ABSTRACT
Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Employment , Physical Fitness , Socioeconomic Factors , Cohort Studies , Cross-Sectional Studies , Finland , Health Behavior , London , Prospective Studies , Social EnvironmentABSTRACT
El carcinoide bronquial representa el 1 a 5 por ciento de todos los tumores pulmonares y es el segundo más frecuente de todos los carcinoides. Constituye un grupo de neoplasias con diferenciación neuroendocrina y potencial maligno con invasión local y metástasis. El presente trabajo tiene como objetivos conocer las características clínicas y tipos de carcinoide en nuestra casuística, así como la utilidad diagnóstica de los estudios histopatológicos complementarios. Se recolectaron los casos del periodo 1988-1996 y se estudiaron con técnicas corrientes, inmunohistoquímica con anticuerpos monoclonales contra enolasa neuronal específica (ENE), sinaptofisina (SIN), cromogranina A (CRO-A) y en cuatro casos con microscopía electrónica. Se encontraron diez casos en el período, 5 mujeres y 5 hombres, con edad que varió de 18 a 74 años; 6 casos fueron formas atípicas y 4 típicas. Las localizaciones más frecuentes fueron lóbulo superior izquierdo y lóbulo inferior derecho. el 50 por ciento fueron uninodulares y el 20 por ciento multinodulares. El diagnóstico clínico se planteó en un caso. El 80 por ciento mostró argentafinidad, 70 por ciento argirofilia; 90 por ciento fueron positivos para ENE, 60 por ciento SIN, 70 por ciento CRO-A. Al microscopio electrónico todos mostraron gránulos neuroendocrinos. Los estudios complementarios utilizados permitieron confirmar el diagnóstico. Tanto la microscopia electrónica como el estudio inmunohistoquímico permiten un diagnóstico específico, especialmente cuando se utiliza un panel de anticuerpos