1. Field of the Invention. The present invention relates generally to methods and systems for collecting cells and biological samples from a female patient's vaginal canal and/or a cervix and more particularly to methods and systems which allow the patient to self-collect the sample, preserve the sample, and send the collected samples to a laboratory or other remote location for analysis.
Cervical cancer screening relies on detecting dysplastic or metaplastic squamous or adenocarcinoma cells in a cell sample obtained from the patient's cervical os. The cervical cells are obtained in a “pap smear” performed by a trained medical professional. Pap smears are generally performed annually and requires that the patient make an appointment at a medical office, take time away from work or family to go to the appointment, endure the embarrassment and physical discomfort of having one or more medical professionals view and access her vagina with a speculum. In some cases, the patient may experience bleeding after the procedure, as a result of trauma induced by the tools in use today.
It is therefore an object of the present invention to provide methods and systems which allow an individual female patient to self-collect biological samples, such as vaginal and cervical samples, by herself without assistance from others. The methods and systems should be useful both in clinical environments where the self-collected sample could be given directly by the patient to a testing laboratory and in non-clinical environments, such as the patient's home, where the sample could be preserved and transported for testing at a remote laboratory. In particular, the methods and systems should allow an individual patient to conveniently remove the sample from the collector, place the sample in a container with a preservative/culture solution, and send the container to the laboratory while avoiding contamination of the sample that could adversely affect test results. The methods and systems should be less invasive and should reduce patient embarrassment and discomfort. The methods and systems for sample collection should be suitable for collecting cells for use in pap smears as well as being compatible with screening for a variety of other diseases and conditions. At least some of these objectives will be met by the inventions described hereinbelow.
2. Listing of the Background Art. Relevant patents and publications include US2017042518; US2013338533; US2012157878; US2002068881; U.S. Pat. Nos. 8,801,628; 8,672,861; 8,460,209; 8,152,739; 5,445,164; 5,191,899; 4,700,703; WO2016/160454; WO2007/045896; and CN201023099. A cervical cell collector including a brush with a plurality of cell-collecting bristles is commercially available under the tradename Wallach's Papette® Cervical Cell Collector (coopersurgical.com).
The present invention provides methods, devices and systems which allow an individual female patient to self-collect biological samples, such as vaginal and cervical samples, by herself without assistance from others. The methods and systems of the present invention are useful in clinical environments where the self-collected sample could be given directly by the patient to a testing laboratory, in office environments where the patient can give the sample to a nurse or physician to follow a standard of care workflow, and in non-clinical environments, such as the patient's home, where the sample could be preserved and transported for testing at a remote laboratory. Using the methods, devices and systems of the present invention allows an individual patient to conveniently remove the sample from the sample collector, place the sample in a container with a preservative/culture, and send the container to the laboratory while avoiding contamination of the sample that could adversely affect test results. The methods and systems are less invasive and reduce patient embarrassment and discomfort. The methods and systems for sample collection should be suitable for collecting cells for use in pap smears as well as being compatible with screening for a variety of other diseases and conditions.
In a first aspect, the present invention provides a device for self-collection of a sample, such as a cervical sample, a vaginal sample, or other tissue or cellular sample that can be collected from the vaginal canal near the cervix. The device comprises an enclosure, a sample-collecting head, a translational actuator, and a rotational actuator. The enclosure is configured to be gripped in a hand of a user and to be inserted into the user's vaginal canal. The sample-collecting head is configured to be advanced and retracted through an opening at a distal head of the enclosure, and the translational actuator is disposed on a side of the enclosure. The translational actuator is coupled to the sample-collecting head and is configured to be engaged by one or other of the user's hands, usually by the thumb of the hand holding the enclosure, to advance the sample-collecting head through the opening to a location proximate the user's cervical os and retract the sample-collecting head through the opening into an interior of the enclosure. In some embodiments, the translational actuator can be a slider or other axially translatable feature. In other embodiments, the translational actuator can be a wheel which can be manually rotated to axially advance a shaft which carries the sample-collecting head. The rotational actuator is configured to be rotated by one or other of the user's hands, usually the hand not holding the enclosure, to rotate the sample-collecting head while the enclosure is in the user's vaginal canal and being held by one or other of the user's hands.
Optionally, indicators showing the extent of axial advancement of the sample-collecting head may be provided on the enclosure. For example, a window with a sliding bar or ribbon may be provided to inform the user of to axial position of the sample-collecting head. Such indicators will be particularly useful with wheel-type translational actuators that provide no inherent positional information.
Still other axial translation mechanism may comprise spiral stems that can be driven by an eccentric disc, flexible stems that can be furled and unfurled on a roller or wheel, and ratcheted stems that can be driven by an engagement wheel.
Further optionally, mechanisms may be provided to vibrate the sample-collecting head, either as an adjunct to rotation or in some instances an alternative to rotation. For example, a piezoelectric transducer could be coupled to a stem which carries the sample-collecting head in order to impart a rotational, axial, or other vibrational motion component to the sample-collecting head.
In particular embodiments of the present invention, a distal region of the enclosure tapers to a distal tip, typically being shaped or configured to conform to a vaginal anatomy. The opening in the enclosure is typically disposed at the tapered distal tip. In other embodiments, the enclosure may be straight, non-tapered, or have other shapes compatible with the anatomy.
In other embodiments of the present invention, the sample-collecting head may comprise any of the variety of shapes, materials, collection features, surface treatments, and the like. Suitable shapes include disks, spears, triangles, pyramids, and the sample-collecting heads may comprise brushes, sponges, protrusions, fingers, bristles, prongs, protrusions, fingers, lipped edges, fanned prongs or fingers, spirals, reticulated polyurethane meshes, and the like. Suitable materials of construction for the sample-collecting head include polyurethanes, cellulose and cellulosic materials, gel foams, gelatin, polytetrafluoroethylenes (PTFE's), graphenes, silicones, polydimethylsiloxane, collagen-based materials (e.g. cryogels), and the like. The sample-collection surfaces of the sample-collecting head may be coated, treated, or otherwise modified to provide sufficient abrasiveness to collect and retain cells without damaging tissue. Other surface treatments and materials may be incorporated to promote sterility, enhance elasticity, allow folding, and the like. The material(s) of construction should also be suitable for storage in a preservative and/or cell culture solution of type used to store the samples when the sample-collecting head is being sent to a central laboratory for analysis, as described hereinbelow. Sponges, if used, should be formed from a material that will not degrade and/or disintegrate or have impurities that could be released to degrade the sample.
In specific embodiments, as described in more detail below, the sample-collecting heads of the present invention may comprise a foldable backing having a forwardly or distally facing sample collection surface. The sample collection surface may comprise any of the surface features such as brushes, sponges, protrusions, fingers, bristles, prongs, protrusions, fingers, lipped edges, fanned prongs or fingers, spirals, or the like, as described previously. The foldable backing allows the head to be folded when present in the interior of the enclosure so that the sample-collecting head may unfold and deploy as it advanced through the opening into the vaginal canal. The sample-collecting head will typically be further configured to refold when retracted back into the interior of the enclosure, where such refolding protects the sample collection surface and any features thereon from mechanical disruption in order to assure preservation of the sample as the sample-collection head is retracted. The foldable or other backing or surface of the sample-collecting head will typically be mounted on a shaft, stem, or other coupling arm which is rotated and axially advanced relative to the enclosure. Usually a string or filament or other tether will also be attached to the sample-collecting heads to allow retrieval of the sample-collecting head should it ever detach from the coupling arm while in the user's vaginal canal. The tether will typically be brought out to the enclosure so that it is accessible in the case of sample-collecting head detachment.
In further specific instances, the sample collection devices of the present invention may comprise a slidable carriage translatably disposed within the housing. The slidable carriage is coupled to both the sample-collecting head and the translational actuator so that advancing and retracting the translational actuator advances and retracts the sample-collecting head. In particular, the translational actuator may comprise a slider having a thumb button and a coupling arm which attaches the thumb button to the slidable carriage. The coupling arm is slidably received in an axial slot in a wall of the housing, allowing the user to advance and retract the thumb button using the thumb of the hand which is holding the enclosure. In further specific instances, the axial slot may have ratchets formed along an axial edge thereof. The coupling arm may be biased to close against or otherwise engage the ratchets to immobilize the slider and the slidable carriage when the thumb button is released and to disengage the ratchets when the thumb button is depressed to advance and retract the slider and the slidable carriage.
In still further instances, the rotational actuator of the devices of the present invention may be coupled to the sample-collecting head by a rotatable barrel and a shaft where the shaft is keyed to the rotatable barrel to allow axial extension and retraction of the sample-collecting head relative to the barrel while the barrel is being rotated by the rotational actuator. Preferably, the rotational actuator is coupled to the rotatable barrel by a gear train which rotates the barrel from two to 12 times, typically from four to 10 times, often about five times, for each rotation of the rotational actuator. Such rotational amplification helps assure that the user will rotate the sample-collecting head a sufficient number of times in order to obtain a useful sample for analysis.
Optionally, features may be added to the sample collectors of the present invention to provide user feedback regarding the number of sample-collecting head rotations and/or to provide limits on the number of rotations of the sample-collecting head in a single use. For example, a rotation counter could be provided, such as a “clicker” that provides an audible sound at each rotation or a numeric counter that increments at each rotation. Alternatively or additionally, a mechanical limit could be provided which prevents further rotation of the sample-collecting head beyond an upper limit, such as 12 rotations. Over-rotation of the sample-collecting head could damage tissue surrounding the cervix.
In other embodiments, the axial actuator and rotational actuator may both comprise wheels or rings. A first wheel or ring could engage the coupling arm to axially translate while a second wheel or ring could be coupled to the coupling arm to directly or indirectly provide rotation.
In still other embodiments, the coupling arm could be driven by battery-powered or other motors to achieve axial and rotational actuation of the sample-collecting head. A variety of gear linkages could be employed, and operation of the motors could be manual, programmed, or a combination thereof.
In other specific instances, the enclosures will have an insertion stop on an exterior of the enclosure, typically a flange circumscribing the body of the enclosure, at a location spaced proximally of the distal end. The insertion stop allows the user to insert the sample collector by an amount which places the distal tip a proper distance from the cervical os when the enclosure when the insertion stop engages tissue surrounding the vaginal opening. In certain instances, the insertion stop may be positionable at different locations along the length of the enclosure and/or sample collectors having different positioning of the insertion stops may be provided to allow a user to select a self-collection device compatible with the user's anatomy. In some cases, physicians or other prescribing individuals may help the user select a sample collector having a proper insertion depth defined by the insertion stop.
In a second aspect, the present invention provides systems for collecting and transporting a cervical sample. The systems may comprise any of the self-collection devices described previously in combination with a collection receptacle having an aperture configured to receive a distal end of the enclosure. The aperture is configured to receive the distal end of the enclosure to allow the sample-collecting head to be advanced through the opening of the enclosure and into an interior volume of the collection receptacle. The systems further include a cover configured to be sealed over the aperture of the collection receptacle after the sample-collecting head has been detached from the device and released into the interior volume of the collection receptacle.
In specific instances of the collecting and transporting systems of the present invention, the aperture will be configured to seal about an exterior of the enclosure of the device for self-collection to prevent or inhibit contamination of the sample as it is being released into the collection receptacle. For example, the aperture may be sized so that the tapered distal region of the device for self-collection frictionally engages and forms a seal between the aperture and the exterior of the enclosure.
In further instances, the collection receptacles of the systems for collecting and transporting cervical samples of the present invention may comprise or otherwise integrate cutters configured to detach the sample-collecting head from the device for self-collection of a cervical sample while the aperture remains sealed about the exterior of the enclosure, further preventing or inhibiting contamination of the sample-collection head before sealing the collection receptacle with the cover. In particular, using a sterile collection receptacle having both the cover and the integrated cutters allows the sample to be collected and released into the receptacle without any need for the user to touch the sample-collecting head with her hands or potentially contaminating tools.
Alternative sample-collecting head detachment mechanisms include interconnected hooks, electrolytically degradable links, and the like. For example, a release button could be provided on an exterior the device enclosure to deliver a charge to an electrolytically degradable link in the stem or elsewhere to detach the sample-collecting head after it is immersed in the preservative fluid.
In a third aspect, the present invention provides methods for self-collection of the cervical sample by a user. Such methods comprise a series of steps performed by the user, typically using either or both hands. The user first grips the enclosure, typically using a single hand, and inserts a distal end of the enclosure into her vaginal canal. A sample-collecting head is then advanced from an interior of the enclosure through an opening to engage tissue proximate the user's cervical os. The sample-collecting head is then rotated while the enclosure remains in the user's vaginal canal to collect sample from the tissue. After the sample is collected, the sample-collecting head is retracted back into the interior of the receptacle and the distal end of the enclosure is withdrawn from the vaginal canal. All such steps may be performed by the user without help or attendance by others.
In specific aspects of the methods of the present invention for self-collection of the cervical sample, the user may grip the enclosure in one hand and insert the distal end of the enclosure into the vaginal canal using that same hand. The user may then use either hand, but typically using the hand which holds the enclosure, to advance a translational actuator on an exterior of the enclosure to advance the sample-collecting head from an interior of the enclosure through the opening to engage tissue proximate the user's cervical os. After engaging the sample-collecting head against the tissue, the user may use either hand, but typically using the hand which doesn't hold the enclosure, to rotate a rotational actuator on an exterior of the enclosure to rotate the sample-collecting head to collect a sample from the tissue proximate the user's cervical os. In particular instances, the gear train may cause the sample-collecting head to rotate from 2 to 12 times for each rotation of the rotational actuator.
After the sample has been collected. The user may use the one hand to retract the translational actuator on the exterior of the enclosure to retract the sample-collecting head back through the opening into the interior of the enclosure. The user may then withdraw the enclosure, typically using the one hand, from the vaginal canal after the sample-collecting head has been retracted.
In preferred instances, the sample-collecting head will be foldable so that it may be folded with a sample-collection surface protected while it is within the interior of the enclosure. In particular, as the sample-collecting head is drawn back into the interior of the enclosure through the opening, the foldable backing will engage the periphery of the opening to protect the sample-collecting surface from frictional engagement which could result in loss of sample.
After the sample has been collected, and the enclosure removed from the patient's vaginal canal, a distal end of the enclosure may be inserted through an aperture of a collection receptacle which contains a cell preservative and/or microbial culture solution, depending on the nature of the test. Typically, the distal end of the enclosure will be sealed against the aperture on the receptacle as the sample-collecting head is advanced through the opening on the enclosure and into the preservative/culture solution. Sealing of the enclosure against the aperture of the collection receptacle reduces the risk of contamination.
The methods of the present invention typically further comprise detaching the sample-collecting head from the enclosure after the enclosure is sealed to reduce the risk of contamination. Detaching the sample-collecting head typically comprises actuating one or more cutting blades disposed in the interior of the enclosure. Preferably, the cutting blades may be actuated using pushers or other components present on the exterior of the collection receptacle to further reduce the risk of contamination. Usually the blades will be stowed in the collection receptacle or otherwise rendered safe after use.
In alternate embodiments, detaching the sample-collecting head from the enclosure after the enclosure is sealed may comprise electrolytically degrading a link, or disengaging a mechanical link, securing the sample-collecting head to the enclosure. Specific examples are provided hereinafter.
All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
Referring now to
The enclosure 12 typically includes a flange or other insertion stop 22 on its exterior surface. The flange 22 will be located at a pre-selected distance proximal of the distal end 14 of the enclosure, where the distance is selected to provide a controlled insertion length for the distal region 18, typically from 1 cm to 10 cm, usually from 2 cm to 8 cm.
The sample collector 10 further includes an axial actuator, typically a slider 24, which includes a thumb button 26 which slides in an axial slot 28. A rotational actuator, such as rotatable knob 30, is typically disposed at the proximal end of the enclosure 12. As best seen in
Referring now to
A carriage 42 having a base 44 at a distal end thereof is attached to the thumb button 26 by a lever arm 50. The lever arm is resiliently or pivotally attached to the base 44 so that the button 26 may be depressed by pressing downwardly, typically by a user's thumb, so that the button will spring back when the downward pressure is removed. A cam element 52 is carried on a lower surface of the button 26, and a pair of channel guides 48 are provided which allow the carriage 42 to axially translate within the enclosure, as will be described in more detail below. Base 44 has a coupling slot 46 formed in its lower edge.
The coupling arm 36 which carries the sample-collecting head 34 is attached at its proximal end to a shaft 64 having a square or other non-circular periphery. The shaft 64, in turn, is reciprocatably mounted in a rotating barrel 66 whose purpose will be described shortly. A coupling disk 60 is secured out or near the junction between the proximal end of the coupling arm 36 and the distal end of the shaft 64. As best seen in
Referring now in particular to
The channel guides 48 of the carriage 42 are received on rails 58 formed on the inner surfaces of the half shells 40 of the enclosure 12. The cam element 52 on the bottom of the thumb button 26 will engage the ratchets 54 when the thumb button is in its unbiased configuration, i.e. is not depressed by the thumb, as shown in
Referring now to
The sample-collecting head 100 will be in its deployed or unfolded configuration, as shown in
Referring now to
As described thus far, the foldable backings and the finger protrusions may be formed separately, typically from different materials. For example, the foldable backings 102 and 122 may be formed from pliable polymers which are structurally sufficient to withstand folding, unfolding, and passage through the opening 32 in the enclosure 12. The protrusions or fingers in contrast, may be formed from sponge-like or other softer materials which are configured to engage tissue and collect cells and other biological sample from the tissues in or surrounding the cervical os.
In contrast, as shown in
A further, alternative sample-collecting head 160 may comprise a plurality of protrusions/fingers 162 which are collected at their proximal ends and which diverge radially outwardly in a distal direction. A stem 146 may be attached to the region where the protrusions/fingers 162 are connected at their respective bases. The protrusions/fingers 162 may simply collapse or fold together when radially constrained, as shown in
In yet another embodiment, a sample-collecting head 170 as illustrated in
As a final example, a sample-collecting head 180 may comprise a sponge structure 182 having a conical cell-collection surface 184 at a distal end and a stem 186 attached at a proximal end, as shown in
Referring now to
Once insertion as shown in
After the sample-collecting head 34 has been locked in place, the user will then rotate knob 30 in order to cause the sample-collecting head 34 to rotate against the tissue surrounding the os CO, as shown by the arrow in
After the user rotates the sample-collecting head a sufficient number of times, typically rotating the knob 30 from 1 to 10 times, which in turn causes a rotation of the sample-collecting head in the range from 5 rotations to 10 rotations (depending on the gear ratio, if any), the sample-collecting head may be axially retracted back within the enclosure 12 through the distal opening 32, as shown in
Referring now to
As shown in
The sample-collecting head 34 is then detached from the sample collector 10. Advantageously, detachment may be effected using a pair of blades 194 which may be externally closed by the user to sever the coupling arm or stem 36. Shown in
In an alternative embodiment, a sample collector 300 is provided with wheel-type axial and rotational actuators in place of the actuators described with reference to
In place of the axial slider described previously, however, the sample collector 300 uses a toothed axial drive wheel 324 to engage and drive a flexible ratcheted section 312 of the stem 306. An upper portion of the toothed axial drive wheel 324 extends through a slot or other aperture in the enclosure so that a user can manually turn the drive wheel. By turning the toothed axial drive wheel 324 a counter-clockwise direction (typically using a thumb), the stem 306 and sample-collecting head 310 can be fully retracted, as shown in
The sample-collecting head 310 can be rotated by manually turning a toothed rotational drive wheel 330 about a longitudinal axis 332. The toothed rotational drive wheel 330 engages an axially splined region 314 of the stem 306. The rotational drive wheel 330 extends through an opening in the enclosure 304 in a manner similar to the toothed axial drive wheel 324. Typically, the axially splined region 314 will be rotationally coupled to the ratcheted region 312 of the stem so that the axially splined region can be rotated without rotating the ratcheted region. Alternatively, the ratcheted region could be ribbed (rather that having axially aligned ratchets) to accommodate rotation just as the splines accommodate axial advancement and retraction of the stem 306. An extension region 316 of the stem 306 extends through an opening 308 in the enclosure and carries the sample-collecting head in a manner similar to the previous embodiments.
In still other embodiments, the spool 320 could be configured to be rotated directly by the user. By doing so, the axial drive wheel 324 could be eliminated and an alternate drive wheel, knob, lever, or the like (not illustrated) coupled to the spool 320 for axial advancement and retraction of the stem 306.
In still other embodiments, a camera, an optical fiber, and/or other image sensor or system could be incorporated into the device to enable real time and/or archival visual or other imaging of the cervix and vaginal vault. The image sensor could provide optical imaging, near infrared imaging, contour imaging, ultrasound imaging, OCT imaging, or any other form of imaging. Such imaging could provide data which could be used either for (i) direct visualization to detect gross lesions/pathology or (ii) to help guide the collecting device to the cervical os (based on an automated feedback tracking software which could align the collecting device to the cervical os). The image sensor could be (i) integrated into the center of the flexible stem which encompasses the collecting device or (ii) on the tip of the enclose which gets inserted into the vaginal canal. Depending on the type of image sensor, a LED or other light source could also be provided. The imaging sensor could be coupled via a wired or wireless link back to a receiver which could be housed in the enclosure of the device or elsewhere, e.g. either through wires/optical cables or via WIFI/Bluetooth. The information from the receiver could be viewed, stored, analyzed on a local device, such as a computer, mobile phone, pad or other smart device, and/or could be sent to a centralized archive (e.g. on the cloud) for analysis and storage. With a local device, this information could also be used so the user can manually adjust the device in her vagina for correct alignment.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
This application is a continuation of PCT Application No. PCT/US2019/43440 (Attorney Docket No. 54815-703.601), filed Jul. 25, 2019, which claims the benefit of U.S. Provisional Patent Application No. 62/711,524 (Attorney Docket No. 54815-703.102), filed on Jul. 28, 2018, the full disclosures of which are incorporated herein by reference.
Number | Date | Country | |
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62711524 | Jul 2018 | US |
Number | Date | Country | |
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Parent | PCT/US2019/043440 | Jul 2019 | US |
Child | 17156386 | US |