HPV E6/E7 mRNA Versus HPV DNA as Triage for Cervical Cancer Screening (PODBT)

April 15, 2014 updated by: Dr Sharmila Pimple, Tata Memorial Hospital

Evaluation of the Diagnostic Performance of HPV E6/E7 mRNA Versus Oncogenic HPV DNA as a Secondary Triage Test for VIA Positive Women in Cervical Cancer Screening Program

AIM: To develop and standardize a cost effective methodology or algorithm for mRNA E6/E7 for HPV genotypes 16, 18, 31, 33 and 45 as compared to commercially available assays which can be incorporated to triage excess false positives from primary screening for cervical cancers

Objectives:

Development and standardization of methodology /algorithm for mRNA E6/E7 testing for HPV genotypes 16, 18, 31, 33 and 45 using Real-time RT-PCR, in cervical samples.
To compare the test performance of this HPV E6/E7 mRNA assay to HPV DNA by HC 2 as secondary screening test, with the reference standard of colposcopy with biopsy, to triage women found positive in primary screening by VIA , in a population based screening for cancer of cervix.
To determine number of false positives in the primary screening test after testing VIA positives with a known high specificity secondary screening test (HPV-DNA HC II ) compared to HPV E6/E7 mRNA testing.

Study Population: Women in the age group of 30-65 years, who test positive on primary cervical screening test VIA will be enrolled for the proposed diagnostic tests along with reference standard of colposcopy with guided biopsy.

Methodology:

Women in the age group of 30-65 years undergoing routine cervical cancer screening through hospital ( Preventive Oncology screening clinic) and community based screening programs with abnormal test result using the primary cervical cancer screening test VIA will be recruited in the study. The primary screening test VIA will be administered by application of 5% Acetic Acid to the cervix and visualizing the cervix with the help of a halogen focus lamp. VIA will be considered to be positive if definite acetowhite lesions are visualized close to the squamocolumnar junction.

Study Overview

Status

Unknown

Conditions

Detailed Description

Objectives:

Development and standardization of methodology /algorithm for mRNA E6/E7 testing for HPV genotypes 16, 18, 31, 33 and 45 using Real-time RT-PCR, in cervical samples.
To compare the test performance of this HPV E6/E7 mRNA assay to HPV DNA by HC 2 as secondary screening test, with the reference standard of colposcopy with biopsy, to triage women found positive in primary screening by VIA , in a population based screening for cancer of cervix.
To determine number of false positives in the primary screening test after testing VIA positives with a known high specificity secondary screening test (HPV-DNA HC II ) compared to HPV E6/E7 mRNA testing.

Study Site: Women tested positive on primary screening test VIA with referrals for further diagnostic testing at TMH will be enrolled under the study for proposed diagnostic tests along with reference test at tertiary care facility , Dept. of Preventive Oncology, Tata Memorial Hospital in Mumbai.

Sample Size To detect statistically significant difference in the test characteristics with 95% confidence limits, 80 % statistical power and alpha =0.05, we require to have around 180 cases of cervical intraepithelial neolplasia in the study.

With a demonstrated prevalence of around 2% for detecting high grade CIN lesions from our urban and rural community based cervical screening programmes, we need to enroll around 9,000 women from population based cervical cancer screening, to get 180 cases of cervical intraepithelial neolplasia

Methodology:

Criteria for a positive VIA test are presented below:

Positive VIA test:

Opaque, dense, dull, definite, well defined aceto white lesions, touching the squamocolumnar junction or close to the external os.
Strikingly dense acetowhite areas in the columnar epithelium.
Condyloma and Leukoplakia occurring closer to the squamocolumnar junction turning intensely white after application of acetic acid.
Growth on the cervix turning acetowhite.

The screened women who are tested Screen Positive by the primary screening test VIA will become eligible for recruitment in the study . Screen positive women from the outreach community screening programs will be referred to TMH ( Preventive Oncology screening clinic) for further diagnostic verification.

Participant Recruitment

The study participants will be recruited from Hospital ( Preventive Oncology screening clinic) and community based screening programmes in Mumbai. Medical Social Workers will explain the details and the purpose of the study to participants attending the screening clinic. Apparently healthy women in the age group of 30-65 yrs with an intact uterus and no past history of cervical neoplasia will become eligible to participate in the programme. If they are fulfilling the inclusion criteria given above, a written informed consent in the vernacular language (either Hindi or Marathi) will be obtained from the participant and a unique participant identification number will be assigned to the eligible women. Information on socio demographic and reproductive variables will then be collected using a detailed questionnaire.

Demographic, reproductive and sexual history data will be recorded at screening following informed consent..

Screen positive women will be tested for the presence of oncogenic HPV types by Hybrid Capture-II (HC-II) and HPV E6/E7 mRNA testing as diagnostic test. In addition to the above two tests all the screen positive women will also further receive Colposcopy with guided cervical biopsy, the reference gold standard test.

Colposcopy will be performed by trained doctors and the colposcopy impression will be noted down along with a punch biopsy from the aceto white area on the cervix detected by the primary screening test VIA. Biopsy specimens will be fixed in 10% formalin and will be processed and reported by the pathology laboratory at the Tata Memorial Centre.

The reference standard for final disease status will be histology.

Post Test Counseling :

At the end of all testing procedures post test counseling will be done by the Doctor and Medical Social Worker to explain the significance and the results of the testing procedures performed. The importance of follow up visit to understand the results of HPV/ mRNA E6/E7 and cervical biopsy will be explained to the women.

Follow up and Treatment:

Treatment for opportunistic and reproductive tract infections (RTI) will be provided. Women with High grade lesions (cervical precancers ) HSIL will be recommended to seek treatment with cryotherapy or LEEP (Loop Electrosurgical Excision Procedure) or by cold knife conization at the Tata Memorial Centre Mumbai.

Total Project Period: Three years:

Proposal submission, training, participant recruitment, data collection and analysis, including follow-up of cases at the end of enrollment period

Study Type

Observational

Enrollment (Anticipated)

1000

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

India
- Maharashtra
  - Mumbai, Maharashtra, India, 400012
    - Recruiting
    - Tata Memorial Hospital
    - Contact:
      
      Sharmila A Pimple, Professor
      
      Phone Number: +912224154379
      
      Email: drsharmilapatil@yahoo.com
    - Contact:
      
      Tanuja R Teni, SciOffF
      
      Phone Number: +912227405071
      
      Email: tteni@actrec.gov.in

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

30 years to 65 years (Adult, Older Adult)

Accepts Healthy Volunteers

Genders Eligible for Study

Female

Sampling Method

Non-Probability Sample

Study Population

Women in the age group of 30 to 65 years (non pregnant and with intact uterus) in urban slum colonies of Mumbai city

Description

Inclusion Criteria:

Female between 30-65years of age
Not pregnant by menstrual history
No history of prior treatment for cancer of the cervix
No history of hysterectomy
Healthy enough to undergo a pelvic examination, i.e., not seriously ill with a debilitating condition

Exclusion Criteria:

Women below and above this age group
Women already screened and detected for cervical precencers and cancers
Women with debilitating condition
Women with Hysterectomy
Women whom are pregnant

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Observational Models: Case-Only
Time Perspectives: Prospective

Number of groups / cohorts

Cohorts and Interventions

Group / Cohort
VIA Positive Those patients having acetowhite lesion over cervix on visual inspection after application of acetic acid

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy Outcome Measure Time Frame: 3 Years	Sensitivity and specificity of HPV DNA test versus E6/E7 mRNA test against gold standard of histopathology confirmed CINs. After the above mentioned time frame, efficacy of 1. HPV DNA Test and 2. E6/E7 mRNA test will be evaluated. Such evaluation is not applicable for individual participants.	3 Years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Tata Memorial Hospital

Collaborators

Ministry of Science and Technology, India

Investigators

Principal Investigator: Sharmila A Pimple, Professor, TMH, Tata Memorial Centre, Mumbai
Principal Investigator: Tanuja R Teni, SciOfficerF, ACTREC, Tata Memorial Centre, Mumbai
Principal Investigator: Gauravi A Mishra, Assoc Prof, TMH, Tata Memorial Centra, Mumbai
Principal Investigator: Surendra S Shastri, HOD, TMH, Tata Memorial Centre, Mumbai

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2013

Primary Completion (Anticipated)

May 1, 2016

Study Completion (Anticipated)

May 1, 2016

Study Registration Dates

First Submitted

March 25, 2014

First Submitted That Met QC Criteria

April 15, 2014

First Posted (Estimate)

April 17, 2014

Study Record Updates

Last Update Posted (Estimate)