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– Alex\]; and (iii) cervical findings on imaging, such as cervical os, cervical canal (inner and/or outer), and parametrial and/or peri-rectal lymphadenopathy \[[@CR24], [@CR26]–[@CR28]\]. We assumed that the use of the estimated lymph nodes percentage more than 5% added value to the ANN’s prediction capacity for diagnosis of invasive cervical cancer.

The present results suggest that the ANN approach may improve the prediction of the possibility of invasive cervical cancer, allowing adequate and individualized information to be made regarding the diagnostic and therapeutic behavior of cervical cancer. However, it is important to develop a cost-effective and reliable diagnostic method capable of predicting invasive cervical cancer and its subtypes. In the present study, an ANN, which combines clinical information and PAP smear data (i.e., morphology, size, and number of cells per PAP smear), might be used as a complement to clinical examination and cytology as a diagnostic aid. The advantage of applying an ANN to the estimation of the possibility of invasive cervical cancer may be in the reduction of unnecessary investigations, such as colposcopy, biopsy, and hysteroscopy. We consider that the ANN approach may assist in patient management decisions. We believe that this approach has a potential of the early diagnosis and treatment of cervical cancer, and of facilitating the development of secondary prevention strategies. In addition, the use of this approach may provide objective information regarding patients’ predicted risk