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Objective: To determine whether parents would accept Human Papillomavirus (HPV) vaccination for their children and which variables may influence their decision, including knowledge about cervical cancer and HPV., Study Design: Three hundred and fifty-six parents of children aged 10-12 years were interviewed regarding the acceptance of an HPV vaccine for their children and their knowledge of HPV and cervical cancer. All data were recorded anonymously. Results were compared using the chi(2)- and the Mann-Whitney test., Results: HPV vaccination would be accepted by 88% of the parents, preferably when the child is aged 10-12 years. Parents of children who received all the vaccinations of the National Vaccination Programme accepted HPV vaccination significantly more. Less than a third of all parents had heard of HPV, and 14% were aware of the causal relationship of HPV and cervical cancer. Knowledge of HPV and cervical cancer, religion, age, education, and marital status did not show any significant relation with HPV vaccine acceptance., Conclusions: A majority of the parents would accept HPV vaccination. HPV vaccine acceptance seems to be dependent on vaccine acceptance in general, even more than on knowledge of HPV and its causal relation with cervical cancer. However, parents requested more information about cervical cancer, HPV, and HPV vaccination, before the HPV vaccine is introduced.

Objective: To investigate the efficacy of different treatment modalities used in microinvasive adenocarcinoma (AC) of the uterine cervix (FIGO stage IA1 and IA2), and review the literature., Methods: Medical and histopathological records of 38 patients treated for microinvasive AC of the cervix were studied retrospectively, and compared with the literature., Results: Twenty-nine patients had stage IA1 and nine stage IA2 cancers. Treatment modalities ranged from radical hysterectomy with pelvic lymph node dissection (PLND) to conization only. Eighteen patients underwent a conization, including two patients with stage IA2 disease, of whom 11 had 18 pregnancies in total, resulting in 13 live births, two terminations and three spontaneous abortions. In two patients a hysterectomy was performed after pregnancy. No recurrences were noted during an average follow-up of 72 months. In the literature 1565 patients were reported. Of the 814 patients undergoing PLND, 12 had positive nodes. Lymphovascular space invasion (LVSI) was present in 25 patients, all without node involvement. None of the 356 described parametria were involved. Twenty-nine recurrences occurred. In total, 21 pregnancies with 16 live births occurred in those patients treated to preserve fertility., Conclusions: There is no uniformity in the treatment of microinvasive AC of the uterine cervix. For stage IA1 disease, conization seems to be safe and PLND is only recommended where LVSI is present. Although the number of reported cases is small, for stage IA2 disease, conization with PLND in case of LVSI seems advisable. More studies are desirable to define the optimal treatment for patients with microinvasive AC of the cervix, especially with regard to those patients with stage IA2 disease.

Large loop excision of the cervical transformation zone (LLETZ) is a well-established treatment for high-grade cervical intraepithelial neoplasia. It has even been postulated that LLETZ is responsible for the elimination of the infectious agent, human papillomavirus (HPV), causing the lesion. Most studies on HPV detection after LLETZ have focused on the persistence of high-risk (hr-) HPV to identify women at risk for residual or recurrent disease. Therefore, the appearance and significance of hr-HPV types newly detected after surgical treatment has not been studied extensively so far. The presence of hr-HPV in 85 high-grade squamous cervical LLETZ biopsies and in the first follow-up smear was determined. In 80 (94%) of the LLETZ biopsies hr-HPV was detected in contrast to 30 (35%) hr-HPV positive follow-up scrapes. Twenty of the 80 hr-HPV positive women (25%) had the same hr-HPV genotypes in their follow-up cervical smears as was found in the corresponding biopsies. In the follow-up smear of 13 women a new hr-HPV genotype was detected and HPV 18 was newly detected in 8 of them. The remarkably high presence of newly detected HPV 18 genotypes may argue for a release or re-activation of this virus from proximal layers of the cervical canal incised during surgery.

We assessed prospectively whether residual cervical intraepithelial neoplasia (CIN) after treatment for high-grade CIN can be predicted by genotype-specific high-risk HPV (HR-HPV) detection in follow-up cervical scrapes. A broad spectrum, highly sensitive SPF(10)-LiPA-PCR HPV detection technique was used on cervical scrapes before large loop excision of the transformation zone (LLETZ), on the LLETZ biopsy and on follow-up scrapes of 90 patients treated for high-grade CIN. HR-HPV was detected in the biopsies of 93% (n = 84) of the patients and in the follow-up scrapes of 48% (n = 43) of the patients. In 12 patients, genotype-specific HR-HPV persistence was detected in both follow-up scrapes. In 10 patients, residual CIN was detected. In 5 of these patients (including all patients with residual CIN 3), the follow-up scrapes showed genotype-specific HR-HPV persistence. In 2 patients, a different HR-HPV was detected, and 3 patients had HR-HPV-negative follow-up scrapes. Conventional cytologic follow-up was abnormal in 13 patients including all 10 patients with residual CIN. The negative predictive value (NPV) of HR-HPV detection on follow-up scrapes was high (94%). Repeat detection of genotype-specific HR-HPV showed a lower sensitivity and NPV than repeat detection of any HR-HPV, but its specificity was higher. Repeat conventional cytologic follow-up showed the highest sensitivity and NPV. In conclusion, the presence of HR-HPV in cervical scrapes after LLETZ for high-grade CIN is a risk factor for the presence of residual CIN. HR-HPV genotype-specific persistence is specifically present in patients with residual CIN 3. However, HR-HPV detection cannot predict or exclude the presence of residual CIN in the individual patient and additional procedures remain necessary., (Copyright 2002 Wiley-Liss, Inc.)

Objective: The benefit of insulin like growth factor binding protein-1 (IGFBP-1) in diagnosing ruptured fetal membranes in cases in which the diagnosis is clinically doubtful, is investigated., Design: A total of 83 patients with clinically doubtful rupture of fetal membranes were included, and treated as usual. The clinical diagnosis, the amniotic fluid crystallization test, and IGFBP-1 detection were performed on all patients and compared with the defined gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value of each test were calculated., Results: In all, 27 patients (33%) had ruptured fetal membranes at the time of inclusion. The clinical diagnosis of the attending obstetrician showed a higher predictive value of both a positive and negative test result than both IGFBP-1 detection, and the amniotic fluid crystallization test., Conclusions: As the clinical diagnosis showed the highest sensitivity and specificity, IGFBP-1 detection has no additional benefit to ascertain the diagnosis of ruptured fetal membranes in cases in which the diagnosis was clinically doubtful.