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Qi W, Lv Q, Chen L, Huang S, Zhan H, Huang Z. Comparative study of photodynamic therapy (PDT) of cervical low-grade squamous intraepithelial lesion (LSIL). Photodiagnosis Photodyn Ther 2024; 48:104247. [PMID: 38871014 DOI: 10.1016/j.pdpdt.2024.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/25/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Prevention of high-risk HPV (HR-HPV) infection and effective medical intervention of persistent HPV infection and precancerous lesions are critical for the prevention of cervical cancer. AIMS The aim of this retrospective comparative study was to evaluate the outcomes of ALA PDT and observation only in the management of low-grade squamous intraepithelial lesions (LSIL). METHODS In PDT Group (n = 138), ALA PDT was applied to patients with colposcopic biopsy confirmed cervical LSIL accompanied with HR-HPV infection longer than 1 year or HPV 16/18 subtype infection. Cervical LSIL only patients received 3 times of ALA PDT and those with concurrent cervical canal or vaginal lesions received 6 times ALA PDT. Control Group (n = 69) received observation only. Colposcopy, TCT and HPV typing were performed before and after treatment. Patients were followed up for up to two years. RESULT The observation group showed 26.1%, 34.8% and 53.6% HR-HPV negative conversion at 3-6, 12 and 24 months, respectively. LSIL regression rate of the observation group was 33.33%, 36.23% and 65.22% at 3-6, 12 and 24 months, respectively. There was 62.32%, 80.56% and 89.22% patients achieved HPV clearance at 3-6, 12 and 24 months after PDT treatment, respectively. The LSIL remission rate was 89.86%, 94.40% and 96.08% at 3-6, 12 and 24 months after ALA PDT, respectively. The abnormal TCT (≧ ASCUS) was reduced from 92% to 10.1%, 4.6% and 3.9% at 3-6, 12 and 24 months after ALA PDT, respectively. The patient age was not a factor affecting the clearance of HPV infection and the LSIL regression rate of PDT treatment. CONCLUSIONS This study demonstrates that the application of multiple ALA PDT treatments has added value in achieving both short-term and long-term HPV and lesion clearance.
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Affiliation(s)
- Weihong Qi
- Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
| | - Qiubo Lv
- Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Lan Chen
- Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuai Huang
- Department of Gynecology and Obstetrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huiqi Zhan
- MOE Key Laboratory of Medical Optoelectronics Science and Technology, Fujian Normal University, Fuzhou, China
| | - Zheng Huang
- MOE Key Laboratory of Medical Optoelectronics Science and Technology, Fujian Normal University, Fuzhou, China.
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van de Sande AJM, Kengsakul M, Koeneman MM, Jozwiak M, Gerestein CG, Kruse AJ, van Esch EMG, de Vos van Steenwijk PJ, Muntinga CLP, Bramer WM, van Doorn HC, van Kemenade FJ, van Beekhuizen HJ. The efficacy of topical imiquimod in high-grade cervical intraepithelial neoplasia: A systematic review and meta-analysis. Int J Gynaecol Obstet 2024; 164:66-74. [PMID: 37350560 DOI: 10.1002/ijgo.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/29/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE A major side effect of cervical excision for high-grade cervical intraepithelial neoplasia (CIN) is premature birth. A non-invasive treatment for reproductive age women is warranted. The aim of the present study was to determine the efficacy of topical imiquimod in the treatment of high-grade CIN, defined as a regression to ≤CIN 1, and to determine the clearance rate of high-risk human papillomavirus (hr-HPV), compared with surgical treatment and placebo. METHODS Databases were searched for articles from their inception to February 2023.The study protocol number was INPLASY2022110046. Original studies reporting the efficacy of topical imiquimod in CIN 2, CIN 3 or persistent hr-HPV infections were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. RESULTS Five studies were included (n = 463). Histological regression to ≤CIN 1 was 55% in imiquimod versus 29% in placebo, and 93% in surgical treatment. Imiquimod-treated women had a greater odds of histological regression to ≤CIN 1 than placebo (odds ratio [OR] 4.17, 95% confidence interval [CI] 2.03-8.54). In comparison to imiquimod, surgical treatment had an OR of 14.81(95% CI 6.59-33.27) for histological regression to ≤CIN 1. The hr-HPV clearance rate was 53.4% after imiquimod and 66% after surgical treatment (95% CI 0.62-23.77). CONCLUSIONS The histological regression rate is highest for surgical treatment followed by imiquimod treatment and placebo.
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Affiliation(s)
- A J M van de Sande
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kengsakul
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Panyananthaphikkhu Chonprathan Medical Center, Department of Obstetrics and Gynecology, Srinakharinwirot University, Nonthaburi, Thailand
| | - M M Koeneman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Jozwiak
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C G Gerestein
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A J Kruse
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Isala Clinics, Zwolle, The Netherlands
| | - E M G van Esch
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - P J de Vos van Steenwijk
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - C L P Muntinga
- Department of Obstetrics and Gynecology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - H C van Doorn
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F J van Kemenade
- Department of Pathology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - H J van Beekhuizen
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Wittenborn J, Flasshove EM, Kupec T, Najjari L, Stickeler E, Maurer J. A Glimmer of Hope for Patients with a T3 Transformation Zone: miRNAs Are Potential Biomarkers for Cervical Dysplasia. Diagnostics (Basel) 2023; 13:3599. [PMID: 38132183 PMCID: PMC10742976 DOI: 10.3390/diagnostics13243599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This pilot study assesses the potential use of miRNAs in the triage of colposcopy patients with type 3 (nonvisible) cervical transformation zone (TZ). Type 3 TZ is a constitutional finding associated with many problems and controversies in colposcopy patient management. Here, we present miRNAs as a potential biomarker for the detection of CIN3 in these cases. MATERIALS AND METHODS Cervical mucosa samples (CMS) were collected from patients presenting with T3 transformation zone during routine workup using the Cytobrush. Depending on the histological and cytological result, as well as the result of the routinely performed HPV PCR, patients were divided into three groups: patients with a high-grade intraepithelial lesion (CIN3) and a positive high-risk HPV test (CIN3 group), patients without an intraepithelial lesion and a positive high-risk HPV test (HPV group), and healthy controls (N = no intraepithelial lesion and negative HPV test). The cervical mucus samples included in the study were tested for their expression levels of distinct miRNAs using qPCR. RESULTS All investigated miRNAs were consistently detectable in every sample. The CMSs of histologically graded CIN 3 showed consistently high expression levels of all eight miRNAs, whereas the CMSs from healthy patients (N) show generally lower expression levels. However, CMSs from patients of the HPV group represented a very heterogeneous group. CONCLUSIONS The data presented here can provide a solid basis for future research into a triage test for patients with a T3 transformation zone on the basis of commonly used clinical equipment.
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Affiliation(s)
- Julia Wittenborn
- Department of Obstetrics and Gynecology, University Hospital of the RWTH Aachen, 52074 Aachen, Germany (J.M.)
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Schimunek L, Schöpp K, Wagner M, Brucker SY, Andress J, Weiss M. Hyperspectral imaging as a new diagnostic tool for cervical intraepithelial neoplasia. Arch Gynecol Obstet 2023; 308:1525-1530. [PMID: 37574506 PMCID: PMC10520109 DOI: 10.1007/s00404-023-07171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Cervical cancer screening by visual inspection with acetic acid (VIA) during colposcopy can be challenging and is highly dependent on the clinical experience of the examiner. Health-care systems lack qualified physicians able to perform the examination in both industrialized and low- and middle-income countries. Previous work has shown the general potential of hyperspectral imaging (HSI) to discriminate CIN from normal tissue, but clinical translation has been limited due to the lack of medically approved HSI systems. METHODS In this study, we evaluate the feasibility of a commercially available HSI system for CIN detection in a prospective monocentric clinical trial. RESULTS By obtaining spectral fingerprints of 41 patients with CIN 1-3 we show that HSI-based differentiation between CIN and normal tissue is possible with high statistical significance. Major spectral differences were seen in the 555-585 wavelength area. CONCLUSION HSI advances tissue differentiation by associating each pixel with high-dimensional spectra and thereby obtains morphological and biochemical information of the observed tissue. Currently available and medically approved HSI systems may represent a contact- and marker-free examiner-independent method for the diagnosis of CIN.
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Affiliation(s)
- Lukas Schimunek
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Katharina Schöpp
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Michael Wagner
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Sara Y Brucker
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Jürgen Andress
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Martin Weiss
- Department of Women's Health, University Hospital Tübingen, 72076, Tübingen, Germany.
- NMI Naturwissenschaftlich Medizinisches Institut an der Eberhard Karls Universität Tübingen, 72770, Reutlingen, Germany.
- Section for Plasmamedicine and Medical Technology, Department of Women's Health, University Hospital Tübingen, Calwerstrasse 7, 72076, Tübingen, Germany.
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Freisleben M, Petzel A, Jülicher A, Jonas A, Betzler J, Choly N, Pashayeva E, Porthun J, Welcker T, Schneider V, Kaufmann AM, Schneider A. Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic? Geburtshilfe Frauenheilkd 2023; 83:1263-1273. [PMID: 37808260 PMCID: PMC10556877 DOI: 10.1055/a-2150-0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Aim In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system. Patients and Methods In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study : 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA. Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n = 206 LA vs. n = 116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n = 79 for the LA group, n = 35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24 h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group. Results In the feasibility study , 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA. In the comparative study , 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p < 0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p = 0.09). The surgeons estimated the patient's pain significantly less than the patients themselves with an underestimate of -14.63 points on the VAS (p < 0.001). Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were "satisfied" or "very satisfied" with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p = 0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p = 0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p = 0.73; R1 5.3% vs.12.2%, p = 0.57, Rx 4.1% vs. 5.4%, p = 0.65) showed no significant difference when comparing the LA group versus the GA group. Conclusion Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were "satisfied" or "very satisfied" with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.
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Affiliation(s)
| | - Anja Petzel
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | - Anne Jülicher
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | - Anna Jonas
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | | | - Natalia Choly
- Institut für Zytologie und Dysplasie, Berlin, Germany
| | | | - Jan Porthun
- NTNU – Technisch-Naturwissenschaftliche Universität Norwegens, Campus Gjøvik, Gjøvik, Norway
| | | | | | - Andreas M. Kaufmann
- Klinik für Gynäkologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CVK, Berlin, Germany
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Yao K, Xie C. Transvaginal small bowel evisceration after cervical loop electrosurgical excision procedure: a case report. BMC Womens Health 2023; 23:499. [PMID: 37726819 PMCID: PMC10510137 DOI: 10.1186/s12905-023-02650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
Transvaginal small bowel evisceration is a life-threatening condition, which is usually seen in postmenopausal women with a history of gynecological surgery. Cervical loop electrosurgical excision procedure (LEEP) is widely used in the treatment of cervical intraepithelial neoplasia (CIN), and its surgical risk and postoperative complications are relatively low because of the simplicity of the operation. However, improper operation may result in perforation of the uterus, which can cause prolapse of the small bowel into the vagina. We here reported an extremely rare case of a young woman with transvaginal small bowel evisceration after cervical LEEP, achieving a good prognosis after the prolapsed bowel was reduced. The patient underwent cervical LEEP as a treatment for CIN III, but the LEEP resulted in a laceration of about 4.0 cm × 3.5 cm on the peritoneum of the uterovesical peritoneal reflection and a laceration of about 2.0 cm × 1.5 cm on the anterior wall of the cervical canal. Through the two lacerations, the pelvic cavity is connected to the vagina and the small intestine prolapsed into the vagina. Due to aggressive surgical intervention, the patient achieved a favorable prognosis after successfully reducing the prolapsed bowel.
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Affiliation(s)
- Kui Yao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, P.R. China
| | - Chuan Xie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, P.R. China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan Province, P.R. China.
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, No. 20 Section Three, South Renmin Road, Chengdu, Sichuan Province, 610041, P.R. China.
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Sivapornpan S, Punyashthira A, Chantawong N, Wisarnsirirak P, Maireang K, Thaweekul Y, Poomtavorn Y, Pattaraarchachai J, Suwannarurk K. The Efficacy of Oral Etoricoxib in Pain Control During Colposcopy-Directed Cervical Biopsy: A Randomized Control Trial. Asian Pac J Cancer Prev 2023; 24:2855-2859. [PMID: 37642074 PMCID: PMC10685209 DOI: 10.31557/apjcp.2023.24.8.2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE To investigate the effectiveness and safety of oral etoricoxib administration before colposcopic procedure for pain relief during and after colposcopy. METHODS A prospective double-blind, randomized controlled trial was conducted at the colposcopy unit of Thammasat University Hospital, Thailand from August 2022 to January 2023. The participants were women undergoing colposcopy. They were allocated into two groups: etoricoxib group and control group. Thirty minutes prior to colposcopy, the participants received etoricoxib or placebo tablet. A numerical rating scale was used to evaluate pain upon speculum insertion, 3% acetic acid application, directed cervical biopsy (CDB), endocervical curettage (ECC), and 10 minutes and 24 hours after colposcopy. RESULT One hundred and ten women were recruited and were divided equally into study and control groups. The mean age of participants was 42.6 years old. One-fourth of cases (29/110) had cervical intraepithelial neoplasia grade 2 or more histology. Subjects in etoricoxib group had less median pain scores during CDB, ECC, and 10-minute and 24-hour post procedure than the control group with statistical significance. Both groups had comparable side effects. CONCLUSION Administration of oral etoricoxib 30 minutes before colposcopy could reduce pain during and up to 24-hour post colposcopy with minimal side effects.
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Affiliation(s)
- Sarunya Sivapornpan
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Awassada Punyashthira
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Nopwaree Chantawong
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Pattra Wisarnsirirak
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Karicha Maireang
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Yuthadej Thaweekul
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Yenrudee Poomtavorn
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Junya Pattaraarchachai
- Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Komsun Suwannarurk
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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