HPV Vaccine: Update and Recommendation

Cervical cancer is the most common cancer in Thai women. Human papillomavirus (HPV) infection is found in more than 99 percent of all women with cervical cancer. Several modalities have been used in preventing cervical cancer such as decreasing risk factors for HPV infection, campaigning cervical cancer screening program (i.e. Pap smear) and high-risk HPV DNA testing. The recent cervical cancer prevention modality is HPV vaccine immunization. Clinical trial results for both bivalent and quadrivalent HPV vaccines showed good safety profiles and promising efficacy in preventing cervical intraepithelial neoplasia and cervical cancer. US Food and Drug Administration (FDA) has approved the HPV vaccine in girls and women aged 9-26 years. Even HPV vaccination for the prevention of cervical cancer is widely introduced, it remains critical that women undergo regular cervical cancer screening disregarding the HPV vaccination history.

The accuracy of cervical cancer and cervical intraepithelial neoplasia diagnosis with loop electrosurgical excisional procedure under colposcopic vision / 부인종양

OBJECTIVE: The colposcopic vision guided loop electrosurgical excisional procedure (LEEP) was studied for the effective diagnosis of cervical cancer and cervical intraepithelial neoplasia (CIN). METHODS: A total of 199 patients participated in this study. Individual cases were from gynecologic outpatients at Thammasat University Hospital, Thailand. These had diagnoses for CIN and were selected for treatment with colposcopic guided LEEP. The average age of patients in this study was 45. Menopausal women represented 31%, (61/199) of the patients. The most frequently found Pap smear result among these women (44%, 88/199), was that of high-grade squamous intraepithelial lesion. The next most frequent Pap smear result (32%, 64/199) was low-grade squamous intraepithelial lesion. Patients' medical records and outcomes were evaluated for consistency of pathological examination between colposcopic directed biopsy and LEEP. Discrepancies between initial diagnosis and the final diagnosis were also analyzed. RESULTS: The colposcopic guided LEEP accurately determined 100% of the cervical cancer cases and 84.8 % of the high-grade squamous intraepithelial lesion cases. Involvement of the ectocervical or endocervical margin regions was found to be 5% and 10% respectively, in this study. Excessive bleeding complication, either during the excision and/or postoperative recovery was found in 3% and 6% of cases, respectively. CONCLUSION: LEEP under colposcopic vision is a recommended technique for ambulatory management of precancerous lesion and early diagnosis of cervical cancer. This technique significantly reduces rate of positive ectocervical cone margin involvement.