Multifractal analysis for detection of different stages in

cervical cancer from colposcopy images

Bhaswati Singha Deoa , Mayukha Palb , Prasanta K. Panigrahic , and Asima Pradhana,d
a
Center for Lasers and Photonics, Indian Institute of Technology, Kanpur, 208016, India
b
ABB Ability Innovation Center, Asea Brown Boveri Company, Hyderabad, 500084,
Telangana, India
c
Department of Physical Sciences, Indian Institute of Science Education and Research Kolkata,
Mohanpur, Nadia, 741246, India
d
Department of Physics, Indian Institute of Technology, Kanpur, 208016, India

ABSTRACT
Cervical cancer is of significant health concern globally, particularly in developing countries where access to
advanced healthcare facilities and medical resources is limited, leading to increased mortality rates. The gold
standard for diagnosing CIN (cervical intraepithelial neoplasia) and invasive cervical cancer involves performing
a colposcopy-guided biopsy followed by a pathological diagnosis. However, its effectiveness is challenged by
limited sensitivity in distinguishing between various stages of cervical cancer, especially in regions where there is
a shortage of skilled colposcopists and insufficient access to medical resources. This study presents a method for
categorizing infectious, pre-cancerous, and cancerous conditions through the application of multifractal analysis,
specifically two dimensional multifractal detrended fluctuation analysis (2D MFDFA), using images obtained
through colposcopy. The utilization of multifractal parameters, namely the generalized Hurst exponent and the
width of the singularity spectrum, in the analysis distinctly demonstrated variations among the infectious, pre-
cancerous, and cancerous conditions. Therefore, it offers valuable insights to healthcare professionals, assisting
in the accurate classification and effective management of cervical cancer using Hurst exponent and multifractal
spectrum width.
Keywords: Cervical cancer, Colposcopy, Multifractal analysis, Hurst exponent

1. INTRODUCTION
Cervical cancer is a significant factor in female mortality, with a global diagnosis count of around 604,000 women
in 2020, resulting in approximately 342,000 fatalities from the disease.1 The primary cause of cervical cancer
is human papillomavirus (HPV), while additional factors include smoking, sexually transmitted infections, and
weakened immune function. Projections suggest that by the year 2030, the yearly fatalities due to cervical
cancer are expected to reach 400,000, with developing nations accounting for 90% of these cases.2 The standard
screening techniques for cervical cancer includes HPV tests, ThinPrep cytologic test (TCT), and colposcopy.3
HPV tests exhibit high sensitivity in identifying cancer or HSIL (high grade squamous intraepithelial lesion) but
are prone to a significant false-positive rate, particularly among young women.4, 5 Conversely, TCTs demonstrate
low sensitivity in the detection of cancer or HSIL.4 Colposcopy is employed as a diagnostic procedure for patients
exhibiting abnormal results in TCT or HPV tests. The gold standard for diagnosing CIN and invasive cervical
cancer involves a colposcopy-guided biopsy followed by a subsequent pathological diagnosis. However, challenges
such as a shortage of well-trained colposcopists, weak correlation between visual and pathological diagnoses, and
disagreements among experts6, 7 contribute to the inadequate sensitivity and specificity of colposcopy, particularly
in developing countries.8, 9 Computer-Aided Medical Diagnosis (CMD) overcomes the limitations associated with
manual examination, offering a diagnostic tool that is more reliable and efficient.10, 11 Multifractal analysis has
emerged as a powerful tool for examining the intricate characteristics of medical signals.12–17 By assessing the
Further author information(E-mail):
b: mayukha.pal@in.abb.com; a,d: asima@iitk.ac.in

Optical Biopsy XXII: Toward Real-Time Spectroscopic Imaging and Diagnosis, edited by Robert R. Alfano,
Angela B. Seddon, Lingyan Shi, Proc. of SPIE Vol. 12836, 128360J
© 2024 SPIE · 1605-7422 · doi: 10.1117/12.3009683

Proc. of SPIE Vol. 12836 128360J-1

multifractal properties of medical signals, researchers gain insights into the complex interplay of diverse scales
and singularities within the signals. This study employs MFDFA to showcase its potential in the non-invasive
early diagnosis of cervical cancer through colposcopy images.

2. MATERIALS AND METHODS

2.1 Dataset Description
Colposcopy images were collected from All India Institute of Medical Sciences, Bhubaneswar, India belonging to
different categories from human cervix as shown in Fig.1. Subjects were classified based on biopsy reports, and
ethical approval for the study was obtained from the hospital.

(a) Infectious (b) CIN1 (c) CIN2 (d) Carcinoma

Figure 1: Colposcopy images from different subjects

2.2 Method
We conducted an analysis of cervical images employing two dimensional multifractal detrended fluctuation anal-
ysis (2D MFDFA) are given as.18, 19

1. Let us consider an image represented by a two-dimensional array P (u, v), where u = 1, 2, . . . , M1 and
v = 1, 2, . . . , M2 .
2. The image is partitioned into M 1s ×
 M2s disjoint square segments, each with a uniform size of s × s,
where M1s = Ms1 and M2s = Ms2 . Individually, these segments are denoted as Pi,j , with Pi,j (u, v) =


P (l1 + u, l2 + v) for 1 ≤ u, v ≤ s, where l1 = (i − 1)s, i = 1, 2, . . . , M1s , l2 = (j − 1)s, j = 1, 2, . . . , M2s .

3. The cumulative sum qi,j (u, v) for each segment Pi,j is calculated as follows:
u X
X v
qi,j (u, v) = Pi,j (k1 , k2 ) (1)
k1 =1 k2 =1

where u, v = 1, 2, . . . , s.
4. The trend of qi,j is assessed by fitting through a predefined bivariate polynomial function q̃. We employed
the simple detrending function in our study:
q̃i,j (u, v) = au + bv + c (2)
where 1 ≤ u, v ≤ s, and a, b, c are parameters evaluated using the least squares method in simple matrix
operations. The expression for the residual matrix is:
δi,j (u, v) = qi,j (u, v) − q̃i,j (u, v) (3)

5. The detrended fluctuation function Fi,j (s) for the segment Pi,j is determined by the sample variance of
the residual matrix δi,j (u, v) as shown below:
s s
1 XX
Fi,j (s) = (δi,j (u, v))2 (4)
s2 u=1 v=1

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 6. Subsequently, the overall detrended fluctuation is calculated by averaging across all segments, as demon-
strated below:  q
M 1s M2s
1 X X
Fq (s) =  Fi,j (s)1/q  (5)
M1s M2s i=1 j=1

For q, any real value is allowed except q = 0. In the case of q = 0, we obtain:

 
M 1s M2s
1 X X
F0 (s) = exp  ln[Fi,j (s)] (6)
M1s M2s i=1 j=1

7. Steps 2–6 are performed across diverse scale sizes s with varying values of q. As a result, the scaling
relationship between the size scale s and the detrended fluctuation function Fq (s) is as follows:

Fq (s) ∼ sh(q) (7)

where, the generalized Hurst exponent is denoted by h(q). The corresponding classical τ (q) function for
each q is obtained as follows:
τ (q) = qh(q) − Df (8)
Here, the fractal dimension of the geometric support of the multifractal metric is denoted by Df (For
two dimensional, Df =2). The singularity strength function α(q) and the multifractal spectrum f (α) are
derived using the Legendre transform.
dτ (q)
α(q) = (9)
dq
f (α) = q[α − h(q)] + 2 (10)

3. RESULTS AND DISCUSSION

The intricate multi-scale self-similar structures of cervix images are examined through 2D MFDFA. Multifractal
analysis assesses power-law scaling for statistical moments (q) at various scales (s). In this study, q ranges
from −8 to 8 in steps of 1, while the scale parameter s varies in increments of 32, 64, 128, and 256. Fig.2
compares generalized Hurst exponent h(q) and multifractal spectra f (α) for different cervix image categories,
revealing significant variations and a concave shape typical of multifractal processes is shown in Fig.2(b). Table 1
summarizes outcomes for infectious, CIN1, CIN2, and carcinoma, with carcinoma exhibiting the highest spectrum
width (0.261), indicating increased complexity. The width of the singularity spectrum (∆α) increases from
infectious to carcinoma, indicating a progression of multifractality strength. It is also observed that the ∆α values
of infectious and CIN1 are very similar, however the observed subtle variations both at high and low frequency
holds significance in distinguishing the tissue conditions. This is evident from the large negative and positive
values as observed in Fig.2(a). Similar observations also persist for other conditions with moderate fluctuations
dominant at near q=0, hence a crossover is observed. CIN2 and Carcinoma demonstrates similar distinction
while infectious and carcinoma shows clear distinction among the class because of their distinct tissue conditions.
The h(q=2) values in Table 1 show an increasing trend, suggesting stronger long-range correlations and self-
similarity as the disease advances. Fig.3 depicts boxplots illustrating variations in h(q) and f (α) among different
subjects, with a clear increase in boxplot size from infectious to carcinoma, indicating increasing variability with
disease progression. The analysis revealed distinctive variations among infectious, pre-cancerous, and cancerous
conditions through the utilization of multifractal parameters, specifically the Hurst exponent and the width of
the singularity spectrum.

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 (a) (b)
Figure 2: (a) Hurst exponent h(q) dependent on moment q (b) Multifractal spectra f(α) with respect to the
singularity strength α

(a) (b)
Figure 3: Boxplot of different categories showing (a) Hurst exponent h(q) (b) Multifractal spectra f (α).
Table 1: Multifractal parameters

Category αmax αmin ∆α h(q=2)

Infectious 2.083 1.979 0.104 2.038
CIN1 2.102 1.985 0.117 2.049
CIN2 2.235 1.980 0.255 2.094
Carcinoma 2.207 1.946 0.261 2.119

4. CONCLUSION
Multifractal analysis emerges as a valuable and quantitative tool for understanding cervical health by charac-
terizing complex structures and providing insights into disease progression. The derived multifractal parameters
serve as precise measures, aiding in objective treatment monitoring and potential diagnostic indicators. This
method not only deepens our understanding of tissue complexity but also holds promise for enhancing diagnostic
accuracy. The differences observed among disease categories emphasize the potential for subtle and detailed
insights. Future work aims to improve multifractal analysis by gathering a more diverse set of cervix images,
thereby advancing its application in cervical health assessment.

ACKNOWLEDGMENTS
Asima Pradhan would like to acknowledge Department of Science and Technology, Ministry of Science and
Technology, India (Project number: DST/TDT/BDTD/21/2021); Biotechnology Industry Research Assistance
Council (Project number: BIRAC/SIIC0063/BIG-13/18) for funding this study. Bhaswati Singha Deo is thankful

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to IIT Kanpur for the Institute fellowship. Mayukha Pal wishes to thank ABB Ability Innovation Centre, India
for their support in this work. Authors would also like to thank Dr. Sweta Singh for helping in the data collection
process.

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