title: An intelligent clinical decision support system for patient-specific predictions to improve cervical intraepithelial neoplasia detection.
abstract: Nowadays, there are molecular biology techniques providing information related to cervical cancer and its cause: the human Papillomavirus (HPV), including DNA microarrays identifying HPV subtypes, mRNA techniques such as nucleic acid based amplification or flow cytometry identifying E6/E7 oncogenes, and immunocytochemistry techniques such as overexpression of p16. Each one of these techniques has its own performance, limitations and advantages, thus a combinatorial approach via computational intelligence methods could exploit the benefits of each method and produce more accurate results. In this article we propose a clinical decision support system (CDSS), composed by artificial neural networks, intelligently combining the results of classic and ancillary techniques for diagnostic accuracy improvement. We evaluated this method on 740 cases with complete series of cytological assessment, molecular tests, and colposcopy examination. The CDSS demonstrated high sensitivity (89.4%), high specificity (97.1%), high positive predictive value (89.4%), and high negative predictive value (97.1%), for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+). In comparison to the tests involved in this study and their combinations, the CDSS produced the most balanced results in terms of sensitivity, specificity, PPV, and NPV. The proposed system may reduce the referral rate for colposcopy and guide personalised management and therapeutic interventions.
authors.affiliation: Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Iroon Politechniou 9, 15773 Zografou Campus, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Bountris
authors.affiliation: Institute of Communication and Computer Systems, National Technical University of Athens, Iroon Politechniou 9, 15773 Zografou Campus, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Haritou
authors.affiliation: Department of Cytopathology, School of Medicine, University General Hospital "ATTIKON", University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Abraham
authors.initials: A
authors.lastname: Pouliakis
authors.affiliation: Department of Cytopathology, School of Medicine, University General Hospital "ATTIKON", University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Niki
authors.initials: N
authors.lastname: Margari
authors.affiliation: West London Gynaecological Cancer Center, Queen Charlotte's and Chelsea, Hammersmith Hospital, Imperial Healthcare NHS Trust, London W12 0HS, UK ; Division of Surgery and Cancer, Faculty of Medicine, Imperial College, London W12 0NN, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Kyrgiou
authors.affiliation: Department of Cytopathology, School of Medicine, University General Hospital "ATTIKON", University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Aris
authors.initials: A
authors.lastname: Spathis
authors.affiliation: 3rd Department of Obstetrics and Gynecology, University General Hospital "ATTIKON", School of Medicine, University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Asimakis
authors.initials: A
authors.lastname: Pappas
authors.affiliation: 2nd Department of Pathology, University General Hospital "ATTIKON", School of Medicine, University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Panayiotides
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Ioannina, St. Niarchou Str, 45500 Ioannina, Greece.
authors.forename: Evangelos A
authors.initials: EA
authors.lastname: Paraskevaidis
authors.affiliation: Department of Cytopathology, School of Medicine, University General Hospital "ATTIKON", University of Athens, Rimini 1, 12462 Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Karakitsos
authors.affiliation: Biomedical Engineering Laboratory, School of Electrical and Computer Engineering, National Technical University of Athens, Iroon Politechniou 9, 15773 Zografou Campus, Athens, Greece.
authors.forename: Dimitrios-Dionyssios
authors.initials: DD
authors.lastname: Koutsouris
mesh_terms: D000465:Algorithms; D065309:Atypical Squamous Cells of the Cervix; D019992:Databases as Topic; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D016571:Neural Networks, Computer; D057285:Precision Medicine; D011336:Probability; D015203:Reproducibility of Results; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology