Câncer de colo uterino na gestação / Cervical cancer in pregnancy

PONTOS-CHAVE • A incidência de câncer durante a gestação tem aumentado devido à tendência das mulheres em postergar a gravidez. O câncer de colo de útero é a terceira neoplasia mais comumente diagnosticada durante o período gestacional. • O rastreamento e o diagnóstico devem se dar como nas pacientes não gestantes; a citologia oncótica cervical é o exame obrigatório do pré-natal, e a colposcopia com biópsia pode ser realizada em qualquer período da gestação. • A gestação complicada pelo diagnóstico de um câncer deve sempre ser conduzida em centro de referência e por equipe multidisciplinar. • A interrupção da gestação em situações específicas, para tratamento-padrão, é respaldada por lei. • A quimioterapia neoadjuvante é uma alternativa segura de tratamento durante a gestação, para permitir alcançar a maturidade fetal. Apresenta altas taxas de resposta, sendo relatada progressão neoplásica durante a gestação em apenas 2,9% dos casos. O risco de malformações fetais decorrentes da quimioterapia é semelhante ao da população geral. Contudo, a quimioterapia está associada a restrição de crescimento intraútero, baixo peso ao nascer e mielotoxicidade neonatal. • Na ausência de progressão de doença, deve-se levar a gestação até o termo.

Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review / Eficacia y seguridad de crioterapia, cono frio o termo-coagulación en comparación con LEEP como terapia para la neoplasia intraepitelial cervical: Revisión sistemática

ABSTRACT OBJECTIVES To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

RESUMEN OBJETIVOS Evaluar la eficacia y seguridad del uso de crioterapia, cono frio o termo-coagulación en comparación con el procedimiento de escisión electroquirúrgica en asa (LEEP) para el manejo de neoplasias intraepiteliales cervicales. MÉTODOS Revisión sistemática de ensayos controlados aleatorizados en mujeres con neoplasia intraepitelial cervical en tratamiento con crioterapia, cono frio, o termo coagulación y LEEP, para estimar su eficacia y seguridad. La búsqueda se realizó en MEDLINE/PUBMED, Registro Cochrane Central de Ensayos Controlados (CENTRAL) y Scopus, hasta setiembre de 2018. RESULTADOS Se identificaron 72 estudios, ocho cumplieron los criterios de inclusión. Cono frio disminuyó el riesgo de enfermedad residual en comparación con LEEP (RR 0,54; IC del 95%, 0,30-0,96, p = 0,04). Crioterapia en comparación con LEEP incrementó el riesgo de recurrencia de enfermedad en un 86,0% (RR 1,86; IC del 95%, 1,16-2,97, p = 0,01) con un tiempo de seguimiento de seis a 24 meses, y de infecciones (RR, 1,17; IC del 95%, 1,08-1,28, p < 0,001); pero redujo el riesgo de sangrado menor en un 51,0% (RR 0,49; IC del 95%, 0,40-0,59, p ≤ 0,001). CONCLUSIONES Cono frio reduce el riesgo de enfermedad residual. Sin embargo, la crioterapia reduce el riesgo de sangrado menor en las 24 horas posteriores al tratamiento e incrementa el riesgo de recurrencia de enfermedad y de infecciones.

Resultados de la conización por radiocirugía en pacientesatendidas en consulta de patología de cuello uterino / Results of Conization by Radiosurgery in patients treated in a Cervical Pathology Clinic

Introducción: La radiocirugía tiene como objetivo proporcionar una herramienta de diagnóstico y tratamiento. Objetivos: Describir los resultados de la conización por radiocirugía en pacientes atendidas en la consulta de patología de cuello uterino de la institución. Métodos: Se realizó una investigación descriptiva de corte transversal en el Hospital General Docente Mártires del 9 de Abril de Sagua la Grande, Villa Clara, Cuba. La población de estudio estuvo conformada por la totalidad de 256 pacientes atendidas en la consulta de patología de cuello uterino que fueron sometidas a conización por radiocirugía, entre enero 2013 y diciembre 2015. Para la recogida de la información se empleó la revisión de documentos y se confeccionó un modelo de recogida de datos. Resultados: El diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa) (78 casos; 30,5 por ciento). Conclusiones: Las lesiones premalignas en el presente estudio comenzaron a aparecer con marcada incidencia a partir de los 20 años y hasta los 49, sobresaliendo el grupo de 30 - 39 años. El aumento en el número de parejas sexuales, así como el comienzo temprano de las relaciones sexuales incrementan el riesgo de padecer lesiones intraepiteliales en el cuello del útero. A partir de los cinco años de iniciada las relaciones sexuales comienzan a aparecer las lesiones intraepiteliales cervicales, el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa). En los diagnósticos histológicos por sacabocado y cono existió correspondencia en todos los casos(AU)

Introduction: Radiosurgery aims to provide a diagnostic and treatment tool. Objectives: To describe the results of conization by radiosurgery in patients treated in the cervical pathology clinic of the institution. Methods: A descriptive cross-sectional investigation was carried out at Mártires del 9 de abril General Teaching Hospital, in Sagua la Grande, Villa Clara, Cuba. The study population consisted of 256 patients attended in the cervical pathology clinic who underwent conization by radiosurgery, from January 2013 to December 2015. For the collection of the information, the document review was used and a data collection form was made. Results: The preoperative diagnosis that contributed the greatest number of cases was IAS III (severe dysplasia) (78 cases; 30.5 percent). Conclusions: The premalignant lesions in the present study began to appear with a marked incidence from the age of 20 and up to 49, with the group of 30-39 years standing out. The increase in the number of sexual partners, as well as the early sexual intercourse increase the risk of suffering intraepithelial lesions in the cervix. After five years of beginning sexual intercourse, cervical intraepithelial lesions begin to appear, the preoperative diagnosis that contributed the greatest number of cases was IAS III (severe dysplasia). In histological diagnoses by punch and cone correspondence existed in all cases(AU)

Comparación entre las técnicas de cribado de patología cervical y las conizaciones de tres hospitales en España / Comparison between cervical pathology screening techniques and the conizations of three hospitals in Spain

OBJETIVO Analizar las características poblacionales y los métodos diagnósticos de patología cervical para la prevención del cáncer de cérvix de tres hospitales españoles para mejorar y unificar los programas de cribado y prevención. MATERIAL Y MÉTODOS Estudio retrospectivo de las características demográficas y clínicas de 408 mujeres con patología cervical uterina diagnosticadas en 3 hospitales españoles. Se comparan los factores de riesgo, el proceso diagnóstico y la indicación de tratamiento de dos grupos: las que requirieron conización cervical (n=222) y las que no precisaron tratamiento quirúrgico (n=186). También se analizan las recomendaciones vacunales y su grado de cumplimiento. RESULTADOS Las mujeres conizadas usaron más anticoncepción hormonal y tienen un mayor hábito tabáquico mientras que el número de compañeros sexuales es mayor en pacientes no conizadas. Más del 50% de pacientes con biopsia cervical positiva presentaron un resultado igual o más grave en la anatomía patológica de la pieza quirúrgica. Existen diferencias significativas en sensibilidad y valor predictivo positivo de la citología y de la determinación de HPV entre hospitales. La recomendación de vacunación en ambos grupos fue similar, el porcentaje de mujeres que no la cumplieron fue elevado y significativamente mayor entre pacientes conizadas. CONCLUSIÓN En nuestro medio las mujeres conizadas tienen características clínicas y epidemiológicas diferentes a las no conizadas, existen diferencias entre las técnicas diagnósticas de distintos hospitales y sin embargo la concordancia entre biopsia y resultado del cono es elevada. Sigue siendo necesaria una correcta educación sanitaria en relación con la vacunación en mujeres con patología cervical.

BACKGROUND To analyse the characteristics of the population and diagnostic methods related to the cervical cancer prevention program in three different-level hospitals of a Spanish region in order to improve and unify the screening program. METHODS We retrospectively studied demographic and clinical characteristics of 408 women with cervical lesions diagnosed in three hospitals in Aragon (Spain). Correlation between risk factors, diagnosis process and conisation indication was analysed divided in two groups: conisation required (n=222) or non-conisation (n=186). We also assessed the number of vaccine recommendations made to the patients and the degree of compliance. RESULTS Conisaited women more frequently used a combined hormonal contraceptive method and are more smokers, while the sexual partners are more in women without conisation. More than 50% of women con positive biopsy was confirmed after surgical treatment. There are significant differences between sensibility and positive predictive value of pap-smear and HPV determination in different hospitals. The recombinant vaccine was recommended to both groups at a similar rate. The percentage of women who were recommended to receive the vaccine but chose not to do it, was high in both groups but significantly higher in the Conisation group. CONCLUSION In our environment conisaited women have different clinical and epidemiological profiles, there are differences between diagnosis techniques in different hospitals, however, the concordance between biopsy and definitive result is high. A good sanitary education is necessary in relation with the vaccination of women with cervical pathology.

Evaluation of the p16 and Ki-67 Biomarkers as Predictors of the Recurrence of Premalignant Cervical Cancer Lesions after LEEP Conization / Avaliação dos biomarcadores p16 e Ki-67 como preditores de recidivas de lesões pré-cancerígenas do colo do útero após conização por cirurgia de alta frequência

Abstract Objective To evaluate the expressions of biomarkers p16 and Ki-67 in low-grade (LG) or high-grade (HG) lesions, and to relate them to risk factors and the recurrence of these lesions. Methods A retrospective case-control study of 86 patients with LG and HG lesions who underwent a loop electrosurgical excision procedure (LEEP) between 1999 and 2004. The control group was composed of 69 women with no recurrence, and the study group, of 17 patients with recurrence. All patients were followed-up over a two-year period after surgery, and screened every six months, including cytology and colposcopy. Biopsy samples collected from LEEP were submitted to immunohistochemical analysis for p16 and Ki-67. The statistical analysis was performed using the Statistical Package for the Social Sciences software (SPSS, IBM-SPSS, Inc., Chicago, IL, US), with a significant p < 0.05. Results The biomarkers p16 and Ki-67, separately or combined, showed no relation to recurrence on the total analysis. However, evaluating specifically HG lesions, the positive expression (2+ and 3 + ) of p16/Ki-67 was associated with recurrence (0.010). In addition, p16 isolated was also more expressive in HG lesions (2+ and 3 + , p= 0.018), but it was unrelated to recurrence. Conclusion Proteins p16 and Ki-67, both isolated and combined, are not reliable primary markers for the recurrence of cervical lesions in the majority of LG lesions. However, analyzing only the group with prior diagnosis of HG lesions, the expressions of p16 and of p16/Ki-67 were associated with recurrence, and they may be useful in monitoring these cases.

Resumo Objetivo Avaliar as positividades dos biomarcadores p16 e Ki-67 em lesões de baixo grau (BG) ou de alto grau (AG), e relacioná-las com os fatores de risco e com a recidiva dessas lesões. Métodos Estudo retrospectivo caso-controle, com 86 pacientes com lesões de BG e AG, submetidas à conização por cirurgia de alta frequência entre 1999 e 2004. O grupo de controle foi constituído de 69 mulheres sem recidivas, e o grupo de estudo, de 17 pacientes que recidivaram. Todas as pacientes foram acompanhadas durante dois anos após a cirurgia, com controle a cada seis meses, incluindo citologia e colposcopia. As peças provenientes de cirurgia de alta frequência (CAF) foram submetidas a imunohistoquímica para p16 e Ki-67. A análise estatística foi realizada com o programa Statistical Package for the Social Sciences (SPSS, IBM-SPSS, Inc., Chicago, IL, EUA), com p significante quando < 0,05. Resultados Isoladamente ou em conjunto, p16 e Ki-67 não se relacionaram com as recidivas quando analisados na totalidade dos casos. Entretanto, avaliando especificamente as lesões de AG, a positividade (2+ e 3 + ) do conjunto p16/Ki-67 foi relacionada com recidiva (0,010). No mais, p16, isoladamente, foi também mais expresso nas lesões de AG (2+ e 3 + , p= 0,018), mas sem relação com recidiva. Conclusão Quando testadas na totalidade dos casos, as proteínas p16 e Ki-67, separadas ou em conjunto, se mostraram ineficientes como marcadores primários de recidiva de lesões precursoras. Entretanto, quando avaliadas somente no grupo diagnóstico prévio de lesão de AG, as expressões das proteínas p16 e p16/Ki-67 têm relação com a recidiva, e podem ser úteis no acompanhamento desses casos.

Resultados de la conización por radiocirugía en pacientes atendidas en consulta de patología de cuello uterino / Results of conization by radiosurgery in cervical pathology patients

Introducción: la radiocirugía tiene como objetivo proporcionar una herramienta de diagnóstico y tratamiento. Objetivos: describir los resultados de la conización por radiocirugía en pacientes atendidas en la consulta de patología de cuello uterino. Método: se realizó una investigación descriptiva de corte transversal en el Hospital General Docente Mártires del 9 de abril, de Sagua la Grande, Villa Clara, Cuba. La población de estudio estuvo conformada por 256 pacientes atendidas en la consulta de patología de cuello uterino que fueron sometidas a conización por radiocirugía, desde enero de 2013 a diciembre de 2015. Para la recogida de la información se empleó la revisión de documentos mediante la confección de un modelo de recogida de datos. Resultados: el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa) con 78 casos (30,5 por ciento). Conclusiones: en el presente estudio las lesiones premalignas comenzaron a aparecer con notada incidencia desde los 20 años y hasta los 49, con marcada ocurrencia en el grupo de 30 a 39 años. El aumento en el número de parejas, así como el comienzo temprano de las relaciones sexuales incrementan el riesgo de padecer lesiones intraepiteliales en el cuello del útero. A partir de los cinco años de iniciada las relaciones sexuales, comienzan a aparecer las lesiones intraepiteliales cervicales, el diagnóstico preoperatorio que aportó mayor cantidad de casos fue el NIC III (displasia severa). Existió correspondencia en todos los casos en los diagnósticos histológicos por sacabocado y cono(AU)

Introduction: radiosurgery aims to provide a diagnostic and treatment tool. Objectives: describe the results of radiosurgery conization in patients treated at the cervical pathology clinic. Method: adescriptive cross-sectional study was carried out at Mártires del 9 de Abril General Teaching Hospital, Sagua la Grande, Villa Clara, Cuba. The study population consisted of 256 patients treated at the cervical pathology clinic, who were submitted to radiosurgery conization, from January 2013 to December 2015. For the collection of the information, a review of documents was done by making a data collection model. Results: CIN III (severe dysplasia was) the preoperative diagnosis that contributed the most cases ( 78 cases (30.5 percent)). Conclusions: in the present study, premalignant lesions began to appear with a marked incidence from the age of 20 to 49, with a distinct occurrence in the group aged 30 to 39 years. The increase number of couples as well as the early beginning of sexual intercourse increase the risk of intraepithelial lesions in the cervix. After five years of sexual intercourse, cervical intraepithelial lesions began to appear, the preoperative diagnosis with the highest number of cases was CIN III (severe dysplasia). There was correspondence in all cases in the histological diagnoses by punch and cone(AU)

Margen quirúrgico positivo de enfermedad neoplásica en conos cervical, según las técnicas de conización bajo visión directa o video colposcopía realizados en el INCAN / Positive surgical margins of neoplastic disease in cervical cones, according to techniques of conization under direct vision or video colposcopy performed in INCAN

En la Zona de Transformación del Cérvix, se produce las alteraciones epiteliales de las Neoplasias Cervicales por infección del Virus del Papiloma Humano (VPH), la conización cervical puede ser: terapéutico y diagnóstico...

There are two indications for cerviical conization: therapeutic and diagnostic neoplastic diseases It´s a challenge to get the piece of cervical cone without disease or positive margins at the edges especially when it is therapeutic...

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China / 부인종양

OBJECTIVE: To explore appropriate treatment modality of microinvasive cervical cancer (MIC) and to analyze prognosis and risk factors of recurrence. METHODS: A cohort of 324 Chinese patients with MIC diagnosed and treated at Peking Union Medical College Hospital was retrospectively reviewed. Demographic features, treatment modalities, pathologic parameters, risk factors of residual disease, survival and risk factors of recurrence were analyzed. RESULTS: Of all patients, 280 cases were staged IA1 and 44 cases staged IA2 MIC. Twenty-five cases (7.7%) were found to have lympho-vascular space involvement (LVSI), but no parametrial involvement or ovarian metastasis was detected. Only one staged IA2 patient with LVSI was found to have lymph node metastasis. 32.4% patients (82/253) had residual diseases after conization. No significant difference of LVSI, lymph node metastasis and residual disease after coniztion was found between stage IA1 and IA2 MIC patients. Multivariate logistic analysis showed positive margin was the only independent risk factor of residual disease after conization (odds ratio [OR], 4.18; p<0.001). Recurrence occurred in five cases, but no mortality was found. Progression-free survival for stage IA1 patients treated by conization or hysterectomy was similar (92.3% and 98.8%, p=0.07). Cox regression analysis revealed LVSI as an independent risk factor for recurrence in stage IA1 patients (OR, 12.14; p=0.01). CONCLUSION: For stage IA1 patients with negative resection margin and no LVSI, conization can be an ideal treatment modality. For stage IA2 patients, more conservative surgery such as simple hysterectomy may be considered. LVSI is an independent risk factor for recurrence in patients with stage IA1 cervical cancer.

Experiencia en el tratamiento de la neoplasia intraepitelial cervical y el carcinoma in situ con radiocirugía / Experience in cervix intraepithelial neoplasia and the in situ carcinoma with radiosurgery

OBJETIVOS: Exponer los resultados de un estudio descriptivo, prospectivo y longitudinal, de 1 437 pacientes con neoplasia intraepitelial cervical y carcinoma in situ tratadas con radiocirugía en la consulta de patología de cuello del Hospital Provincial Universitario Carlos Manuel de Céspedes de Bayamo, en el quinquenio 2004-2009. MÉTODOS: Se realizó un estudio descriptivo, prospectivo y longitudinal, de 1 437 pacientes que se les realizó cono por asa diatérmica, donde se estudiaron como variables, la edad, el diagnóstico preoperatorio, las complicaciones transoperatorias y posoperatorias, la calidad del tejido extirpado y la radicalidad del proceder, se utilizó como método estadístico para el procesamiento de los datos el método de los porcentajes. RESULTADOS: Las pacientes con edades comprendidas entre 35 y 45 años resultaron el grupo donde un mayor número de conizaciones se realizó la NIC II, constituyó el diagnóstico preoperatorio más frecuente, las complicaciones transoperatorias y posoperatorias fueron mínimas, la calidad del tejido extirpado para la interpretación anatomopatológica fue buena en más de un 95 por ciento de los casos, los bordes de sección comprometidos no superaron el 2 por ciento. CONCLUSIONES: El cono realizado por radiocirugía en el tratamiento de la NIC y el CIS, es un proceder eficaz y seguro

OBJECTIVES: To expose the results from a longitudinal, prospective and descriptive study conducted in 1 437 patients diagnosed with cervical intraepithelial neoplasm (CIN) and in situ carcinoma (ISC) treated by radiosurgery in the neck pathology consultation of the Carlos Manuel de Céspedes University Provincial Hospital during 2004-2009. METHODS: A longitudinal, prospective and descriptive study conducted in 1 437 patients underwent conus by diathermy loop where variables studied included: age, preoperative diagnosis, transoperative and postoperative complications, quality of the removed tissue and procedure radicalization and for the percentage method we used statistics for data processing. RESULTS: Patients aged between 35 and 45 were the group with more conizations, NIC II was the more frequent preoperative diagnosis, transoperative and postoperative complications were minimal, quality of removed tissue for anatomy and pathology interpretation was good in more than 95 percent of cases, borders of involved section were lower than 2 percent. CONCLUSIONS: Conus carried out by radiosurgery in treatment of NIC and ISC is a safe and effective procedure

Carcinoma de células escamosas microinvasivo do colo uterino: qual a melhor conduta? / Microinvasive squamous cells carcinoma of the uterine cervix: which conduct is the best?

O interesse pelo diagnóstico do carcinoma microinvasivo do colo uterino, uma entidade pouco frequente, tem aumentado. É um dos temas de maior controvérsia na literatura. A colposcopia mostra aspecto de lesão intraepitelial de alto grau em que não há alterações específicas. A conização pelo método de bisturi a frio é inicialmente requerida para seu diagnóstico. O tratamento padrão depende da profundidade da invasão, a qual define o estadiamento (IA1 e IA2). É indicada a histerectomia extrafascial nos casos IA1 e a histerectomia radical no IA2. As pacientes com margens cirúrgicas negativas e desejosas de terapia conservadora (conização no IA1 e traquelectomia radical no IA2) com intuito de gestação futura devem receber acompanhamento rigoroso com citologia e colposcopia.

The interest in microinvasive carcinoma of the cervix, a rare disorder, has increased. The microinvasive carcinoma is the most controversial subject in literature. The colposcopy shows aspect of intraepithelial injury of high degree in which there are no specific alterations. The conisation for cold-knife method is initially required for its diagnosis. The standard treatment depends on the depth of the invasion, which defines its staging (IA1 e IA2). Extrafascial hysterectomy is indicated in IA1 cases and the radical hysterectomy in IA2 cases. The patients with negative surgical restrictions and in need of conservative therapy (conisation in the IA1 and radical trachelectomy in the IA2) in order to carry on a future gestation must receive careful attention based on cytology and colposcopy.

Conización leep en NIE de alto grado en una institución privada de salud / Leep conization for high degree intraepithelial neoplasias

Antecedentes: La conización cervical del cuello uterino es considerada el tratamiento de elección de las neoplasias intraepiteliales de alto grado. Objetivo: Analizar los resultados del tratamiento de esta patología mediante conización Leep. Método: Se revisan los antecedentes y biopsias de 145 pacientes con diagnóstico histológico de neoplasia intraepitelial II y III tratadas con conización cervical por asa Leep en la Unidad de Patología del Tracto Genital Inferior de Clínica Dávila desde el 1 de junio de 2002 al 31 de mayo de 2008. Resultados: Hubo una correlación colpo-biópsica de 80 por ciento (116/145) para Lie de alto grado. Hubo borde positivo en 75 pacientes (51,7 por ciento) y negativo en 70 (48,3 por ciento). Fue necesario un segundo tratamiento en 5 pacientes (3,4 por ciento); en 3 casos por recidivas y en 2 por lesiones invasoras. El 89 por ciento permanece en seguimiento, comprobándose que la totalidad de estas ha tenido un tratamiento considerado satisfactorio. Conclusión: Nuestros resultados confirman que las lesiones cervicales de alto grado deben ser tratadas por métodos escisionales preferentemente, siendo la conización con asa Leep el método de elección por su facilidad de realización, bajo costo de insumos y puede ser realizado sin grandes requerimientos de infraestructura.

Background: The cervical conización of the uterine cervix is considered the treatment of election of high degree intraepithelial neoplasias. Objective: To analyze the results of treatment of this pathology by Leep Conization. Method: The antecedents and biopsies of 145 patients with histological diagnosis of intraepithelial II and III neoplasia, treated with cervix Conization Leep at Lower Genital Tract Unit of Davila Clinic from June first 2002 to May 31 2008 are reviewed. Results: There was a colpo-biopsy correlation of 80 percent (116/145) for high degree CIN. There was positive edge in 75 patients (51.7 percent) and negative in 70 (48.3 percent). A second treatment in 5 patients were necessary (3.4 percent); in 3 cases by recurrences and 2 by invasive lesions. 89 percent remain in control, verifying itself that the totality of these has had a satisfactory considered treatment. Conclusion: Our results confirm that the high degree cervical lesions must preferably be treated by excision methods, being the Leep Conization the method of election by their facility of accomplishment, low cost and can be made without great infrastructure requirements.

Tratamiento y seguimiento de las lesiones premalignas del cuello uterino / Treatment and follow-up of premalignant cervix lesions

La incidencia del cáncer del cuello uterino en Cuba no ha disminuido; en el 2006 se diagnosticaron 1512 casos nuevos y fallecieron 473 mujeres a causa de esa enfermedad. El diagnóstico y el tratamiento han de efectuarse durante la etapa preinvasora. El presente estudio tiene como objetivo evaluar la conización del cuello uterino como método diagnóstico y terapéutico conservador en pacientes con neoplasia intraepitelial del cuello uterino y conocer los resultados obtenidos con esta modalidad terapéutica. Se realizó un estudio retrospectivo, longitudinal con las historias clínicas de pacientes sometidas a biopsia por cono con bisturí frío en el servicio de ginecología del Instituto Nacional de Ontología y Radiobiología entre enero del 2000 y diciembre del 2003. El seguimiento mínimo fue de 3 años, con colpocitología seriada cada 6 meses y con muestra adecuada para el diagnóstico por el método de Papanicolau. Las variables investigadas fueron edad, antecedentes ginecoobstétricos, diagnóstico anatomopatológico y resultado del seguimiento mediante prueba de Papanicolau. En el 28 por ciento de los casos recurrió la enfermedad dentro de los 2 primeros años del seguimiento control y las lesiones fueron de alto grado, según la clasificación de Bethesda. Se concluye que el cono es un método de diagnóstico eficaz, útil y efectivo como tratamiento de la neoplasia intraepiteliar cervical de bajo grado y que su eficacia disminuye en la medida en que aumenta el grado de lesión.

The incidence of cervix cancer in Cuba has not decreased. In 2006, 1512 cases were diagnosed and 473 females died due to this disease. The diagnosis should be made and the treatment should be applied during the preinvasive stage. The present study was aimed at evaluating the cervix conization as a diagnostic and therapeutic conservative method in patients with intraepithelial cervix neoplasia and at knowing the results obtained with this therapeutic modality. A retrospective, longitudinal study was conducted with the medical histories of patients undergoing cone biopsy with cold blade at the gynecology service of the National Institute of Oncology and Radiobiology from January 2000 to December 2003. The minimal follow-up was 3 years, with serial colpocytology every six months and with an adequate sample for the diagnosis by Papanicolau's method. The investigated variables were age, gynecoobstetric history, anatomopathological diagnosis, and result of the follow-up by Papanicolau's test. In 28 percent of the patients the disease recurred within the first 2 years of the control follow-up and the lesions were considered as high degree, according to Bethesda's classification. It was concluded that the cone is an efficient, useful and effective diagnostic method to treat low-grade cervical intraepithelial neoplasm, and that its efficiency decreases as the lesion degree increases.

Cervical stenosis following electrosurgical conization / Estenose cervical após conização eletrocirúrgica

CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING: Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS:This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confidence intervals (95 percent). Levels of 5 percent were considered significant. RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66 percent and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS: We did not find associations between the variables for stenosis. However, we observed borderline significance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

CONTEXTO E OBJETIVO: A estenose cervical é uma complicação pós-operatória dos procedimentos para tratamento das lesões pré-invasivas do colo uterino e assume importância particular tanto pelas repercussões clínicas associadas como pela limitação causada nos acompanhamentos citológico e colposcópico. O objetivo foi verificar a incidência da estenose cervical em uma coorte de pacientes submetidas a conização eletrocirúrgica do colo uterino e apontar possíveis fatores prognósticos associados. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, observacional realizado no Instituto Fernandes Figueira, Departamento de Ginecologia, Rio de Janeiro, Brasil. MÉTODOS: Estudo observacional em uma coorte de pacientes submetidas à conização eletrocirúrgica do colo uterino. As variáveis possivelmente preditoras foram analisadas de forma bivariada entre os grupos com e sem estenose. Calculou-se também a razão de taxas de incidência-densidade da estenose cervical para cada variável possivelmente preditora e os respectivos intervalos de confiança (95 por cento). O nível de significância considerado foi de 5 por cento. RESULTADOS: Foram incluídas 274 pacientes submetidas a conização eletrocirúrgica do colo uterino com um tempo mínimo de seis meses de acompanhamento após o procedimento. A incidência bruta de estenose cervical foi de 7,66 por cento e a incidência-densidade foi de 3,3/1000 pacientes-mês. Não houve diferença estatisticamente significativa entre as características clínico-demográficas dos grupos. CONCLUSÃO: Não se encontrou associação entre as variáveis e a estenose, porém observou-se um nível de significância limítrofe em relação às complicações hemorrágicas do peri e pós-operatório (p = 0,089).

Persistencia de lesión cervical premaligna posterior a conización por LEEP en el Hospital San Juan de Dios en el año 2005 / Persistence of premalignant cervical lesions after conization by LEEP at the Hospital San Juan de Dios in 2005

El estudio "Persistencia de lesión cervical premaligna posterior a LEEP en el Hospital San Juan de Dios", investigó la persistencia de lesión cervical en pacientes sometidas a LEEP basándose en el compromiso de márgenes, así como la relación de algunos factores de riesgo como lo es el HPV. Se determinó la persistencia en pacientes sometidas a LEEP en el Servicio de Ginecología del Hospital San Juan de Dios en el período del 1 de enero al 31 de diciembre del 2005. El estudio se realizó basado en la información recaudada de los expedientes clínicos de las pacientes con patología cervical, controladas en el Servicio de Colposcopía en consulta externa de dicho hospital.

Lesões intra-epiteliais cervicais de alto grau: avaliação da recidiva após tratamento primário com cirurgia de alta freqüência / Cervical intraepithelial lesions of high grade: assessment of recurrence after primary treatment with surgery for high frequency

A cirurgia de alta freqüência do colo uterino tem sido o método de escolha para o tratamento das lesões intra-epiteliais cervicais de alto grau nesta última década, por preservar a capacidade reprodutiva da mulher. Os autores analisaram, durante 12 meses, 61 pacientes cujos resultados de biopsia do colo uterino foram lesão intra-epitelial cervical de alto grau (NIC II e NIC III), para avaliar a recidiva dessas lesões após tratamento por cirurgia de alta freqüência. Ao final desse período as taxas de recorrência foram 3,3%, 23% e 32,8%, três, seis e 12 meses após o tratamento, respectivamente. A relevante eficácia da cirurgia de alta freqüência mostra a importância da detecção e do tratamento adequado das lesões intra-epiteliais cervicais de alto grau, visando prevenir o câncer de colo uterino.

Over the last decade, the large loop excision of the transformation zone (LLETZ) in the cervix has been the method of choice for the treatment of cervical intraepithelial lesion high grade (classified histologically as CIN II and CIN III). The benefit of this form of treatment is that it preserves the woman's reproductive capability. The authors of this study followed 61 patients for 12 months whose results of the cervical biopsy were CIN II and CIN III, to evaluate the rate of recurrence of these lesions after the treatment the LLETZ. At the end of this period the recurrence rates were 3.3%, 23% and 32.8%, three, six and 12 months after the treatment, respectively. The efficacy of the LLETZ the importance of proper diagnosis and treatment of cervical intraepithelial lesions high grade in order to avoid invasive cervical carcinoma.

Cirugía ambulatoria en el Servicio de Cirugía General Oncológica / Ambulatory surgery in the General Oncology Surgery Service

Se hizo un estudio descriptivo, transversal y retrospectivo que incluyó a los pacientes que podían tratarse mediante cirugía mayor ambulatoria y de corta estadía hospitalaria, con el fin de determinar los beneficios de este método, nunca antes aplicados en nuestra provincia en este tipo de institución de salud. Predominaron las afecciones ginecológicas, entre ellas la conización de cuello uterino. Utilizamos anestesia local, espinal general endovenosa, general endotraqueal y combinada (acupuntura e hipnosis). Las enfermedades asociadas no constituyeron limitaciones en la muestra que escogimos y se encontró un mínimo de complicaciones posquirúrgicas. Las evidentes ventajas económicas (el ahorro de camas hospitalarias y la disminución del coste hospitalario), así como un elevado grado de satisfacción de los operados y sus familiares, valida la utilización de este método, ya no tan novedoso, y justifica también que se recomiende incrementar la aplicación del procedimiento y que se extienda al mayor número posible de afecciones quirúrgicas(AU)

A descriptive, traverse and retrospective study was made that included the patients that could be by means of ambulatory bigger surgery and of short hospital demurrage, with the purpose of determining the benefits of this method, never before applied in our county in this type of institution of health. The gynecological affections prevailed, among them the conización of uterine neck. We use anesthesia local, spinal general endovenosa, general endotraqueal and combined (acupuncture and hypnosis). The associate illnesses didn't constitute limitations in the sample that we chose and he/she was a minimum of complications posquirúrgicas. The evident economic advantages (the saving of hospital beds and the decrease of the hospital cost), as well as a high degree of satisfaction of those operated and their relatives, been worth the use of this method, no longer so novel, and it also justifies that it is recommended to increase the application of the procedure and that he/she extends to the biggest number possible of surgical affections(AU)

A Conização como abordagem para lesões endocervicais / Conization as an approach for the treatment of endocervical lesions

O tratamento de lesões intra-epiteliais no colo uterino é fundamental para prevenção secundária do câncer invasor. Neste trabalho discute-se a abordagem adequada para tratar as lesões intra-epiteliais de alto grau em função de sua localização ecto ou endocervical. O procedimento eletrocirúrgico é uma opção equivalente a outras técnicas de conização do colo uterino; entretanto, apresenta a vantagem do baixo custo, a facilidade técnica e baixa morbidade do método. A caracterização colposcópica da lesão, quanto a localização, extensão e visualização é fator determinante para dimensionar o cone a ser excisado. As complicações provocadas pelos métodos excisionais estão relacionadas com o tamanho da excisão; por isto, determinar em cada paciente a extensão da excisão em função do comprometimento da ecto e endocérvice é uma abordagem correta no tratamento das lesões precursoras no câncer de colo uterino.

O uso da eletrocoagulacao na terapeutica das lesoes intra-epiteliais escamosas de alto grau do colo uterino / Eletrocoagulation for the treatment of high grade squamous intraepithelial lesions of the uterine cervix

Analisar a eficacia da eletrocoagulacao como terapeutica nas pacientes portadoras de lesao intra-epitelial escamosa de...

Comparación de los resultados del cepillado de canal con el estudio histológico en pacientes conizados / Comparison of the endocervical canal cytobrush to the histological study of patients treated with conization

Con el objeto de establecer una correlación citohistológica, se estudiaron 137 pa-cientes de la consulta de patología de cuello durante 1 año, a éstas se les realizó el estudio del canal endocervical a través del método del cytobrush y finalmente se les practicó un tratamiento quirúrgico consistente en conización del cuello uterino. El resultado más llamativo que se obtuvo fue el encontrar una correlación de un 81 porciento de los casos, lo cual demostró que a través del empleo de este método se puede precisar con mayor exactitud la existencia de lesión en el canal endocervical que justificaron la conducta médica posterior