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Ovarian Cancer
Uterine and Tubal Lavage for Earlier Cancer Detection Using an Innovative Catheter: A Feasibility and Safety Study
  1. Elisabeth Maritschnegg, MsC, PhD*,
  2. Florian Heitz, MD†,
  3. Nina Pecha, MD*,
  4. Jirí Bouda, MD‡,
  5. Fabian Trillsch, MD§∥,
  6. Christoph Grimm, MD*,
  7. Adriaan Vanderstichele, MD,
  8. Christiane Agreiter, MSc*,
  9. Philipp Harter, MD†,
  10. Eva Obermayr, MSc, PhD*,
  11. Ignace Vergote, MD,
  12. Robert Zeillinger, PhD* and
  13. Paul Speiser, MD*
  1. *Molecular Oncology Group, Department of Obstetrics and Gynecology, Comprehensive Cancer Center–Gynecologic Cancer Unit, Medical University of Vienna, Vienna, Austria;
  2. †Department of Gynaecology and Gynaecologic Oncology, Kliniken Essen Mitte, Essen, Germany;
  3. ‡Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic;
  4. §Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg;
  5. ∥Department of Obstetrics and Gynaecology, University Hospital, LMU Munich, Munich, Germany;
  6. Department of Gynecologic Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
  1. Address correspondence and reprint requests to Paul Speiser, MD, Waehringer Guertel 18-20, 5Q, 1090 Vienna, Austria. E-mail: paul.speiser{at}meduniwien.ac.at.

Abstract

Objectives Poor survival of high-grade serous pelvic cancer is caused by a lack of effective screening measures. The detection of exfoliated cells from high-grade serous pelvic cancer, or precursor lesions, is a promising concept for earlier diagnosis. However, collecting those cells in the most efficient way while fulfilling all requirements for a screening approach is a challenge. We introduce a new catheter for uterine and tubal lavage (UtL) and the clinical evaluation of its performance.

Methods/Materials In study I, the clinical feasibility of the UtL using the new catheter was examined in 93 patients admitted for gynecologic surgery under general anesthesia. In study II, the safety of the UtL procedure was assessed. The pain during and after the UtL performed under local anesthesia was rated on a visual analog scale by 22 healthy women.

Results In study I, the UtL was carried out successfully in 92 (98.9%) of 93 cases by 16 different gynecologists. It was rated as easy to perform in 84.8% of patients but as rather difficult in cancer patients (odds ratio, 5.559; 95% confidence interval, 1.434–21.546; P = 0.007). For benign conditions, dilatation before UtL was associated with menopause status (odds ratio, 4.929; 95% confidence interval, 1.439–16.884; P = 0.016). In study II, the pain during UtL was rated with a median visual analog scale score of 1.6. During a period of 4 weeks after UtL, none of the participants had to use medication or developed symptoms requiring medical attention. The UtL took 6.5 minutes on average. The amount of extracted DNA was above the lower limit for a sensitive, deep-sequencing mutation analysis in all cases.

Conclusions Our studies demonstrate that the UtL, using the new catheter, is a safe, reliable, and well-tolerated procedure, which does not require elaborate training. Therefore, UtL fulfils all prerequisites to be used in a potential screening setting.

  • Early diagnosis
  • High-grade serous cancer
  • Catheter
  • Uterine lavage
  • Feasibility study

https://doi.org/10.1097/IGC.0000000000001361

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    Footnotes

    • This work was supported by Jubilaeumsfond, Austrian National bank (No. 15641).

    • Paul Speiser owns the following patents related to the current manuscript: 2013113816 A1 titled “Non-invasive cancer diagnosis” and 20170128695 A1 titled “Three lumen balloon catheter apparatus”. He is co-founder and shareholder of OVARTEC GmbH. OVARTEC GmbH has licensed the patents mentioned above. All authors declare no conflict of interest.