CEB’s Boundary Marking Tool Used For Biopsy Research
Doctors in NCI’s Hormonal and Reproductive Epidemiology Branch (HREB) are using the Boundary Marking Tool developed by NLM’s Communications Engineering Branch to support a multi-year study aimed at devising a more effective strategy for selecting biopsy sites on the uterine cervix for women undergoing colposcopy.
Evidence has accumulated that, for increasing sensitivity of pre-cancer detection in the uterine cervix, the prevailing protocol of “take one biopsy from the visually-worst lesion” may need significant alteration, both to biopsy more than one site, and to possibly include regions other than the visually-worst.
The study is now underway with data collection for 1,000 patients having begun in February at the University of Oklahoma Health Sciences Center. As part of the exam procedure, a photograph of the uterine cervix is captured with a digital camera fixed to a colposcope. The resulting cervix image is transferred to a laptop computer, where the Boundary Marking Tool (BMT) displays the image, and the examining doctor draws boundaries around cervix lesions and marks multiple biopsy spots, in order of preference. Biopsies are actually taken at these spots, and the biopsy results provide laboratory-proven diagnoses that are maintained along with the images and spatial information as part of the study data.
Conventional Pap testing only affords a global assessment of the cervix, although it is known that HPV infections of the cervix often occur simultaneously at multiple sites and severities. In this study, the collected biopsies will be kept in separate containers and used for the measurement of HPV DNA and other biomarkers; the fine-grained spatial information collected with the BMT software will allow the study of the “topology” of these molecular markers of HPV infection, so that NCI researchers can begin to understand how multiple cervix infections and lesions grow independently.
The BMT is used at a second step when an independent medical expert repeats the biopsy marking as a quality control check. Finally, the BMT is used as part of regular teleconferences among the study participants to display the collected images, biopsy spots, and biopsy results.