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Research: BREWER and colleagues, De
Listed in Issue 30
Abstract
BREWER and colleagues, Department of Obstetrics and Gynecology, UCI Medical Center, University of California, Irvine, Orange USA conducted a phase III randomised trial to evaluate oral beta carotene and placebo treatment in cervical cancer treatment.
Background
Methodology
This study evaluated serial changes in colposcopic and cervicographic findings in women with cervical intraepithelial neoplasia (cancer) (CIN) stage II and III. All women treated with beta carotene or placebo for at least 6 months were included if they satisfied the criteria of persistent or progressive disease (no change or worsening of CIN grade) or disease regression (improvement of two grades or more). These two groups were compared for changes in colposcopic and cervicographic patterns biopsies and cervicography were performed at enrolment and after 6 months. Pap smears and colposcopic assessments were performed quarterly. Mosaic pattern, punctation and white epithelium were graded and diagrammed at colposcopic examinations and cervicographic measurements of metaplastic epithelium were recorded.
Results
Data were available for 23 women with regression and 16 with persistent lesions. Small lesions and those without coarse punctation were significantly more likely to regress than larger ones or those with coarse punctation. Lesions with mild acetowhite changes were more likely to regress than those with dense white epithelium. A centripetal movement pattern of metaplastic epithelium toward the cervical os was detected in lesions which regressed, but not in lesions which persisted or progressed.
Conclusion
The results of this study describes the centripetal growth of metaplastic squamous epithelium associated with regression of CIN II and III. This observation may be useful in identifying women for conservative management. The absence of this pattern correlates with persistent or progressive disease.
References
Brewer CA et al. Colposcopic regression patterns in high-grade cervical intraepithelial neoplasia. Obstet Gynecol 90 (4 Pt 1): 617-21. Oct 1997.
