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1.
Femina ; 50(1): 35-50, 20220131. ilus
Article in Portuguese | LILACS | ID: biblio-1358220

ABSTRACT

As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)


Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)


Subject(s)
Humans , Female , Cervix Uteri/cytology , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/diagnosis , Squamous Intraepithelial Lesions/surgery , Squamous Intraepithelial Lesions/diagnosis , Squamous Intraepithelial Lesions/diagnostic imaging , Cervical Intraepithelial Neoplasia/diagnostic imaging , Colposcopy , Conization/instrumentation , Papillomavirus Infections/pathology , High-Intensity Focused Ultrasound Ablation , Hysterectomy
2.
Article in English | LILACS | ID: biblio-1369046

ABSTRACT

Introduction: Cervical cancer is the third most common malignant tumor in the female population and the fourth cause of death from cancer in women in Brazil. The squamocolumnar junction and the transformation zone concentrate 90% of pre-invasive and invasive cervical lesions. Objective: To evaluate the prevalence of cytology without cells of the squamocolumnar junction and feasibility of active search. Methods: Cross-sectional study at a university hospital between 2017 and 2018. The prevalence of cytology without squamocolumnar junction cells was calculated. A convenience sample was obtained and mean age and relationship with presence of transformation zone cells were calculated. An active search was performed and cytology collected, with estrogen preparation if indicated. Medical records of the other women were analyzed. Results: Squamocolumnar junction cells were not found in 28.84% of samples. Mean age was 53 years, without association with presence of squamocolumnar junction cells (p=0.409). Seventy-six women returned, 36 of which (47.37%) used estrogen. Level 2 or 3 cervical intraepithelial neoplasia, microinvasive carcinoma or cancer was not identified. A total of 134 medical records were analyzed; only 36 women (26.87%) completed screening. Conclusions: The presence of squamocolumnar junction cells indicates quality of cytology; the use of estrogen in postmenopausal women favors its collection. There were difficulties in active search. An immediate repetition of cytology should be considered.


Introdução: O câncer de colo uterino é o terceiro tumor maligno mais frequente na população feminina e a quarta causa de morte de mulheres por câncer no Brasil. A junção escamo-colunar e a zona de transformação concentram 90% das lesões pré-invasoras e invasoras cervicais. Objetivo: Avaliar prevalência de colpocitologias sem células da junção escamo-colunar e a viabilidade de busca ativa. Métodos: Estudo transversal em hospital universitário entre 2017 e 2018. Calculada prevalência de citologias sem células da junção escamo-colunar. Obtida amostra por conveniência, calculada média de idade e relação com a presença da junção escamo-colunar. Realizada busca ativa e colhidas citologias com preparo estrogênico, se indicado. Analisados os prontuários das demais mulheres. Resultados: A prevalência de ausência de células da junção escamo-colunar foi de 28,84%. A média de idade foi 53 anos, sem associação com presença da junção escamo-colunar (p=0,409). Retornaram 76 mulheres e 36 (47,37%) usaram estrogênio. Não identificamos neoplasia intraepitelial cervical graus 2 ou 3, carcinoma microinvasor e câncer. Analisados 134 prontuários, dos quais apenas 36 mulheres (26,87%) concluíram o rastreio. Conclusões: A presença de células da junção escamo-colunar indica qualidade da coleta, e o uso de estrogênio na pós-menopausa favorece sua obtenção. Houve dificuldade de busca ativa. A repetição imediata da citologia deve ser considerada.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Uterine Cervical Neoplasms/diagnosis , Cervical Intraepithelial Neoplasia/diagnosis , Papanicolaou Test/methods , Prevalence , Cross-Sectional Studies , Sensitivity and Specificity , Age Factors , Hospitals, University
3.
Rev. bras. ginecol. obstet ; 42(6): 340-348, June 2020. tab, graf
Article in English | LILACS | ID: biblio-1137843

ABSTRACT

Abstract Objective To evaluate the performance of the hybrid capture 2 (HC2) high-risk papillomavirus (hrHPV) assay and cytological test in women with previous abnormalities, to detect cervical intraepithelial neoplasia grade 2 or worse (≥ CIN 2). Methods A cytological test and HC2 (Qiagen, Gaithersburg, Maryland, EUA) for hrHPV were conducted in 359 liquid-based (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) samples collected from women from the Vale do Ribeira Region, during July 2013 and September 2015 with previous cytology classified as atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (ASC-H), and atypical glandular cells (AGC). The histopathological examination was conducted in 179 women. The performance evaluations were calculated using the "exact" Clopper-Pearson 95% confidence interval (CI) test by MEDCALC (Medcalc Software Ltd, Ostend, Belgium). Results The ≥ CIN 2 frequency was 11.7% (21/179). The HC2 for hrHPV and repeat cytology to detect ≥ CIN 2 obtained, respectively, a sensitivity of 90.5% (95% CI = 69.6-98.8) and 90.5%, (95%CI = 69.6-98.8), a specificity of 65.8% (95% CI = 57.9-73.2) and 43.7% (95%CI = 35.8-51.8), a positive predictive value of 26.0% (95% CI = 21.4-31.3) and 17.6%, (95%CI = 14.9-20.6), and a negative predictive value of 98.1% (95%CI = 93.3-99.5) and 97.2% (95% CI = 90.1-99.2). Conclusion Hybrid capture 2 for hrHPV improves the performance of the detection of ≥ CIN 2, without compromising sensitivity, and provides a greater safety margin to return to the triennial screening of women undergoing follow-up due to previous abnormalities, without underlying ≥ CIN 2.


Resumo Objetivo Avaliar o desempenho da captura híbrida 2 (CH2) para papilomavírus humano de alto risco (HPVar) e repetição do exame citopatológico em mulheres com anormalidades em citologia anterior, para detectar neoplasia intraepitelial cervical grau 2 ou pior (≥ NIC 2). Métodos Foi realizado exame citopatológico e CH2 para HPVar (Qiagen, Gaithersburg, Maryland, EUA) em 359 amostras em meio líquido (Sure Path, Becton Dickinson, TriPath Imaging, Burlington, NC, USA) coletadas de mulheres da região do Vale do Ribeira, durante julho de 2013 e setembro de 2015 com citologia anterior classificada como células escamosas atípicas de significado indeterminado (ASC-US), lesão intraepitelial de baixo grau (LSIL), células escamosas atípicas, não podendo excluir lesão de alto grau (ASC-H) e células glandulares atípicas (AGC). O exame histopatológico foi realizado em 179 mulheres. As avaliações de desempenho foram calculadas usando o teste de intervalo de confiança (IC) "exato" de Clopper-Pearson de 95% pelo software MEDCALC (Medcalc Software Ltd, Ostend, Bélgica). Resultados A frequência de≥ NIC 2 foi 11,7% (21/179). A CH2 para o HPVar e a citologia de repetição para a detecção ≥ NIC 2 obteve, respectivamente, sensibilidade de 90.5% (IC 95% = 69,6-98,8) e 90,5% (IC 95% = 69,6-98,8), especificidade de 65,8% (IC 95% = 57,9-73,2) e 43,7%, (IC 95% = 35,8-51,8), valor preditivo positivo de 26,0% (IC 95% = 21,4-31,3) e 17,6%, (IC95% = 14,9-20,6), e valor preditivo negativo de 98,1% (IC 95% = 93,3-99,5) e 97,2%, (IC 95% = 90,1-99,2). Conclusão No geral, a CH2 para HPVar aprimora o desempenho para detecção de ≥ NIC 2, sem comprometer a sensibilidade e proporciona maior margem de segurança do retorno ao rastreio trienal de mulheres com anormalidades citológicas prévias, sem≥ NIC 2 subjacente.


Subject(s)
Humans , Female , Adolescent , Adult , Aged , Young Adult , Papillomaviridae/isolation & purification , Vaginal Smears , Uterine Cervical Neoplasms/diagnosis , Triage , Cervical Intraepithelial Neoplasia/diagnosis , Papillomavirus Infections/diagnosis , Atypical Squamous Cells of the Cervix/pathology , Brazil , Uterine Cervical Neoplasms/pathology , Cross-Sectional Studies , Sensitivity and Specificity , Cervical Intraepithelial Neoplasia/pathology , Papillomavirus Infections/pathology , Middle Aged
4.
J. coloproctol. (Rio J., Impr.) ; 39(4): 297-302, Oct.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056650

ABSTRACT

Abstract Objective: To describe the epidemiological, clinical and laboratory profiles of women with anal neoplasia associated with cervical neoplasia attending a tertiary healthcare facility in northeastern Brazil. Methods: This epidemiological, descriptive study was conducted using a database from a cross-sectional study carried out between December 2008 and January 2016. Women with a diagnosis of cervical neoplasia associated with anal neoplasia were included in the present study. Results: Of the women with cervical neoplasia, 14% were found to have an anal intraepithelial lesion or anal cancer. Median age was 33 years, 68% were non-white, and 70% were from urban regions, had little schooling and low income. Most reported having had anoreceptive (73%) and unprotected intercourse (84%). Regarding symptoms, 7% reported bleeding and 11% pruritus. Overall, 10% of the sample tested positive for the human immunodeficiency virus. Anal cytology was abnormal in 92%. High-resolution anoscopy was abnormal in all cases. Histopathology revealed three cases of invasive carcinoma and high-grade lesions in 32% of the cases. Conclusion: Women with a diagnosis of anal and cervical neoplasia are often young, non-white women, who initiated their sexual life at an early age, were exposed to unprotected anoreceptive intercourse, live in urban centers, have little schooling and a low-income level.


Resumo Objetivo: Descrever os perfis epidemiológico, clínico e laboratorial de mulheres com neoplasia anal associada à neoplasia cervical atendidas em uma unidade de saúde terciária no nordeste do Brasil. Métodos: Este estudo epidemiológico e descritivo usou um banco de dados de um estudo transversal realizado entre dezembro de 2008 e janeiro de 2016. Mulheres com diagnóstico de neoplasia cervical associada à neoplasia anal foram incluídas no presente estudo. Resultados: Das mulheres com neoplasia cervical, 14% apresentaram lesão intra-epitelial anal ou câncer anal. A mediana de idade foi de 33 anos; 68% das pacientes não eram brancas e 70% eram provenientes de regiões urbanas, com baixa escolaridade e baixa renda. A maioria relatou histórico de relações sexuais anoreceptivas (73%) e desprotegidas (84%). Quanto aos sintomas, 7% relataram sangramento e 11% prurido. No geral, 10% das pacientes apresentaram serologia positiva para o vírus da imunodeficiência humana. A citologia anal foi anormal em 92% da amostra. A anuscopia de alta resolução foi anormal em todos os casos. A histopatologia revelou três casos de carcinoma invasivo e lesões de alto grau em 32% dos casos. Conclusão: As mulheres com diagnóstico de neoplasia anal e cervical geralmente são jovens, não brancas, que iniciaram sua vida sexual em idade precoce, foram expostas a relações sexuais anoreceptivas desprotegidas, moram em centros urbanos e têm baixa escolaridade e baixo nível de renda.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Anus Neoplasms/epidemiology , Health Profile , Carcinoma in Situ/epidemiology , Uterine Cervical Neoplasms/epidemiology , Anus Neoplasms/diagnosis , Socioeconomic Factors , Brazil , Carcinoma in Situ/diagnosis , Uterine Cervical Neoplasms/diagnosis , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/epidemiology , Tertiary Care Centers
5.
Rev. cuba. invest. bioméd ; 38(4): e249, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093419

ABSTRACT

Introducción: El virus de papiloma humano per se no es capaz de desarrollar todas las transformaciones neoplásicas en el cérvix uterino, de manera que factores de riesgo como los genéticos, ambientales, estilo de vida sexual y el desbalance oxidativo podrían contribuir a la enfermedad. Objetivo: Determinar el comportamiento del sistema enzimático antioxidante en mujeres con atipia de células escamosas de significado indeterminado y neoplasia intraepitelial cervical grado I. Métodos: Se conformaron tres grupos de estudio: el primero incluyó 30 mujeres con diagnóstico de atipias, el segundo se constituyó con 40 mujeres con neoplasia intraepitelial grado I y el tercero consistió en 30 mujeres con citología negativa tomadas como control, provenientes de la consulta de Patología de Cuello del Agustín Gómez Lubián de Santa Clara. Mediante métodos espectrofotométricos se determinaron los niveles de actividad enzimática superóxido dismutasa y catalasa así, como las concentraciones de glutatión reducido. Las comparaciones se realizaron con el programa SPSS, versión 18. Resultados: En el grupo de atipias aunque los tres parámetros tuvieron una tendencia a la disminución no hubo diferencias significativas con respecto al control. Mientras que el grupo de neoplasia grado I evidenció disminución significativa de los tres indicadores estudiados al ser comparados con el grupo control. Conclusiones: Se constató afectación del sistema antioxidante enzimático en el grupo de neoplasia grado I, lo cual podría considerarse un cofactor importante en la progresión de las lesiones en el cérvix uterino(AU)


Introduction: Human papillomavirus per se can not carry out all the neoplastic transformations occurring in the uterine cervix. Genetic and environmental risk factors as well as sexual behavior and oxidative imbalance may also play a role. Objective: Determine the behavior of the enzymatic antioxidant system in women with squamous cell atypia of indeterminate significance and grade I cervical intraepithelial neoplasia. Methods: Three study groups were formed. The first group included 30 women diagnosed with atypia, the second group was made up of 40 women with grade I intraepithelial neoplasia, and the third or control group consisted of 30 women with negative cytology from Agustín Gómez Lubián Cervical Pathology service in Santa Clara. Spectrophotometric methods were used to determine the levels of superoxide dismutase and catalase enzymatic activity, as well as the concentrations of reduced glutathione. Comparisons were made with the SPSS software, version 18. Results: In the atypia group the three parameters showed a decreasing tendency, but differences with respect to the control group were not significant. In the grade I neoplasia group, however, a significant reduction was found of the three study indicators when compared with the control group. Conclusions: Damage to the enzymatic antioxidant system was observed in the grade I neoplasia group. This could be considered to be an important cofactor in the progress of uterine cervix lesions(AU)


Subject(s)
Female , Papilloma , Carcinoma in Situ/prevention & control , Cervix Uteri , Cervical Intraepithelial Neoplasia/diagnosis , Cell Biology , Life Style , Antioxidants/analysis , Sexual Behavior , Case-Control Studies , Indicators and Reagents
6.
Rev. cuba. obstet. ginecol ; 45(3): e478, jul.-set. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093653

ABSTRACT

Introducción: El cáncer cérvico uterino es la segunda neoplasia más común en mujeres en el mundo. Una buena correlación entre las pruebas de tamizaje, diagnóstico y tratamiento de las lesiones cervicales optimiza su manejo, evita procedimientos innecesarios y maximiza recursos disponibles. Objetivo: Identificar la relación entre los métodos diagnósticos de las patologías del cuello uterino. Métodos: Se realizó un estudio observacional, descriptivo, transversal y prospectivo en el Hospital Provincial Camilo Cienfuegos de Sancti Spíritus, desde septiembre de 2015 a septiembre de 2017. Se tomó una población de 1172 pacientes de la consulta de patología de cuello uterino según los criterios de la investigación. Los métodos científicos fueron: de nivel teórico, empírico-experimental y matemático-estadístico. Se asumieron las variables: edad, factores de riesgo asociados, sintomatología, citología, colposcopia y biopsia. Resultados: El grupo de edad que con mayor frecuencia se presentó estuvo comprendido entre 26 y 35 años de edad. Los principales factores de riesgo asociados fueron: edad de inicio de las relaciones sexuales antes de los 18 años, virus del papiloma humano, paridad de más de dos hijos y antecedentes familiares de alguna patología de cuello. La sintomatología destacada fue el sangramiento poscoital e intermenstrual. Los resultados de los métodos diagnósticos fueron: virus del papiloma humano y displasia leve, tanto en la citología como en la biopsia, y lesiones de bajo grado en la colposcopia. Conclusiones: La asociación entre los métodos diagnósticos estudiados mostró una buena correlación citocolposcópica y colpohistológica, con diagnóstico de confirmación principalmente ante lesiones de alto grado(AU)


Introduction: Cervical cancer is the second most common neoplasm in women in the world. Good correlation between screening tests, diagnosis and treatment of cervical lesions optimizes management, avoiding unnecessary procedures and maximizing available resources. Objective: To identify the relationship between the diagnostic methods of cervical pathologies. Methods: An observational, descriptive, cross-sectional and prospective study was conducted at Camilo Cienfuegos Provincial Hospital in Sancti Spíritus, from September 2015 to September 2017. A population of 1172 patients was taken from the cervical pathology clinic according to the research criteria. The scientific methods were theoretical, empirical-experimental and mathematical-statistical. The assumed variables were age, associated risk factors, symptomatology, cytology, colposcopy and biopsy. Results: The age group that most frequently appeared was ages between 26 and 35 years. The main associated risk factors were age of first sexual intercourse before 18 years old, human papillomavirus, parity of more than two children and family history of some cervix pathology. The outstanding symptomatology was postcoital and intermenstrual bleeding. The results of the diagnostic methods were human papillomavirus and mild dysplasia, both in cytology and biopsy, and low-grade colposcopy lesions. Conclusions: The association between the diagnostic methods studied showed good cytocolposcopic and colpohistological correlation, with confirmation diagnosis mainly in cases of high-grade lesions(AU)


Subject(s)
Humans , Female , Adolescent , Adult , Uterine Cervical Diseases/pathology , Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy/methods , Epidemiology, Descriptive , Cross-Sectional Studies , Prospective Studies
7.
Revista Digital de Postgrado ; 8(3): e179, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1094822

ABSTRACT

Determinar la prevalencia de las lesiones intraepiteliales cervicales de bajo y alto grado en pacientes de edad fértil en la consulta de ginecología del centro Materno pediatrico Zulia, en el período comprendido febrero 2016 -febrero 2018 Maracaibo, Estado Zulia. Métodos: Se realizó un estudio descriptivo retrospectivo en el que se incluyeron mujeres entre los 15 y 44 años, que acudieron a la consulta de Ginecología obstetricia del centro materno pediátrico Zulia para el periodo comprendido febrero 2016 ­ febrero 2018. Se evaluó la normalidad de las variables cuantitativas, empleándose la mediana o el promedio con sus varianzas según su distribución, y frecuencias y proporciones para las variables categóricas. Resultados: Se incluyeron 150 pacientes. La mediana de la edad fue 29 años con rango (R: 15-43 años), la mediana del número de partos 1 (R: 0-3). Uso de métodos anticonceptivos, la mayoría utilizaba ACO. El 60% de las citologías se reportaron como negativas, 20 % lesión de bajo grado (LSIL), 10% células escamosas atípicas de significado indeterminado (ASC-US), 2% lesiones de alto grado (HSIL), 2,3% células escamosas atípicas de significado indeterminado de alto grado ASC-H, 3,3% células glandulares atípicas de significado incierto (ASGUS) y 2% carcinoma invasor. Conclusión: La prevalencia de las anormalidades citológicas fue alta en todos los grupos analizados, sin embargo, existe un mayor número de LSIL hacia la tercera década de la vida y en aquellas que iniciaron su vida sexual después de los 40 años. De igual manera se encontró una relación inversa entre el número de partos, planificación familiar hormonal y aparición de lesiones pre neoplásicas(AU)


To determine the prevalence of cervical intraepithelial lesions of low and high grade in patients of fertile age in the gynecology clinic of the Zulia maternity center, in the period February 2016-February 2018 Maracaibo, Zulia State. Methods: A retrospective descriptive study was carried out that included women between 15 and 44 years old, who attended the obstetrics gynecology clinic of the Zulia pediatric maternity center for the period February 2016-February 2018. The normality of the quantitative variables, using the median or average with their variances according to their distribution, and frequencies and proportions for the categorical variables. Results: 150 patients were included. the median age was 29 years with range (R: 15-43 years), the median number of births 1 (R: 0-3). Using contraceptive methods, most used ACO. 60% of cytologies were reportedas negative, 20% low grade lesion (LSIL), 10% atypical squamous cells of undetermined significance (ASC-US), 2% high grade lesions (HSIL), 2.3% cells Atypical squamous of indeterminate significance of high grade ASC-H, 3.3% atypical glandular cells of uncertain significance (ASGUS) and 2% invasive carcinoma. Conclusion: The prevalence of cytological abnormalities was high in all the groups analyzed, however, there is a greater number of LSIL in the third decade of life and in those who began their sexual life their 40 years. Likewise, an inverse relationship was found between the number of births, hormonal family planning and the appearance of pre-neoplastic lesions(AU)


Subject(s)
Humans , Female , Adolescent , Adult , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/epidemiology , Cervical Intraepithelial Neoplasia/diagnosis , Papillomavirus Infections/diagnosis , Biopsy/instrumentation , Biopsy/statistics & numerical data , Retrospective Studies , Colposcopy/instrumentation , Papanicolaou Test/statistics & numerical data , Squamous Intraepithelial Lesions of the Cervix/pathology
8.
Article in Portuguese | LILACS | ID: biblio-1047057

ABSTRACT

Introdução: O câncer cervical é atribuído ao papilomavírus humano (HPV) cuja infecção, na maioria das vezes, sofre regressão espontânea. A menor porção de casos que evoluem para lesão precursora de baixo e alto graus e invasora pode ter relação com uma falha na atividade das células de Langerhans em eliminar o vírus. Objetivo: Determinar se há redução do número de células de Langerhans em colos uterinos acometidos por neoplasias intraepiteliais cervicais (NIC), graus I e III, comparado ao grupo controle (cervicites crônicas), por imuno-histoquímica, possibilitando correlacionar a ação do sistema imune com o desenvolvimento dessas lesões. Método: Foram analisados 40 casos de cervicite crônica, NIC I e III, com diagnóstico anatomopatológico entre janeiro de 2014 e dezembro de 2015, buscando-se comparar a quantidade de núcleos marcados positivamente como célula de Langerhans pela proteína S-100 por imuno-histoquímica, quantificando-os em áreas padronizadas. Resultados: Dos 40 casos avaliados, 17 foram cervicite crônica, 13 NIC I e 10 NIC III. Na análise comparativa do número de células em cada grupo a média, desvio-padrão e mediana foram maiores no grupo cervicite crônica e menores no grupo NIC III. O valor de p encontrado para a variação do número de células de Langerhans, entre os grupos, foi significativo (p=0,0442); mas, ao comparar os grupos de NIC com o controle, só o grupo NIC III teve variação significativa (p=0,0209). Conclusão:Há diminuição significativa do número de núcleos de células de Langerhans marcados em lesões do tipo NIC III em comparação a cervicites crônicas.


Introduction: Cervical cancer is attributed to human papillomavirus (HPV), whose infection mostly undergoes spontaneous regression. The smaller part of cases that evolve to low and high-grade lesions or invasive lesions may be related to failure of Langerhans cell activity to eliminate the virus. Objective: To determine if there is reduction of Langerhans' cells in cervix uterus affected by cervical intraepithelial neoplasms (CIN) grades I and III compared to control group (chronic cervicitis) by immunohistochemistry, granting the correlation of the immune system action with the development of these lesions. Method: It were analyzed 40 cases of chronic cervicitis, CIN I and III with anatomopathological diagnosis between January 2014 and December 2015, attempting to compare the amount of positively labeled Langerhans cells nuclei by S-100 protein by immunohistochemistry, quantifying them in standard areas. Results: Of the 40 evaluated cases, 17 were chronic cervicitis, 13 CIN I and 10 CIN III. The comparative analysis of the number of cells in each group showed that the mean, standard deviation and median number of Langerhans cells per area were higher in the chronic cervicitis group and lower in the CIN III group. The p value found in the variation of the Langerhans cells number among the groups was significant (p=0.0442). However, when comparing the CIN groups directly with the control group, only the CIN III group had a significant variation (p=0.0209). Conclusion: There is a significant decrease in the number of marked Langerhans cell nuclei in CIN III type lesions compared to chronic cervicitis.


Introducción: El cáncer cervical puede atribuirse al virus del papiloma humano (VPH) cuya infección a menudo sufre regresión espontánea. El menor número de casos que evolucionan a lesiones precursoras de bajo y alto grado o invasivas puede estar relacionado con una falla en la actividad de las células de Langerhans para eliminar el virus. Objetivo: Determinar si hay reducción del número de células de Langerhans en colos uterinos acometidos por neoplasias intraepiteliales cervicales (NIC) grados I y III comparado al grupo control (cervicitis crónicas), por medio de inmunohistoquímica, posibilitando correlacionar la acción del sistema inmune con estas lesiones. Método: Se analizaron 40 casos de cervicitis crónica, NIC I y III, con diagnóstico anatomopatológico entre enero de 2014 y diciembre de 2015, comparando la cantidad de núcleos marcados positivamente como célula de Langerhans por la proteína S-100 por inmuno-histoquímica, cuantificándolos. Resultados: De 40 casos, 17 fueron cervicitis crónica, 13 NIC I y 10 NIC III. En el análisis comparativo del número de células en cada grupo la media, desviación estándar y mediana fueron mayores en el grupo cervicite crónica y menores en el NIC III. El valor de p encontrado para la variación del número de células de Langerhans entre los grupos fue significativo (p=0,0442), pero al comparar los grupos de NIC con el control sólo el grupo NIC III tuvo variación significativa (p=0,0209). Conclusión: Hay disminución significativa del número de núcleos marcados de células de Langerhans en lesiones de tipo CIN III en comparación con cervicitis crónica.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Langerhans Cells/pathology , Cervical Intraepithelial Neoplasia/diagnosis , Papillomaviridae , Brazil , Immunohistochemistry , Carcinoma in Situ , Uterine Cervicitis/diagnosis , Cross-Sectional Studies
9.
Salud pública Méx ; 60(6): 722-733, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-1020937

ABSTRACT

Abstract: Objective: To describe the methods of a study aimed at evaluating high risk-HPV (hrHPV)-based screening and cervical cytology as triage compared to conventional cervical cytology as primary screening in the detection of grade 2+ cervical intraepithelial neoplasia in the National Cancer Screening Program (NCSP) of Mexico. Materials and methods: We will use information originated from the Womens Cancer Information System of Mexico regarding cervical cancer from 2008 to 2018. The database includes cytology results, diagnostic confirmation by histopathology and/or treatment colposcopy. We will then carry out statistical analyses on approximately 15 million hrHPV. Results: We will evaluate the overall performance of hrHPV-based screening as part of the NCSP and compare hrHPV-based to cytology-based screening under real-life conditions. To guarantee an unbiased comparison between hrHPV with cytology triage and conventional cytology we will use propensity score matching. Conclusion: Decision makers may use our results to identify areas of opportunity for improvement in NCSP processes.


Resumen: Objetivo: Describir los métodos de un estudio que busca comparar el beneficio de la introducción de la prueba de VPH de alto riesgo como prueba primaria frente a la citología convencional para la detección de la neoplasia intraepitelial cervical grado 2 o mayor, dentro del Programa de Prevención y Control del Cáncer de la Mujer, para el periodo de 2008 a 2018. Material y métodos: Se utilizarán los registros del Sistema de Información de Cáncer de la Mujer, se realizarán los análisis estadísticos con aproximadamente 15 millones de resultados de VPH-alto riesgo, además se utilizarán los resultados de citología, colposcopia, histología y los casos referenciados al centro oncológico para tratamiento. Para comparar ambos grupos usaremos "propensity score matching". Resultados: Se evaluará el desempeño general de la prueba de VPH-alto riesgo, en condiciones reales dentro del Programa Nacional de Prevención y Control de la Mujer y su tendencia en el tiempo. Conclusiones: Los resultados de estudio ayudarán a los tomadores de decisiones a identificar áreas de oportunidad para mejorar el programa en México.


Subject(s)
Humans , Female , Adult , Middle Aged , Uterine Cervical Neoplasms/epidemiology , Databases, Factual , Cervical Intraepithelial Neoplasia/epidemiology , Papillomavirus Infections/epidemiology , Early Detection of Cancer/statistics & numerical data , Human Papillomavirus DNA Tests/statistics & numerical data , Vaginal Smears , Prevalence , Triage , Sensitivity and Specificity , Cervical Intraepithelial Neoplasia/diagnosis , Colposcopy , Age Distribution , Propensity Score , Geography, Medical , Procedures and Techniques Utilization , Mexico/epidemiology
11.
Rev. chil. obstet. ginecol. (En línea) ; 83(4): 338-351, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-978105

ABSTRACT

RESUMEN Antecedentes: Un algoritmo puede definirse como un conjunto de operaciones y procedimientos que se deben seguir con el fin de resolver un problema. Objetivo: Conocer el cumplimiento del flujo de decisiones clínicas del protocolo preconizado en los algoritmos de derivación y de confirmación diagnóstica para la citología cervical atípica de significado indeterminado - H1, estipulados en el Programa Nacional de Búsqueda y Control del Cáncer Cervical de Chile. Métodos: Estudio epidemiológico de tipo descriptivo, observacional, cuantitativo y de seguimiento de una cohorte de mujeres portadoras de un primer informe de citología cervical atípica de significado indeterminado - H1, pertenecientes a los consultorios de Atención Primaria de Salud del área Metropolitana Sur de Santiago, Chile. El seguimiento fue a través de la aplicación de los "Algoritmo de derivación a especialista o U.P.C. del primer PAP atípico según la clasificación Bethesda 2001" y "Algoritmos para confirmación diagnóstica". Resultados: Se seleccionaron 446 mujeres con un primer informe H1. El cumplimiento de conductas de acuerdo al algoritmo de derivación fue de 42.4% y las conductas alternativas fue de 5.8%. La adherencia de conducta en los algoritmos para confirmación diagnóstica fue cumplida en un 89.6%. Conclusiones: El cumplimiento de las conductas ajustadas a algoritmo de derivación del primer Pap atípico fue realizado por la mitad de las mujeres y el cumplimiento del algoritmo de confirmación diagnóstica fue realizado por la gran mayoría.


SUMMARY Background: An algorithm can be defined as a set of operations and procedures that must be followed in order to solve a problem. Objective: Determine the compliance of the clinical decisions flow and procedures recommended by the ASCUS results derivation and diagnostic confirmation algorithms established in the National Program of Search and Control of Cervical Cancer of Chile. Methods: An epidemiological, descriptive, observational and quantitative study of a follow up investigation of a cohort of women with ASCUS cytological reports. These women belonging in the health care centers in the South Metropolitan area of Santiago de Chile. The algorithms "The Specialist Derivation Algorithm or UPC for the first atypical Pap according to the Bethesda 2001 classification" and "Diagnosis Confirmation Algorithm" were used for the follow-up process of these patients. Results: Women with a first ASCUS report were selected (n = 446). The compliance of the clinical decisions flow to derivation algorithm was 42.4% and alternative behaviors were 5.8%. In the diagnosis confirmation algorithm was 89.6% the compliance the recommended procedures. Conclusion: Half ASCUS carrier women followed the procedures recommended by the derivation algorithm. In the algorithms of diagnostic confirmation it is met mostly.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Algorithms , Uterine Cervical Neoplasms/epidemiology , Papanicolaou Test/statistics & numerical data , Atypical Squamous Cells of the Cervix/pathology , Primary Health Care , Logistic Models , Uterine Cervical Neoplasms/diagnosis , Epidemiology, Descriptive , Cytological Techniques , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/epidemiology , Colposcopy , Guideline Adherence , Early Detection of Cancer , Observational Study
12.
Rev. latinoam. enferm. (Online) ; 26: e2999, 2018. graf
Article in English | LILACS, BDENF | ID: biblio-901942

ABSTRACT

ABSTRACT Objective: to develop and validate the content of a clinical protocol aimed at prevention of cervical cancer in primary care. Method: technological research according to the steps: (1) submission of the project to the research ethics committee; (2) bibliographic survey; (3) elaboration of the clinical protocol; and (4) content validation. In the third step, the information was collected through bibliographic research and gynecology specialists were consulted. For the final step, four judges were selected to evaluate the clinical protocol according to AGREE 2. Domains that reached the minimum level of agreement of 75% in the scores were considered validated. Results: the scores obtained in each domain of the instrument were as follows: domain 1 (scope and purpose) = 87.5%; domain 2 (stakeholder involvement) = 83.3%; domain 3 (development rigor) = 79.7%; domain 4 (clarity of presentation) = 76.3%; domain 5 (applicability) = 78.1%; and domain 6 (editorial independence) = 85.4. Conclusion: the clinical protocol proved to be a validated material with scores above the minimum required. The protocol obtained positive recommendations with modifications and went through adjustments in order to make it more effective.


RESUMO Objetivos: desenvolver e validar o conteúdo de um protocolo clínico direcionado à prevenção do câncer cervical na atenção primária. Método: Trata-se de uma pesquisa de desenvolvimento tecnológico em saúde(8) realizada em quatro etapas: (1) submissão do projeto ao comitê de ética em pesquisa; (2) levantamento bibliográfico; (3) elaboração do protocolo clínico; e (4) validação de conteúdo. Na terceira etapa, as informações foram levantadas mediante pesquisa bibliográfica e consultados especialistas em ginecologia. Para a etapa final, foram selecionados quatro juízes que avaliaram o protocolo clínico segundo o AGREE 2. Foram considerados validados os domínios que obtiveram nível de concordância mínimo de 75% nas pontuações. Resultados: as pontuações obtidas, em cada domínio do instrumento, foram as seguintes: domínio 1 (escopo e finalidade)=87,5%; domínio 2 (envolvimento das partes interessadas)=83,3%; domínio 3 (rigor do desenvolvimento)=79,7%; domínio 4 (clareza da apresentação)=76,3%; domínio 5 (aplicabilidade)=78,1%; e domínio 6 (independência editorial)=85,4. Conclusão: o protocolo clínico mostrou-se um material validado com pontuações superiores ao mínimo exigido. Obteve recomendações positivas com modificações e passou por ajustes a fim de torná-lo mais efetivo.


RESUMEN Objetivos: desarrollar y validar el contenido de un protocolo clínico dirigido a la prevención del cáncer cervical en atención primaria. Método: investigación tecnológica conforme a las etapas: (1) sujeción del proyecto al comité de ética en investigación; (2) levantamiento bibliográfico; (3) elaboración del protocolo clínico; y (4) validación de contenido. En la tercera etapa, las informaciones fueron levantadas mediante investigación bibliográfica y consultados especialistas en ginecología. Para la etapa final, fueron seleccionados cuatro jueces que evaluaron el protocolo clínico según el AGREE 2. Fueron considerados válidos los dominios que obtuvieron nivel de concordancia mínimo de 75% en las puntuaciones. Resultados: las puntuaciones obtenidas, en cada dominio del instrumento, fueron las siguientes: dominio 1 (alcance y finalidad) = 87,5%; dominio 2 (implicación de las partes interesadas) - 83,3%; dominio 3 (rigor del desarrollo) = 79,7%; dominio 4 (claridad de la presentación) = 76,3%; dominio 5 (aplicabilidad) = 78,1% y dominio 6 (independencia editorial) = 85,4. Conclusión: el protocolo clínico se mostró como un material válido con puntuaciones superiores al mínimo exigido. Obtuvo recomendaciones positivas con modificaciones y pasó por ajustes a fin de hacerlo más efectivo.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Uterine Cervical Neoplasms/prevention & control , Women's Health , Cervical Intraepithelial Neoplasia/diagnosis , Clinical Protocols/standards , Validation Studies as Topic
14.
Rev. chil. obstet. ginecol. (En línea) ; 82(5): 539-553, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-899940

ABSTRACT

OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.


GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Electrosurgery/methods , Biopsy , Logistic Models , Cervix Uteri/pathology , Predictive Value of Tests , Retrospective Studies , ROC Curve , Analysis of Variance , Sensitivity and Specificity , Cervical Intraepithelial Neoplasia/diagnosis , Conization , Decision Making
15.
Rev. enferm. UERJ ; 24(4): e18737, jul./ago. 2016. ilus
Article in Portuguese | LILACS, BDENF | ID: biblio-947757

ABSTRACT

Objetivos: identificar as expectativas dos enfermeiros em ensinar e aprender na consulta de enfermagem em braquiterapia ginecológica e discutir os nexos entre as intencionalidades expressas por estes profissionais. Método: estudo descritivo, embasado na Fenomenologia Sociológica e realizado no período de janeiro a maio de 2012. Os participantes foram seis enfermeiros que atuam em dois serviços de referência em radioterapia. Os dados foram obtidos por meio de entrevistas fenomenológicas. Resultados: da análise dos depoimentos emergiram duas categorias concretas do vivido: Atender à singularidade dos sujeitos no tratamento e Valorizar o cuidado técnico. Conclusão: o tipo vivido dos enfermeiros é o de profissionais com sensibilidade para adaptar o cuidado individual à tecnologia, em que o ensinar e aprender na consulta de enfermagem subsidiam o enfermeiro a compreender cada cliente com seu grau de entendimento, o que exige personalizar o atendimento, a fim de que haja qualidade de vida no tratamento.


Objectives: to identify nurses' expectations in teaching and learning in the gynecological brachytherapy nursing appointment and to discuss the links between the intentionalities expressed by these professionals. Method: this descriptive study, based on Sociological Phenomenology, was conducted from January to May 2012. The participants were six nurses working in two radiotherapy referral services. Data were obtained by phenomenological interview. Results: analysis of the declarations yielded two concrete categories of lived experience: Contemplating the uniqueness of each subject in treatment; and Giving due value to the technical care. Conclusion: the lived experience of nurses is that of professionals with the sensitivity to adapt individual care to the technology, where teaching and learning in the nursing appointment provides nurses with input to understanding each client with their own degree of understanding, which is what demands personalized care, so that there is quality of life in the treatment.


Objetivos: identificar las expectativas de los enfermeros en enseñar y aprender durante la consulta de enfermería en braquiterapia ginecológica y discutir los nexos entre las intenciones expresadas por estos profesionales. Método: estudio descriptivo, basado en la Fenomenología Sociológica y llevado a cabo de enero a mayo de 2012. Los participantes fueron seis enfermeros que trabajan en dos servicios de referencia en radioterapia. Los datos se obtuvieron a través de entrevistas fenomenológicas. Resultados: del análisis de las declaraciones emergieron dos categorías concretas de experiencias: Atender a la singularidad de los sujetos en el tratamiento y valorar el cuidado técnico. Conclusión: los enfermeros se mostraron profesionales con sensibilidad para adaptar el cuidado individual a la tecnología, en la cual el enseñar y el aprender en la consulta de enfermería subsidian al enfermero a comprender a cada cliente con su nivel de entendimiento, lo que requiere personalizar la atención para que haya calidad de vida en el tratamiento.


Subject(s)
Humans , Female , Adult , Radiotherapy , Brachytherapy/nursing , Office Nursing , Cervical Intraepithelial Neoplasia/diagnosis , Nurse's Role , Nursing Care , Uterine Cervical Neoplasms , Epidemiology, Descriptive , Nursing , Cervical Intraepithelial Neoplasia/nursing , Cervical Intraepithelial Neoplasia/drug therapy , Qualitative Research , Humanization of Assistance
16.
Salud pública Méx ; 58(2): 197-210, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-793001

ABSTRACT

Abstract Objective: This paper describes the study design and baseline characteristics of the study population, including the first 30 829 women who enrolled in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA Study). This is a large population based study that is evaluating the performance and cost-effectiveness of different triage strategies for high-risk HPV (hrHPV) positive women in Mexico. Materials and methods: The target population is more than 100 000 women aged 30 to 64 years who attend the Cervical Cancer Screening Program in 100 health centers in the state of Tlaxcala, Mexico. Since August 2013, all women in the region have been invited to enroll in the study. The study participants are evaluated to determine hrHPV infection using the Cobas 4800 HPV test. The HPV-16/18 genotyping and cytology triage strategies are performed as reflex tests in all hrHPV-positive participants. Women with a positive HPV-16/18 test and/or abnormal cytology (atypical squamous cells of undetermined significance or worse, ASCUS+) are referred for colposcopy evaluation, where a minimum of four biopsies and an endocervical sample are systematically collected. Histologic confirmation is performed by a standardized panel of pathologists. Results: Among the 30 829 women who have been screened, the overall prevalence of hrHPV is 11.0%. The overall prevalence of HPV16 and HPV18 are 1.5% and 0.7%, respectively. Cytological abnormalities (ASCUS+) were detected in 11.8% of the hrHPV-positive women. A total of 27.0% (920/3,401) of the hrHPV-positive women were referred to colposcopy because of a positive HPV16/18 test and/or abnormal reflex cytology, (31.6% had only ASCUS+, 53.6% were HPV16/18 positive with a normal cytology result, and 9.5% were positive to both triage tests). Conclusion: The results of this study will help policy makers and health service providers establish the best practices for triage in cervical cancer screening in Mexico and other countries.


Resumen Objetivo: El objetivo de este artículo es describir el diseño del estudio FRIDA y las características basales de las primeras 30 829 mujeres tamizadas. El estudio FRIDA (Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage) es un estudio de demostración con base poblacional diseñado para evaluar el desempeño y costo-efectividad de diferentes alternativas de triage en mujeres VPH de alto riesgo (VPHar) positivas bajo condiciones reales de un programa de tamizaje para cáncer cervical en México. Material y métodos: La población objetivo la conforman poco más de 100 000 mujeres de 30 a 64 años que asisten al programa de detección oportuna de cáncer cervical en alguno de los 100 centros de salud de la jurisdicción sanitaria 1 de Tlaxcala. Desde agosto de 2013, todas las mujeres son invitadas al estudio. Las participantes del estudio son tamizadas para determinar la infección con VPHar mediante la prueba VPHar Cobas 4800. Se realizan las pruebas de triage de tipificación de VPH16/18 y citología en todas las mujeres con resultados VPHar positivos. Las mujeres con un resultado positivo a VPH16/18 y/o citología anormal (células escamosas atípicas de resultado incierto o peor: ASCUS+) son referidas a evaluación colposcópica, seguida de una colección sistemática de un mínimo de cuatro biopsias cervicales y un cepillado endocervical. La confirmación histológica se lleva a cabo por un panel de patólogos. Resultados Un total de 30 829 mujeres han sido tamizadas, con una prevalencia de VPHar del 11.0%. La prevalencia global de VPH16 y VPH18 es 1.5% y 0.7%, respectivamente. Se detectó un 11.8% de anormalidades citológicas (ASCUS+). Entre las mujeres VPHar positivas, la prevalencia de un resultado de triage positivo (VPH16/18 o citología anormal) fue 27.0%, distribuido de la siguiente forma, 31.6% de éstos fueron sólo ASCUS+ VPH16/18 negativo, 53.6% fueron VPH 16/18 positivos y citología normal, y 9.5% positivos a ambas pruebas de triage. Conclusión: Los resultados de este estudio ayudarán tanto a los tomadores de decisiones como a los proveedores de servicios de salud a establecer la mejor estrategia de triage en programas de tamizaje de cáncer cervical basados en VPHar en México y en otros países.


Subject(s)
Humans , Female , Adult , Middle Aged , Preventive Health Services/organization & administration , Uterine Cervical Neoplasms/diagnosis , Triage/methods , Papillomavirus Infections/epidemiology , Early Detection of Cancer/methods , Preventive Health Services/methods , Vaginal Smears , Biopsy , Uterine Cervical Neoplasms/virology , Risk , Prevalence , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/epidemiology , Cervical Intraepithelial Neoplasia/virology , Colposcopy , Human papillomavirus 16/isolation & purification , Human papillomavirus 18/isolation & purification , Atypical Squamous Cells of the Cervix/pathology , Atypical Squamous Cells of the Cervix/virology , Mexico/epidemiology
17.
Salud pública Méx ; 58(2): 211-219, Mar.-Apr. 2016. graf
Article in English | LILACS | ID: lil-792994

ABSTRACT

Abstract Objective: To outline the design of a clinical trial to evaluate the impact of HPV vaccination as part of a hrHPV-based primary screening program to extend screening intervals. Materials and methods: A total of 18,000 women aged 25-45 years, attending the regular cervical cancer-screening program in primary health care services in Tlalpan, Mexico City, will be invited to the study. Eligible participants will be assigned to one of three comparison groups: 1) HPV16/18 vaccine and hrHPV-based screening; 2) HPV6/11/16/18 vaccine and hrHPV-based screening; 3) Control group who will receive only hrHPV-based screening. Strict surveillance of hrHPV persistent infection and occurrence of precancerous lesions will be conducted to estimate safety profiles at different screening intervals; participants will undergo diagnosis confirmation and treatment as necessary. Conclusion: The FASTER-Tlalpan Study will provide insights into new approaches of cervical cancer prevention programs. It will offer valuable information on potential benefits of combining HPV vaccination and hrHPV-based screening to safety extend screening intervals.


Resumen Objetivo: Describir los métodos de un ensayo clínico que permita evaluar el impacto de la incorporación de la vacunación contra VPH en el programa de detección oportuna de cáncer cervical con el fin de ampliar los intervalos de tamizaje. Material y métodos: Un total de 18 000 mujeres entre 25 y 45 años, usuarias del programa de detección oportuna de cáncer cervical de la Ciudad de México en Tlalpan, serán invitadas a participar en el estudio. Las mujeres elegibles serán aleatorizadas a uno de tres grupos de comparación: 1) Vacunación contra VPH16/18 y tamizaje con VPHar; 2) Vacunación contra VPH6/11/16/18 y tamizadas con VPHar; 3) Grupo control que será sólo tamizado con VPHar. Se llevará a cabo una estrecha vigilancia de la infección persistente de VPHar y de la ocurrencia de lesiones precancerosas, con el fin de estimar el perfil de seguridad de intervalos de tamizaje de distinta duración. Todas las participantes contarán con procedimientos de confirmación diagnóstica y tratamiento en caso necesario. Conclusión: El estudio FASTER-Tlalpan introducirá una nueva visión de la implementación de nuevos abordajes en la prevención de cáncer cervical. Ofrecerá información de los potenciales beneficios de la combinación de la vacunación contra VPH y el tamizaje basado en VPHar para extender los intervalos de tamizaje.


Subject(s)
Humans , Female , Adult , Middle Aged , Preventive Health Services/organization & administration , Uterine Cervical Neoplasms/prevention & control , Clinical Trials as Topic/methods , Vaccination , Papillomavirus Vaccines , Early Detection of Cancer , Program Evaluation , Cervical Intraepithelial Neoplasia/diagnosis , Human papillomavirus 11/immunology , Mexico
18.
Rev. bras. ginecol. obstet ; 38(3): 147-153, Mar. 2016. tab, graf
Article in English | LILACS | ID: lil-781448

ABSTRACT

Purpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture,made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2ş). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2ş (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening.


Objetivo Comparar a capacidade preditiva dotesteHPVcomoexame de Papanicolau para a detecção de lesões precursoras do câncer do colo do útero, em três anos de seguimento, numa população de usuárias do Sistema Único de Saúde (SUS). Métodos Estudo de coorte retrospectiva de 2.032 mulheres com resultados satisfatórios para exame de Papanicolaou e teste HPV, por captura híbrida de segunda geração, realizados em estudo prévio. Foi realizado seguimento durante 36 meses por meio da busca em prontuários, Sistema de Informação do Câncer do Colo do Útero (SISCOLO) e Sistema de Informação sobre Mortalidade (SIM). O desfecho foi o diagnóstico histopatológico de neoplasia intraepitelial cervical grau 2 ou lesão mais grave (NIC2ş). Curvas de progressão foram construídas, para o período, utilizando o método de Kaplan-Meier, com base nos resultados dos exames na entrada do estudo; e estimadas a sensibilidade, especificidade, valor preditivo positivo e negativo, e a razão de verossimilhança positiva e negativa, para cada teste. Resultados Um total de 1.440 mulheres foram submetidas a pelo menos um exame no período de seguimento. As curvas de progressão demonstraram diferenças na capacidade de predição para NIC2ş conforme os resultados dos testes (p < 0,001), sendo expressivamente maior quando ambos os exames estavam alterados, seguido de ter apenas o teste HPV positivo. O teste HPV apresentou maior sensibilidade do que o exame de Papanicolau (88,7% e 73,6%, respectivamente; p < 0,05) emelhor razão de verossimilhança negativa (0,13 e 0,30, respectivamente). Já a especificidade e a razão de verossimilhança positiva foram semelhantes. Conclusões Os resultados sinalizam a importância da inclusão do teste HPV no rastreamento primário do câncer do colo do útero.


Subject(s)
Humans , Female , Adult , Young Adult , Cervical Intraepithelial Neoplasia/diagnosis , Papanicolaou Test , Papillomavirus Infections/diagnosis , Uterine Cervical Neoplasms/diagnosis , Brazil , Cervical Intraepithelial Neoplasia/virology , Follow-Up Studies , Mass Screening , Papillomaviridae , Retrospective Studies , Sensitivity and Specificity , Uterine Cervical Neoplasms/virology , Vaginal Smears
19.
Rev. centroam. obstet. ginecol ; 21(1): 4-7, ene.-mar. 2016. tab
Article in Spanish | LILACS | ID: biblio-835854

ABSTRACT

Ojetivo: Describir las técnicas de crioterapia de simple y doble congelación, determinar la eficacia complicaciones del tratamiento en las mujeres que asisten a la consulta externa. Métodos: estudio descriptivo transversal, seleccionando 120 mujeres a conveniencia que asistieron a la consulta externa del Instituto Hondureño de Seguridad Social con diagnóstico de neoplasia intraepitelial de bajo grado. Resultados: de las 120 pacientes tratadas con crioterapia, 25 pacientes persistieron con NIC 7 de ellas tratadas con doble congelación y 16 con una sola congelación. 4 pacientes presentaron complicaciones las cuales fueron tratadas con la técnica doble...


Objective: Describe cryotherapy techniques and double freezing, determine the efficacy of treatment complications in women attending outpatient. Methods: cross-sectional study, 120 women choosing to convenience attending the outpatient Social Security Institute diagnosed with low-grade intraepithelial neoplasica. Results: Of the 120 patients treated with cryotherapy, 25 patients persisted with CIN 7 were treated with double freeze and 16 with a single freeze. 4 patients had complications which were treated with the technique with double freeze...


Subject(s)
Humans , Cryotherapy , Cryotherapy/methods , Efficacy , Cervical Intraepithelial Neoplasia/diagnosis
20.
Rev. bras. ginecol. obstet ; 38(2): 82-87, Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-775631

ABSTRACT

Objective The aim of this study was to determine the expression of the immunohistochemical markers p16 and Ki-67 in cervical intraepithelial neoplasms and their influence on the level of agreement among different observers and for the same observer. Methods The study included 184 patients with cervical intraepithelial neoplasms previously confirmed through biopsies performed between 2005 and 2006. Three pathologists reviewed the biopsies by using hematoxylin-eosin staining to reach a consensus on the diagnosis. Subsequently, an immunohistochemical study analyzed the expression of p16 and Ki-67 in such cases. Results The comparison among the reviewing pathologists revealed only moderate agreement (kappa = 0.44). The agreement improved when the differentiation of highgrade lesions (cervical intraepithelial neoplasm - CIN - 3) was analyzed (kappa = 0.59). p16 staining exhibited a high negative predictive value and sensitivity; however, the specificity was low. Overall, both qualitative and quantitative analyses of p16 and a quantitative analysis Ki-67 exhibited low accuracy. The agreement among diagnoses before immunohistochemistry was 0.47. The use of immunohistochemistry increased the agreement to 0.68. Conclusion Our study showed that the agreement among observers using traditional diagnostic criteria of cervical intraepithelial lesions can improve with the use of immunohistochemistry.


Objetivo Observar a expressão dos marcadores imuno-histoquímicos p16 e Ki-67 em neoplasias intraepiteliais cervicais e sua influência na concordância entre observadores diferentes e, entre o mesmo observador. Métodos Foram incluídas no estudo 184 pacientes com neoplasias cervicais intraepiteliais confirmadas por biópsia realizadas durante os anos de 2005 e 2006. As biópsias foram revistas, primeiramente, por três patologistas utilizando-se apenas a coloração de Hematoxilina-Eosina. Foi realizado um consenso acerca do diagnóstico. Posteriormente, foi realizado o estudo imuno-histoquímico e analisada a expressão de p16 e Ki- 67 nesses casos. Resultados A comparação entre os patologistas revisoresmostrou uma concordância apenas regular (k = 0,44. A concordância foi melhor quando analisada apenas a capacidade de diferenciar lesões de alto grau (NIC 3) (k = 0,59). A marcação de p16 mostrou alto valor preditivo negativo e sensibilidade, porém baixa especificidade. Em geral, tanto p16 qualitativo, quanto p16 quantitativo e Ki-67 quantitativo mostraram baixa acurácia geral. A concordância entre os diagnósticos antes da imuno-histoquímica obteve k = 0,47, e após o auxílio da imuno-histoquímica houve um aumento do Kappa para 0,68. A marcação de p16 mostrou alto valor preditivo negativo e sensibilidade, porém baixa especificidade. Em geral, tanto p16 qualitativo, quanto p16 quantitativo e Ki-67 quantitativo mostraram baixa acurácia geral. Conclusão Nosso estudo mostrou que a concordância no diagnóstico tradicional de lesões intraepiteliais cervicais é regular e que pode ser melhorada como o auxílio da imuno-histoquímica.


Subject(s)
Humans , Female , Adult , Cervical Intraepithelial Neoplasia/diagnosis , Ki-67 Antigen , Uterine Cervical Neoplasms/diagnosis , Cyclin-Dependent Kinase Inhibitor p16 , Immunohistochemistry , Papillomavirus Infections , Sensitivity and Specificity
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