of 2019 yearly screening (23.64% vs 8.89%) (P<0.05) .
The completion rate of cervical cancer screening in 2020 was obviously better than that in 2019, but it still needs to be further improved. Compared with 2019, HPV infection rate decreased, the major prevalent HPV subtypes changed, and LISL prevalence increased in 30-39 and 50-59 age groups in 2020. Follow-up management is suggested to be strengthened in 30-39 and 50-59 age groups.
Cervical cancer is one of the most prevalent malignancies in women, which ranks fourth among malignancies in terms of incidence and mortality worldwide. Radical surgical procedure is the main treatment for early cervical cancer. With the development of healthcare and innovation of treatment concepts, multiple new medical ideas and technologies led by the Querleu-Morrow classification have continuously emerged and have been applied to clinical practice, facilitating the development of surgical procedures towards precision, individualization and humanization. We detailed the appropriate choice and implementation of radical surgical procedures for cervical cancer, aiming at increasing clinicians' understanding of relevant standards for such procedures, and thereby improving the precision and personalization levels of such procedures or treatments.
Cervical cancer is a common gynecologic malignant tumor. Surgical treatment is an important treatment for early stage cervical cancer. Whether having lymph node metastasis is of great significance to the assessment of the prognosis of cervical cancer and the choice of treatment options. Preoperative assessment of lymph node metastasis based on identified related risk factors and imaging findings is helpful to the formulation of surgical strategies. In recent years, sentinel lymph node biopsy has been recommended for surgical treatment of patients with early stage cervical cancer due to its safety and feasibility. Patients with cervical cancer can selectively undergo sentinel lymph node biopsy, systematic lymph node resection, or para-aortic lymph node resection based on their preoperative lymph node assessment. According to intraoperative diagnosis of the degree of lymph node involvement, the extent of surgical resection can be determined. So the assessment of lymphatic metastasis, especially the formulation of surgical strategieswere of great significance in the treatment of cervical cancer.
As one of the three major treatments for cervical cancer, radiotherapy plays an important role in treating cervical cancer. In recent years, new technologies such as three-dimensional external beam radiotherapy and image-based brachytherapy have been widely used in the treatment of cervical cancer, which can increase the dose of tumor radiation while reducing the dose radiating surrounding normal tissues. In addition, the researches on the use of individualized radiotherapy guided by imaging indicators and proton therapy are also in progress. This paper presents the basic knowledge of radiotherapy for cervical cancer and the application of radiotherapy in the treatment of cervical cancer, summarizes the application of new technologies, and proposes issues that need to be emphasized in the use of new technologies, in order to guide clinical application.
