Self- and physician-collected high-risk human papillomavirus (HPV) testing to detect high-grade cervical lesions among Thai women.

OBJECTIVE: We compared the performance of high-risk human papillomavirus (HPV) messenger RNA testing of physician- and self-collected specimens for detecting histological grade 2 or higher cervical intraepithelial neoplasia (CIN) among women who visited a colposcopy clinic in Thailand. METHODS: From January 2022 to April 2022, 500 women participated in this cross-sectional multicenter study; 494 had complete data and valid specimen results. The participants were women who attended any one of the 10 participating institutes' colposcopy clinics due to abnormal cytology, positive high-risk HPV testing, or for follow-up. Participants used a self-sampling Aptima Multitest Swab specimen collection kit to self-collect vaginal samples before physicians biopsied the cervix during the colposcopic examination. The self- and physician-collected specimens were tested for high-risk HPV messenger RNA using Aptima nucleic acid amplification assays. Cervical tissues were collected during colposcopic-directed biopsy from the most severe lesion or a random biopsy and endocervical curettage specimen if no lesion was detected. RESULTS: We detected high-risk HPV messenger RNA in 75.4% of self-collected specimens and 70.6% of physician-collected specimens. The prevalence of histological grade 2 or higher CIN from cervical histology was 25.1% (n=124). For self-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 87.0% (95% CI 79.7% to 92.4%; n=108) and 28.5% (95% CI 24.0% to 33.4%). For physician-collected specimens, the sensitivity and specificity of high-risk HPV messenger RNA for grade 2 or higher CIN were 90.2% (95% CI 83.6% to 94.9%; n=112) and 36.1% (95% CI 31.2% to 41.3%). CONCLUSIONS: Self-collected specimens for high-risk HPV messenger RNA testing demonstrated good sensitivity and negative predictive value for detecting grade 2 or higher CIN in Thai women attending the participating institutes' colposcopy clinics. Self-collected samples performed similarly to physician-collected ones.

Effectiveness of oral etoposide in recurrent or refractory epithelial ovarian cancer, primary peritoneal cancer and fallopian tube cancer.

The aim of treatment in recurrent or refractory epithelial ovarian cancer is palliation. In a patient with platinum-resistant status, several chemotherapy regimens have been reported with similar response rates. Among these agents, the oral etoposide holds an advantage of the route of administration and management in the out-patient setting. This retrospective study was conducted to evaluate the effectiveness of oral etoposide. Data of patients with recurrent or refractory epithelial ovarian, primary peritoneal and fallopian tube cancer who received oral etoposide treatment in Ramathibodi Hospital, Mahidol University from January 1997 to December 2017 were collected. Progression-free survival (PFS) and overall survival (OS) were primary and secondary outcomes, respectively. The oral etoposide at a dose of 50 mg/m2 was prescribed. Sixty-six records were analysed. Median OS and median PFS were 8.3 months (95% confidence interval (CI): 6.8, 10.4) and 3.1 months (95%CI: 2.3, 3.9), respectively. Other factors including age, body mass index (BMI), histopathology subtype, primary treatment, result of the primary surgery, platinum status, site and size of recurrent cancer, treatment after discontinuation of oral etoposide and the line of chemotherapy regimen were not associated with the prognosis. The initial cancer stage was the only independent poor prognostic factor. The main toxicity was neutropenia. Impact StatementWhat is already known on this subject? After the recurrence of epithelial ovarian cancer, peritoneal cancer or fallopian tube cancer, the aim of treatment in this setting is palliation with accentuating on symptomatic control and enhancing the quality of life. According to previous clinical trials, the chemotherapy regimens which were considered as a second-line or beyond the second-line therapy have been reported with similar response rates. Among these agents, the oral etoposide could be administrated by oral route. There were several articles reported the effectiveness of oral etoposide in different dosage.What do the results of this study add? This study adds that administration of oral etoposide at a dose of 50 mg/m2 showed fairish oncologic outcomes with manageable toxicity.What are the implications of these findings for clinical practice and/or further research? The results will provide evidence that the oral etoposide can be considerate as a choice of palliative chemotherapy because of an advantage of the route of administration and management in the out-patient setting.

Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women.

AIMS: The primary prevention for cervical cancer, a human papilloma virus (HPV) vaccine, has been available in Thailand for almost 3 years. The present study evaluates knowledge about the Papanicolaou (Pap) smear, HPV and the HPV vaccine and focuses on identifying predictors for the acceptability of the HPV vaccine. METHODS: A sample of 764 women attending the gynecology clinic at Ramathibodi Hospital, Bangkok, was asked to answer a questionnaire on their personal background, their knowledge of the Pap smear and HPV and the HPV vaccine and the acceptability of the HPV vaccine for themselves and their daughters. RESULTS: Knowledge of the Pap smear (96%) is higher than that of HPV (41%) and the HPV vaccine (36%). Only 40% of participants had previously heard about HPV. The acceptability of the HPV vaccine for participants and their daughters was high, 77% and 84%, respectively. Knowing about HPV increases acceptance for the HPV vaccine (adjusted OR = 1.7, 95% CI = 1.2-2.5, in the participants and OR = 2.3, 95% CI = 1.5-3.6 in their daughters). Participants younger than 45 years old (OR = 2.3 and 95% CI = 1.6-3.4 for themselves; OR = 2.2 and 95% CI = 1.4-3.3 for their daughters) were more likely to accept the vaccination than those aged 45 years old and above. CONCLUSION: Knowledge about HPV and the HPV vaccine is generally poor in Thai women. However, the acceptability of the HPV vaccine is good. Knowing about HPV and age under 45 years predict the acceptability of the HPV vaccine.

Female hospital-based healthcare professionals' knowledge of cervical cancer, HPV and attitudes towards HPV vaccination.

OBJECTIVE: To find out female hospital-based healthcare professionals' knowledge of cervical cancer, HPV and attitudes towards HPV vaccination. DESIGN: A descriptive cross-sectional hospital-based study. SETTING: Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. SAMPLE: A total of 350 female hospital-based healthcare professionals who had not been diagnosed as having any cancer and willing to participate in the study. METHODS: Participants completed written consent and an anonymous questionnaire and knowledge of cervical cancer, HPV and attitudes towards HPV vaccination were the main outcome measures. RESULTS: Among 300 responders, the mean age was 36.1 years. Most of them were married with children and had received university education. Nursing assistants accounted for 47.1%, and their income per month was about 5,001-15,000 baht. Most (56.3%) had only one lifetime sexual partner. Sixty-eight to 85.3% have a good knowledge of cervical cancer and Pap smear. However, only 12.0 to 58.3% have some knowledge of HPV, and less than fifty percent of them have knowledge of HPV vaccination. Nevertheless, 51.7 to 60.7% of them have good attitudes toward vaccination. Their age and income might influence their attitudes about having themselves vaccinated, and their career might be a factor which altered their attitudes about having their daughter vaccinated if they have one. CONCLUSIONS: Female hospital-based healthcare professionals have a good knowledge about cervical cancer and Pap smears, but they need motivation to have Pap tests regularly. More information regarding HPV and vaccination is needed to provide to them for cervical cancer prevention and best practices.

Can vaginal misoprostol effectively increase rate of a satisfactory colposcopy? A randomized double-blind placebo-controlled trial.

OBJECTIVE: To evaluate the effectiveness of vaginal misoprostol in overcoming an unsatisfactory colposcopy in the patients who had abnormal cervical cytology and to evaluate side effects of vaginal misoprostol. METHODS: Sixty patients with an unsatisfactory colposcopy during the period of September 2007-November 2008 were recruited and randomly allocated to receive either two tablets of 200 microg misoprostol (400 microg) or two tablets of similar-looking placebo vaginally. Colposcopic re-examination was performed approximately 6 h later. The results and side effects before and 2 weeks after the colposcopic re-examination were recorded. RESULTS: Six out of 30 patients in the misoprostol group (20.0%) had a satisfactory colposcopic re-examination compared with 2 out of 27 patients (7.4%) in the placebo group without statistically significant difference (P = 0.172). Three patients in the placebo group dropped out due to not present at the appointment time. Six out of 30 patients (20.0%) and 1 out of 30 patients (3.3%) in the misoprostol group had side effects before and 2 weeks after the colposcopic re-examination orderly. Twenty-seven patients in the placebo group did not have any side effects before and 2 weeks after the colposcopic re-examination. All side effects occurred were minimal and well tolerated. CONCLUSIONS: Four hundred micrograms of vaginal misoprostol were not proved to be effective in converting an unsatisfactory to a satisfactory colposcopy.

Association between prognostic factors and disease-free survival of cervical cancer stage IB1 patients undergoing radical hysterectomy.

This study was designed to identify prognostic factors of patients with cervical cancer stage IB1 undergoing radical hysterectomy. The medical records and specimens of two hundred and five patients with cervical cancer stage IB1 undergoing radical hysterectomy at Songklanagarind Hospital from July 1995 to June 2005 were reviewed. Patients' age, tumor size, histologic type, tumor grade, depth of invasion, degree of stromal invasion, lymph-vascular space invasion (LVSI), surgical margin status, pelvic node status, and adjuvant treatment were assessed for correlation with disease-free survival (DFS). The mean age of these patients was 44.2 years and the median follow up was 56 months. Twenty five patients (12.2%) developed recurrent disease. The overall 5-year DFS was 86%. In univariate analysis, depth of invasion, degree of stromal invasion, LVSI, and pelvic node status were significant prognostic factors. In multivariate analysis, degree of stromal invasion remained the only independent prognostic factor. In conclusion, degree of stromal invasion was the main independent predictor of prognosis in surgical cases of cervical cancer stage IB1.