HRME: Screening for Cervical Cancer and Its Precursors in Low-Resource Settings
NCT ID: NCT02494310
Last Updated: 2017-02-03
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
200 participants
INTERVENTIONAL
2015-09-01
2016-12-31
Brief Summary
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Detailed Description
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The study will include 200 women with abnormal Pap tests identified through BCH's existing mobile screening program. Participants will be randomized by cluster to receive follow up care either through the new mobile diagnostic and treatment unit (experimental arm) or through recall to BCH (standard of care). We are using cluster randomization to avoid contamination between arms because some women getting mobile unit services may be concerned that they are getting lesser services than what they could get at BCH or some women being referred to BCH may resent not having the convenience of a mobile unit. Because the areas visited by the mobile units are geographically isolated, we do not anticipate any patients crossing over to the other study arm.
VIA will be performed with 5% acetic acid applied to the cervix and any abnormal lesions noted. Standard colposcopy will then be performed and abnormal lesions noted. Proflavine (0.01%) will then be applied topically. Lugol's solution will then be applied and colposcopy performed and abnormal lesions noted. Proflavine (0.01% will then be reapplied. HRME images will be acquired from any areas that are abnormal by VIA and/or colposcopy. In addition, all 4 quadrants will be probed by HRME (4Q HRME) to ensure that non-acetowhite lesions are also located. The provider will note their impression of the lesion and the HRME image at each site (normal, benign, low-grade precancer, high grade precancer or cancer). The entire HRME imaging procedure should add less than 10 minutes to the standard colposcopy exam. VIA, colposcopy and HRME observations will recorded by quadrant. Any abnormal areas by VIA and/or colposcopy will be biopsied. If no abnormal areas are noted, one cervical biopsy will be obtained from a normal appearing area with a HRME image of this area obtained. Two expert pathologists, blinded to all study results, will review histology and classify as either normal, CIN1, CIN2, CIN3, AIS or cancer, according to standard criteria; discrepant results will be resolved by consensus review.
TREATMENT:
Women randomized to the mobile diagnostic and treatment unit who have a HSIL Pap and/or a lesion noted by VIA and/or colposcopy will undergo immediate treatment with cryotherapy following biopsies, provided the lesion meets the following criteria: 1) covers \<75% of the ectocervix; 2) can be fully covered with the cryotherapy tip; 3) does not extend into the endocervical canal. If the colposcopic findings are concerning for invasive cancer or the lesion is not amenable to treatment with cryotherapy, the patient will be referred immediately to BCH for additional evaluation and treatment per standard of care.
Women with a biopsy showing CIN2+ who did not undergo cryotherapy due to a negative VIA/colposcopy, will be recalled to BCH immediately for LEEP (CIN2/3). Women with a biopsy showing CIN2/3 who underwent cryotherapy will be recalled to BCH or the mobile unit for a 6-month follow-up visit. If persistent or recurrent disease is noted, they will be referred to BCH for further treatment. Women with a biopsy showing cancer of adenocarcinoma in situ (AIS) will be recalled to BCH immediately for cold knife cone (CKC) or other evaluation and treatment per standard of care regardless of whether or not cryotherapy was performed. Women with CIN1 or less will return for follow-up to the mobile unit or BCH for follow-up at 12 months. Women randomized to return to a central facility for follow up care will undergo VIA, colposcopy, HRME and biopsies as described above. Patients found to have CIN2+ will be treated per standard of care at BCH.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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HRME - Prevention Mobile Unit
Procedures to be done in the mobile unit (van): Visual inspection will be performed with 5% acetic acid (VIA) applied to the cervix followed by standard colposcopy. Proflavine (0.01%) will then be applied topically. Lugol's solution will then be applied and colposcopy performed and abnormal lesions noted. HRME images will be acquired from any areas that are abnormal by VIA and/or colposcopy. VIA, colposcopy and HRME observations will recorded by quadrant. Any abnormal areas by VIA and/or colposcopy will be biopsied. If no abnormal areas are noted, one cervical biopsy will be obtained from a normal appearing area with a HRME image of this area obtained.
High-Resolution Microendoscopy Imaging
Innovative technique to evaluate epithelial cell morphology in situ. The device is not invasive and does not exchange energy with human body.
HRME - Barretos Cancer Hospital
Procedures to be done at Barretos Cancer Hospital: Visual inspection will be performed with 5% acetic acid (VIA) applied to the cervix followed by standard colposcopy. Proflavine (0.01%) will then be applied topically. Lugol's solution will then be applied and colposcopy performed and abnormal lesions noted. HRME images will be acquired from any areas that are abnormal by VIA and/or colposcopy. VIA, colposcopy and HRME observations will recorded by quadrant. Any abnormal areas by VIA and/or colposcopy will be biopsied. If no abnormal areas are noted, one cervical biopsy will be obtained from a normal appearing area with a HRME image of this area obtained.
High-Resolution Microendoscopy Imaging
Innovative technique to evaluate epithelial cell morphology in situ. The device is not invasive and does not exchange energy with human body.
Interventions
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High-Resolution Microendoscopy Imaging
Innovative technique to evaluate epithelial cell morphology in situ. The device is not invasive and does not exchange energy with human body.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
2. Women with an intact cervix (patients who have undergone previous LEEP, cone and/or cryotherapy are eligible)
3. Women of childbearing potential must have a negative urine or serum pregnancy test
4. Women who are at least 18 years of age or older
5. Ability to understand and the willingness to provide informed consent and sign a written Informed Consent Document (ICD)
Exclusion Criteria
2. Women who have undergone a hysterectomy with removal of the cervix
3. Women with a known allergy to proflavine or acriflavine
4. Women who are pregnant or nursing
5. Women unable or unwilling to provide informed consent or sign a written Informed Consent Document (ICD)
18 Years
FEMALE
No
Sponsors
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William Marsh Rice University
OTHER
M.D. Anderson Cancer Center
OTHER
National Institutes of Health (NIH)
NIH
Barretos Cancer Hospital
OTHER
Responsible Party
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Jose Humberto Tavares Guerreiro Fregnani, PhD
Barretos Cancer Hospital
Other Identifiers
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HRME-UH2
Identifier Type: -
Identifier Source: org_study_id
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