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Cervical Intraepithelial Neoplasia

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Colposcopy - a direct magnified inspection of cervix

Colposcopy - a direct magnified inspection of cervix + Fluorescence Spectroscopy - electromagnetic spectroscopy which analyzes fluorescence from a sample.

Colposcopy - a direct magnified inspection of cervix + loop electrosurgical excision procedure (LEEP) - thin, low-voltage electrified wire loop to cuts out cervix abnormal tissue.

Pictures of the cervix will be taken before and after the application of acetic acid. A clean probe will be placed against the cervix that sends out light and reads how much light is absorbed by the tissue.

Fluorescence Spectroscopy

Colposcopy

A small heated wire loop is used to remove a cone-shaped piece of abnormal tissue. Procedure is performed on the same day as the colposcopy exam.

LEEP Procedure

Helen E. Rhodes, MD

Primary objectives

1. To conduct a randomized clinical trial of the emerging technology fluorescence and reflectance spectroscopy, comparing colposcopy to colposcopy + spectroscopy in the diagnostic setting, stratifying patients by outside Papanicolaou (Pap) smear of low grade and high grade squamous intraepithelial lesions, and to use multispectral digital colposcopy retrospectively.

   The number of clinically read referral Paps, clinically read UT MD Anderson Cancer Center (MDACC) Paps, quantitatively read Paps, quantitatively read biopsies, point probe fluorescence/reflectance spectroscopy, and the multi-spectral digital colposcopy image, that shows a possible cancer, High-grade Squamous Intraepithelial Lesion (HGSIL), Low-grade Squamous Intraepithelial Lesion (LGSIL), or changes less than LGSIL to colposcopically directed biopsies at the first visit, Loop Electrical Excision Procedure (LEEP) at the second visit if needed, repeat evaluations at 6, 12, and 18 months that have Paps, or Paps + Endocervical Curettage or sample of the cervical canal + possible biopsy, and at the 24 month visit when all patients will at minimum have a Pap and an Endocervical Curettage for certain, and a cervical biopsy if any colposcopic abnormality is present.
2. To see if optical spectroscopy using both the point probe and the multi-spectral device improves diagnosis by improving specificity over colposcopy alone.

   1. To study the number of colposcopically directed biopsies that show High-grade Squamous Intraepithelial or cancer.
   2. To study the number of LEEP specimens that show HGSIL or cancer.

A colposcopy is an exam of the cervix, using a magnifying lens. Fluorescence spectroscopy uses a special light source to look for abnormal cells during the colposcopy.

If you agree to take part in this study, depending on your referral Pap smear diagnosis, you will be randomly assigned (as in the toss of a coin) to one of 3 groups. Participants in Group 1 will undergo a standard colposcopy. Participants in Group 2 will undergo a colposcopy plus fluorescence spectroscopy. If your referral Pap smear diagnosis is high-grade dysplasia (abnormal tissue), you may be assigned to Group 3. Participants in Group 3 will have a colposcopy exam and a loop electrical excision procedure (LEEP--a procedure where a small heated wire loop is used to remove a cone-shaped piece of abnormal tissue) on the same day.

At Visit 1, your complete medical history will be recorded. You will have a physical exam. You will have a colposcopy. You will have a pap smear, and cultures will be taken for gonorrhea and chlamydia. The bodily fluid samples for the cultures are collected by using a cotton swab or cytobrush (the same kind of brush used to collect cells for a Pap smear) to collect mucous from the canal of the cervix. Blood (about 6 teaspoons) may be drawn for syphilis, hepatitis, and Human Immunodeficiency Virus (HIV) tests. You may have a Human Papilloma Virus (HPV) test. The HPV test is performed in the same manner as the bodily fluid sample collection. Depending on which arm you are assigned to, you may have an endocervical curette (ECC) and cervical biopsies of abnormal areas. Before you begin the study, you should ask your study doctor whether or not you were assigned to the group that will be receiving the ECC and cervical biopsies. During the ECC, cells/tissue will be scraped from the cervical canal with an instrument which is made to only take cells/tissue from the surface of the cervical canal. A cervical biopsy is when a tiny piece of tissue from the outside surface of the cervix is removed. Women who are able to have children must have a negative urine pregnancy test. You will complete a behavioral risk-factor interview and questionnaire. The questionnaire should take about 10 minutes to complete.

If you are in Group 2, at each visit you will have a picture of the cervix before and after the application of acetic acid. You will also have a clean probe, the size of a pencil, placed against your cervix. The probe sends out light and reads how much light is absorbed by the tissue. The reading will show doctors and nurses the types of molecules present in the cells of the cervix. Two (2) to 3 measurements will be made. Each measurement takes about a minute.

All participants will have routine visits every 6 months for 2 years. If you miss your scheduled appointment, the next available appointment will be scheduled for you. At these visits, study data will be collected. You will have a colposcopy and Pap smear. You will have cervical biopsies taken and an ECC (if a high-grade lesion is seen). You will have another HPV test.

If at your 24- month appointment there is a lesion on your cervix that can be seen by colposcopy, you will be treated with a loop electrosurgical excision cone procedure. This is a procedure where a tiny heated wire is used to remove the lesion from your cervix. If there is no lesion on your cervix that can be seen by colposcopy, researchers will take 1 cervical biopsy and an endocervical curettage.

You will be taken off study if the disease gets worse. You will be considered off study after the 24-month visit.

This is an investigational study. The spectroscopy device has not been approved by the FDA. It is authorized for use in research only. About 360 women will take part in this multicenter study. Up to 120 women will be enrolled at UT MD Anderson Cancer Center.

Spectroscopy Versus Standard Care in Cervical Cancer Patients

A Randomized Trial of Spectroscopy Versus Standard Care in Cervical Intraepithelial Neoplasia

A LEEP is unnecessary if histological examination results in diagnosis of low grade squamous intraepithelial lesion or normal. Comparison of 3 arms (colposcopy to colposcopy + spectroscopy, colposcopy + LEEP Procedure) in the diagnostic setting, stratifying participants by outside Papanicolaou (Pap) smear of low grade and high grade squamous intraepithelial lesions, and to use multispectral digital colposcopy retrospectively, in identifying unnecessary LEEPs performed.

National Cancer Institute (NCI)

M.D. Anderson Cancer Center

Colposcopy - a direct magnified inspection of cervix.

Colposcopy + Fluorescence Spectroscopy

Colposcopy + LEEP

Total

Age, Continuous

Female

Male

Sex: Female, Male

This study was terminated due to difficulty enrolling subjects.

Helen E. Rhodes, MD / Assistant Professor

The primary outcome measure could not be assessed because no subject received randomized treatment assignment. The study was terminated.

Number of Unnecessary Loop Electrosurgical Excision Procedures (LEEP)

Overall Study

Pharmaceutical Solutions

Coagulants

Hemostatics

Experimental Arm. Haemostasis at the end of the procedure using vaginal packing and Monsel's solution.

Haemostasis at the end of the procedure using only Monsel's solution.

This study will evaluate the role of vaginal packing after cervical conization as haemostasis technique

Vaginal Packing

Ricardo D Reis, MD

The LEEP conization is commonly used for cervical pathologies treatment. The techniques for hemostasis usually used are: cautery, Monsel's solution and vaginal pack. Actually, there is no consensus about the best technique and there is not much information that validates the use of some of that. To compare the use or not of vaginal pack as methods of hemostasis after LEEP conization for management of cervical lesions.

A randomized clinical trial was conducted at Gynecology Oncology Department/Barretos Cancer Hospital for patients with indication of LEEP conization. After local IRB approval, patients were allocated in two arms (50 patients each): without vaginal pack (group 1 - GP1) and with vaginal pack (group 2 - GP2). The Monsel's solution was used in all patients. Intraoperative and postoperative outcomes will be evaluated: operative time, intraoperative and postoperative bleeding, hormonal status, age, parity and cone specimens' characteristics as well as short-term outcome were recorded and compared using Chi-square test, Fisher exact test and t-test where appropriate.

Patients were allocated in two arms (50 patients each): without vaginal pack (group 1 - GP1) and with vaginal pack (group 2 - GP2).Randomization was generated through a computer program creating a random entry list in the study, separating in group 1 (local application of Monsel's solution without intra-vaginal gauze buffer) and group 2 (application of Monsel's solution with intra-vaginal gauze). In this way, all patients had an equal chance of being included in both groups.

The allocation of patients to one group or another was only known moments before the surgical procedure was started.

Comparing Two Techniques of Haemostasis After Cervical Conization

Randomized Clinical Trial Comparing Two Techniques of Haemostasis After Cervical Conization With High Frequency Surgery

Bleeding was assessed by the need for reintervention.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Spectroscopy Versus Standard Care in Cervical Cancer Patients	NCT00529464	Cervical Cancer	Fluorescence Sp... Colposcopy LEEP Procedure	18 Years -	M.D. Anderson Cancer Center
Comparing Two Techniques of Haemostasis After Cervical Conization	NCT03293628	Cervical Intrae... Cervix Neoplasm	Vaginal Packing	19 Years - 68 Years	Barretos Cancer Hospital

Spots Global Cancer Trial Database for loop electrical excision procedure