Precancerous screening using visual inspection with acetic acid (VIA) is suggested by the World Health Organization (WHO) for low-middle-income countries (LMICs). However, because of the limited number of gynecological oncologist clinicians in LMICs, VIA screening is primarily performed by general clinicians, nurses, or midwives (called medical workers). However, not being able to recognize the significant pathophysiology of human papilloma virus (HPV) infection in terms of the columnar epithelial-cell, squamous epithelial-cell, and white-spot regions with abnormal blood vessels may be further aggravated by VIA screening, which achieves a wide range of sensitivity (49-98%) and specificity (75-91%); this might lead to a false result and high interobserver variances. Hence, the automated detection of the columnar area (CA), subepithelial region of the squamocolumnar junction (SCJ), and acetowhite (AW) lesions is needed to support an accurate diagnosis. This study proposes a mask-RCNN architecture to simultaneously segment, classify, and detect CA and AW lesions. We conducted several experiments using 262 images of VIA+ cervicograms, and 222 images of VIA-cervicograms. The proposed model provided a satisfactory intersection over union performance for the CA of about 63.60%, and AW lesions of about 73.98%. The dice similarity coefficient performance was about 75.67% for the CA and about 80.49% for the AW lesion. It also performed well in cervical-cancer precursor-lesion detection, with a mean average precision of about 86.90% for the CA and of about 100% for the AW lesion, while also achieving 100% sensitivity and 92% specificity. Our proposed model with the instance segmentation approach can segment, detect, and classify cervical-cancer precursor lesions with satisfying performance only from a VIA cervicogram.
Keywords: acetowhite lesions; columnar area; instance segmentation; squamocolumnar junction; visual inspection of acetic acid.