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1.
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
2.
Rev. cuba. obstet. ginecol ; 43(4): 33-42, oct.-dic. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-901329

ABSTRACT

Introducción: el prolapso de cúpula vaginal es una complicación que afecta entre 0,2 y 2 por ciento de las pacientes con antecedente de histerectomía total. La meta principal del tratamiento quirúrgico consiste no solo en mejorar la sintomatología, sino además evitar la recurrencia. Objetivo: determinar la frecuencia de la regularidad en pacientes intervenidas mediante sacrocolpopexia laparoscópica por prolapso de cúpula vaginal poshisterectomía y su posible relación con algunas variables sociodemográficas y quirúrgicas. Métodos: se realizó un estudio observacional, descriptivo y transversal, en una serie consecutiva de 41 pacientes atendidas quirúrgicamente en el Centro Nacional de Cirugía de Mínimo Acceso de La Habana, Cuba desde el 1º de agosto de 2008 hasta el 30 de abril de 2016. Resultados: la recurrencia se presentó en cinco pacientes de la serie (12,2 por ciento) después de un tiempo medio de seguimiento de 7,3 años. En ellas fue mayor la frecuencia de comorbilidad dado por la presencia de antecedentes patológicos personales (9,8 por ciento frente a 2,4 por ciento), así como de histerectomía previa por vía convencional en relación con la laparoscópica (7,3 por ciento frente a 4,9 por ciento). Las diferencias encontradas no fueron significativas. La tasa de éxito (supervivencia libre de recurrencia) a los cinco años fue de 84,4 por ciento. Conclusiones: se presentó una baja frecuencia de recurrencia en las pacientes intervenidas sin poder establecer su posible asociación con algunas variables seleccionadas(AU)


Introduction: Vaginal vault prolapse is a complication that affects 0.2 to 2 percent of patients with a history of total hysterectomy. The main goal of surgical treatment is not only to improve symptoms, but also to avoid recurrence. Objective: To determine the frequency of regularity in patients undergoing laparoscopic Sacrocolpopexy due to prolapse of the vaginal vault and its possible relation with some sociodemographic and surgical variables. Methods: An observational, descriptive and cross-sectional study was conducted in a consecutive series of 41 patients surgically treated at the National Center for Minimally Access Surgery, Havana, Cuba from August 1, 2008 to April 30, 2016. Results: Recurrence occurred in five patients of the series (12.2 percent) after a mean follow-up time of 7.3 years. Their frequency of comorbidity was higher due to the presence of personal pathological history (9.8 percent vs. 2.4 percent) as well as previous hysterectomy by conventional route in relation to laparoscopy (7.3 percent vs. 4.9 percent). The differences found were not significant. The success rate (recurrence-free survival) at five years was 84.4 percent. Conclusions: A low frequency of recurrence in the patients who underwent surgery. It was not possible to establish their possible association with some selected variables(AU)


Subject(s)
Humans , Female , Uterine Prolapse/surgery , Uterine Prolapse/complications , Colposcopy/methods , Recurrence , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Study
3.
Rev. cuba. obstet. ginecol ; 43(4): 1-12, oct.-dic. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-901327

ABSTRACT

Introducción: las lesiones intraepiteliales cervicales son precursoras del cáncer de cuello uterino, enfermedad que causó 465 muertes en Cuba en el año 2015. Objetivo: describir la evolución de las lesiones intraepiteliales de bajo grado del cérvix durante un bienio según lo dispuesto en el Programa Nacional de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo a 79 pacientes diagnosticadas citológicamente con una lesión escamosa intraepitelial de bajo grado en el período comprendido entre el 1ro de septiembre de 2012 y el 31 de agosto de 2013 en el Hospital Materno Ramón González Coro. Seguimiento evolutivo cada seis meses durante dos años. Resultados: 54,4 por ciento tenía entre 25 y 39 años de edad. Del total, 65,8 por ciento negativizó la citología entre los 6 y 18 meses. En los dos años de evolución, 25,3 por ciento del total progresó a una lesión de alto grado. Existió buena correlación citocolposcópica en 80 por ciento de las pacientes. El cálculo de la mediana de la zona transformación atípica en las lesiones de alto grado fue de 25 por ciento, muy superior a las de bajo grado. Hubo confirmación histológica en todos los casos cuya lesión progresó. Conclusiones: las pacientes que negativizaron la citología lo hizo durante los 18 meses de seguimiento. Existió buena relación citohistológica, no así colpohistológica. La evolución no guardó relación con las variables sociodemográficas excepto con el uso de DIU. Lesiones que ocupan más del 20 por ciento de la zona de transformación se relacionó con progresión hacia una lesión escamosa intraepitelial de alto grado(AU)


Introduction: Cervical intraepithelial lesions are signs of cervical cancer, a disease that caused 465 deaths in Cuba in 2015. Objective: To describe the evolution of low-grade intraepithelial lesions of the cervix during a biennium according to the provisions of the National Program of Early Diagnosis of Cervical Cancer. Methods: A descriptive, longitudinal and prospective study was carried out on 79 patients diagnosed by cytology with a low-grade squamous intraepithelial lesion from September 1, 2012 to August 31, 2013 at Ramón González Coro Gyneco-Obstetric Hospital. These subjects received an evolutionary follow-up every six months for two years. Results: 54.4 percent were between 25 and 39 years of age; 65.8 percent had negative cytology between 6 and 18 months. In the two years of evolution, 25.3 percent of the total progressed to a high-grade lesion. There was good cytocolposcopic correlation in 80 percent of the patients. The calculation of the median of the atypical transformation zone in the high-grade lesions was 25 percent, much higher than the low-grade ones. There was histological confirmation in all cases whose lesion progressed. Conclusions: Negative cytology in our patients was assessed during the 18 months of follow-up period. There was good cytohistological relationship, but not so for colpohistological relationship. The evolution was not related to the sociodemographic variables except with the use of IUD. Lesions that occupy more than 20 percent of the transformation zone were associated with progression towards a high-grade squamous intraepithelial lesion(AU)


Subject(s)
Humans , Female , Adult , Squamous Intraepithelial Lesions of the Cervix/pathology , Squamous Intraepithelial Lesions of the Cervix/epidemiology , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Colposcopy/methods , Squamous Intraepithelial Lesions of the Cervix/diagnostic imaging
4.
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
5.
Rev. cuba. obstet. ginecol ; 43(3): 4-14, jul.-set. 2017. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-901310

ABSTRACT

Introducción: el cáncer cervicouterino es una de las amenazas más graves para la vida de las mujeres. Actualmente en el mundo lo padecen más de un millón de ellas. En Ecuador, ocupa el segundo lugar en incidencia y causa 1,2 por ciento de muertes anuales en el país. Su detección oportuna es posible gracias a la citología cervicovaginal que contribuye eficazmente a detectar lesiones precancerosas y disminuir significativamente el carcinoma del cuello uterino. El estudio de la paciente se complementa con colposcopia y toma de biopsia para aumentar la certeza diagnóstica. En algunos casos, no se ha observado una buena correlación diagnóstica. Objetivo: determinar la relación citocolpohistológica en pacientes atendidas con Papanicolaou alterado en consulta de Patología del Tracto Genital Inferior. Métodos: se revisaron 82 historias clínicas de pacientes atendidas con Papanicolaou alterado en la consulta de Patología del Tracto Genital Inferior en el Hospital Básico Píllaro de Ecuador desde abril de 2015 hasta abril de 2016. Resultados: del total de pacientes, 32,9 por ciento tenían entre 30 y 39 años de edad; 90,2 por ciento iniciaron sus relaciones sexuales durante la adolescencia. De ellas, 89 por ciento tuvo entre una y cinco parejas sexuales; 59,7 por ciento tuvo entre uno y tres partos. Existió un 21,4 por ciento de correlación cito-colposcópica en el diagnóstico de las lesiones intraepiteliales de bajo grado. La relación colpo-histológica mostró un 87,5 por ciento de coincidencias en las lesiones intraepiteliales de bajo grado y en las lesiones intraepiteliales de alto grado un 71,4 por ciento. Conclusiones: el inicio precoz de la actividad sexual, las múltiples parejas sexuales y la multiparidad continúan resaltando en la aparición de las lesiones premalignas del cuello uterino(AU)


Introduction: Cervical cancer is one of the most serious threats to the lives of women. In the world today, more than a million of them suffer from it. In Ecuador, it ranks second in incidence and causes 1.2 percent of annual deaths in the country. Its timely detection is possible thanks to cervicovaginal cytology that contributes effectively to detecting precancerous lesions and significantly decreasing carcinoma of the cervix. The patient's study is complemented by colposcopy and biopsy to increase diagnostic certainty even when good diagnostic correlation has not been observed in some cases. Objective: Determine the cyto-colpo-histological relationship in patients treated due to altered Papanicolaou, in consultation of Pathology of the Lower Genital Tract in Píllaro Basic Hospital. Ecuador. Methods: In the present study, we reviewed 82 clinical records of patients treated with altered Papanicolaou in the Lower Genital Tract Pathology consultation at the Píllaro Basic Hospital, Ecuador from April 2015 to April 2016. Results: 32.9 percent of patients aged 30 to 39 years; 90.2 percent started sexual intercourse throughout adolescence. 89 percent had one to five sexual partners. 59.7 percent had one to three deliveries. There was 21.4 percent cyto-colposcopic correlation in the diagnosis of low-grade intraepithelial lesions (LSIL). The colpo-histological relationship showed 87.5 percent of coincidences in the LSIL and 71.4 percent. showed high-grade intraepithelial lesions (HSIL)(AU)


Subject(s)
Humans , Female , Adult , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/diagnostic imaging , Colposcopy/methods , Precancerous Conditions/pathology , Epidemiology, Descriptive , Retrospective Studies , Histocytological Preparation Techniques/methods , Ecuador , Papanicolaou Test/methods
7.
Rev. cuba. obstet. ginecol ; 43(1): 0-0, ene.-mar. 2017.
Article in Spanish | LILACS, CUMED | ID: biblio-901281

ABSTRACT

Introducción: la infección persistente por los subtipos oncogénicos del virus del papiloma humano es la causa principal del desarrollo del cáncer cérvico-uterino. Las mujeres que presentan citología normal pueden estar infectadas por subtipos de alto riesgo carcinogénico. Objetivo: brindar información actualizada existente en la literatura científica internacional acerca de la prevalencia de la infección por el virus del papiloma humano a nivel mundial y de la importancia de la detección temprana de estos virus en mujeres con citología negativa. Método: se realizó una revisión de los estudios desarrollados a nivel global y para esto se utilizaron las bases de datos PubMed, MedLine, BioMed Central y SciELO. Resultados: la prevalencia de la infección por los subtipos de alto riesgo del virus del papiloma humano en las mujeres con citología normal fue del 10 - 12 por ciento, con algunas diferencias entre países. El mayor pico de frecuencia de esta infección viral se localizó en jóvenes menores de 25 años y, en algunas regiones geográficas, se observó un segundo pico en mayores de 49 años. Los cinco subtipos oncogénicos más frecuentes de estos virus fueron 16, 18, 31, 52 y 58 con ciertas variaciones a nivel global. Conclusiones: el diagnóstico precoz de la infección por el virus del papiloma humano, especialmente los genotipos de alto riesgo, es un factor importante para una mejor prevención del cáncer cérvico-uterino(AU)


Introduction: Persistent infection with the oncogenic subtypes of human papillomavirus is the leading cause of cervical cancer. Women with normal cytology may be infected with subtypes of high carcinogenic risk. Objective: Provide updated information on the prevalence of human papillomavirus infection worldwide and the importance of their early detection in women with negative cytology. Methods: A review of the studies developed at a global level was carried out and PubMed, MedLine, BioMed Central, and SciELO databases were used. Results: The prevalence of infection with high - risk subtypes of human papillomavirus in women with normal cytology was 10 - 12 percent, with some differences between countries. The highest peak of frequency of this viral infection was located in young women under 25 years old and, in some geographic regions a second peak could be observed in those older than 49 years. The five most frequent oncogenic subtypes of these viruses were 16, 18, 31, 52 and 58 with certain variations globally. Conclusions: Early diagnosis of human papillomavirus infection, especially high-risk genotypes, is an important factor for better prevention of cervical-uterine cancer(AU)


Subject(s)
Humans , Female , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Early Diagnosis , Cytological Techniques/methods , Outcome Assessment, Health Care , Colposcopy/methods , Papanicolaou Test/methods
8.
Rev. centroam. obstet. ginecol ; 21(3): 59-65, jul.-sept. 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-869639

ABSTRACT

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...


Subject(s)
Humans , Female , Colposcopy/methods , Conization/methods , Cervix Uteri/cytology , Neoplasms/diagnosis
10.
Rev. chil. obstet. ginecol ; 80(3): 215-220, jun. 2015. ilus
Article in Spanish | LILACS | ID: lil-752870

ABSTRACT

INTRODUCCIÓN: La colposacropexia por vía abdominal abierta (CSPA) es el gold standard para el tratamiento del prolapso de la cúpula vaginal (PCV). OBJETIVO: Mostrar nuestra experiencia, en un Hospital de mediana complejidad, en los primeros siete casos sometidos a un CSPA, reportando las complicaciones intra y post operatorias. MÉTODO: Se realizó un estudio prospectivo descriptivo en nuestras siete primeras pacientes portadoras de un prolapso de cúpula vaginal estadio III o IV (POP-Q) sintomáticas, sin incontinencia urinaria y sometidas a una CSPA, con una malla mixta en el Servicio de Obstetricia y Ginecología del Hospital de Quilpué. RESULTADOS: Se reclutaron 7 pacientes. Ninguna de ellas presentaba complicaciones con riesgo vital peri-operatorio, en un período de seguimiento de 33 meses. En el 100% de las pacientes se logró cura objetiva definida como un POP-Q estadio 0 o I, y buena calidad de vida según el Cuestionario de Impacto del Piso Pélvico (PFIQ-7, versión validada en español). Durante el seguimiento, sólo una paciente presentó exposición asintomática de 5 mm de la malla, resuelta con su resección por vía vaginal. Ninguna paciente requirió de una cirugía por prolapso de órganos pélvicos después de la CSPA. CONCLUSIÓN: Los resultados obtenidos concuerdan con la literatura. La CSPA sigue siendo el gold standard para el tratamiento del PCV, no siendo superada por el momento, por ninguna otra técnica, incluso la colposacropexia laparoscópica. Estimamos que el uso de mallas parcialmente reabsorbibles pueden disminuir la exposición de mallas, sin embargo se requieren de más estudios.


INTRODUCTION: The abdominal sacral-colpopexy is currently considered the gold standard for the management of (CSPA) vaginal vault prolapse (PCV). OBJECTIVE: To report our surgical experience at a county hospital with our first seven abdominal sacral-colpopexy cases. Reporting intra and post-operative complications. METHODS: We conducted a prospective descriptive study involving our first seven cases of patients with symptomatic vaginal vault prolapse stage III or IV (POP-Q) without urinary incontinence. All patients were undergoing CSPA with a partially absorbable mesh in the Obstetrics and Gynecology Department at the Quilpué Hospital. RESULTS: Seven patients were recruited. None of them presented a life threatening complication during a mean follow up period of 33 months. A hundred percent of patients achieved objetive cure defined as POP-Q stage 0 or I and subjective cure defined as a significant improvement in a validated questionnaire (PFIQ-7 spanish version). During patients follow up, only one patient had an asymptomatic 5 mm mesh exposure, resolved with a vaginal resection. None of the patients required surgery for pelvic organ prolapse after the CSPA. CONCLUSION: These results are in agreement with the international literature. The CSPA continues to be the gold standard for the PCV treatment of vaginal vault prolapse and has not been surpassed by either vaginal technique or the laparoscopic sacral-colpopexy. We believe that the use of partially reabsorbable meshes can decrease the rate of mesh exposure, however further studies are required.


Subject(s)
Humans , Female , Middle Aged , Surgical Mesh , Colposcopy/methods , Pelvic Organ Prolapse/surgery , Polypropylenes , Quality of Life , Sacrum/surgery , Vagina , Prospective Studies , Surveys and Questionnaires , Treatment Outcome , Colpotomy , Abdomen/surgery
11.
Einstein (Säo Paulo) ; 13(1): 52-57, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-745875

ABSTRACT

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age. .


Objetivo Analisar a ocorrência de atipias nos exames citológicos e histológicos de jovens e idosas indígenas, e também avaliar se a faixa etária preconizada pelo Ministério da Saúde e pelo Instituto Nacional de Câncer em rastreamento do câncer de colo uterino é adequada para essa população. Métodos O Projeto Xingu/UNIFESP, em parceria com o Núcleo de Prevenção de Doenças Ginecológicas, desenvolve programas de prevenção do câncer do colo de útero. Foi realizado estudo exploratório, retrospectivo e descritivo de exames cito/histopatológicos em jovens do Parque Indígena do Xingu de 12 a 24 anos e em idosas a partir dos 64 anos, no período de 2005 a 2011. Resultados Em idosas, houve baixa ocorrência de atipias citológicas, mas nas jovens indígenas, ocorreram casos eventuais de lesão de alto grau. Conclusão Justifica respeitar o limite de 64 anos para a interrupção do rastreamento, como o estabelecido pelo Ministério da Saúde/Instituto Nacional de Câncer, mas, nas jovens, seria importante iniciar o rastreamento mais precocemente. .


Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Young Adult , Carcinoma/pathology , Mass Screening/methods , Population Groups , Uterine Cervical Neoplasms/pathology , Age Distribution , Age Factors , Brazil/epidemiology , Carcinoma/epidemiology , Colposcopy/methods , Early Detection of Cancer , Retrospective Studies , Risk Factors , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears , Vaginal Neoplasms/epidemiology , Vaginal Neoplasms/pathology
13.
Article in English | WPRIM | ID: wpr-202223

ABSTRACT

OBJECTIVE: This study was performed to evaluate the clinical performance of APTIMA human papillomavirus (AHPV) assay and Hybrid Capture 2 (HC2) assay in screening for cervical disease, especially in women with atypical squamous cell of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). METHODS: A total of 411 women diagnosed with ASC-US or LSIL were referred and further triaged by HC2 test. Prior to colposcopy, liquid-based cytology specimens were collected for the AHPV assay. Sensitivity and specificity were established based on the histological findings of cervical intraepithelial neoplasia (CIN). RESULTS: In all 411 subjects, the positive detection rate of AHPV assay was 70.8% (95% confidence interval [CI], 66.4 to 75.2), which was significantly lower than the positive detection rate of 94.9% obtained using HC2 test (95% CI, 92.3 to 96.8). Only one CIN 3-positive case was detected among the 120 AHPV-negative women, which was then confirmed by Pap smear test to be LSIL. The sensitivities of AHPV and HC2 for CIN 3 were similar (94.1% and 100%, respectively). However, AHPV showed a significantly higher specificity than HC2 test (30.2% and 5.3%, respectively; p<0.001). CONCLUSION: AHPV assay is effective in identifying CIN 3-positive cases because of its high specificity and lower false-negative rate. The use of AHPV for the triage of ASC-US and LSIL might help to reduce the referral rate of colposcopy during cervical cancer screening.


Subject(s)
Adult , Aged , Cervical Intraepithelial Neoplasia/diagnosis , China/epidemiology , Colposcopy/methods , Early Detection of Cancer/methods , False Negative Reactions , Female , Human Papillomavirus DNA Tests/methods , Humans , Middle Aged , Papillomavirus Infections/complications , Prevalence , Sensitivity and Specificity , Triage , Uterine Cervical Neoplasms/diagnosis , Young Adult
14.
Säo Paulo med. j ; 131(6): 405-410, 2013. tab, graf
Article in English | LILACS | ID: lil-697417

ABSTRACT

CONTEXT AND OBJECTIVE: Human immunodeficiency virus (HIV)-infected women have higher incidence, prevalence, persistence and recurrence of pre-invasive cervical lesions (CIN II or III). The aim here was to investigate the risk of recurrence of CIN II/III among HIV-infected women (HIV+) and uninfected women in a cohort treated by means of large-loop excision of the transformation zone (LLETZ). DESIGN AND SETTING: Cohort study conducted at Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz). METHODS: 60 HIV+ and 209 HIV-negative patients were included in a cohort for follow-up after undergoing LLETZ to treat CIN II/III. A histopathological diagnosis of CIN II/III during the follow-up was taken to constitute recurrence. The following possible confounding variables were assessed: age at treatment and at end of follow-up; histological grade of intraepithelial disease treated; surgical margin involvement; adequacy of colposcopy during the follow-up; CD4+ lymphocyte count; HIV viral load; and type of antiretroviral therapy. RESULTS: Among the 60 HIV+ women, six showed recurrent disease during the follow-up. However, among the 209 HIV-negative women, seven showed a new precursor lesion. The relative risk of disease recurrence in the HIV+ women was 4.21 (95% CI = 1.42 to 12.43). The Kaplan-Meyer curve showed that the risk of recurrence was significantly higher among HIV+ women (log-rank test: P = 0.0111). CONCLUSION: The HIV+ women in our cohort presented a risk of CIN II/III recurrence at least 42% higher than among the HIV-negative women. These patients should form part of a rigorous screening and follow-up protocol for identification and appropriate treatment of cervical cancer precursor lesions. .


CONTEXTO E OBJETIVOS: Mulheres infectadas pelo vírus da imunodeficiência humana (HIV) apresentam maior incidência, prevalência, persistência e recorrência após tratamentos de lesões pré-invasivas do colo uterino (NIC II ou III). O objetivo foi verificar o risco de recorrência de NIC II/III em mulheres infectadas pelo HIV (HIV+) e não infectadas (HIV-) em uma coorte tratada pela exérese eletrocirúrgica da zona de transformação do colo uterino (EZT). TIPO DE ESTUDO E LOCAL: Estudo de tipo coorte realizado no Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz). MÉTODOS: 60 HIV+ e 209 HIV- foram incluídas em uma coorte após terem sido submetidas à EZT para tratamento de NIC II/III. Foi considerado como recorrência o diagnóstico histopatológico de NIC II/III. Foram estudadas as seguintes variáveis possivelmente confundidoras: idade no tratamento e ao final do seguimento, grau histológico da doença intra-epitelial tratada, comprometimento de margens, adequação da colposcopia no seguimento, contagem de linfócitos CD4+, carga viral de HIV e tipo de terapia antiretroviral. RESULTADOS: Dentre as 60 mulheres HIV+, 6 apresentaram doença recorrente durante o seguimento. De 209 HIV-, 7 apresentaram uma nova lesão precursora. O risco relativo de recorrência de doença nas HIV+ foi de 4,21 (IC 95% 1,42-12,43). Uma curva de Kaplan-Meyer mostra que o risco de recorrência é significativamente maior em mulheres HIV+ (teste de log-rank: P = 0,0111). CONCLUSÃO: Mulheres HIV+ em nossa coorte apresentaram risco de recorrência pelo menos 42% maior do que mulheres HIV-. Essas pacientes devem fazer parte de um protocolo de rastreio e acompanhamento rigoroso para identificação e tratamento adequado das lesões precursoras do câncer ...


Subject(s)
Adult , Female , Humans , Acquired Immunodeficiency Syndrome/complications , Cervical Intraepithelial Neoplasia/surgery , Electrosurgery/methods , Neoplasm Recurrence, Local , Uterine Cervical Neoplasms/surgery , Antiretroviral Therapy, Highly Active , Acquired Immunodeficiency Syndrome/drug therapy , Brazil/epidemiology , Cohort Studies , Colposcopy/methods , Follow-Up Studies , Incidence , Kaplan-Meier Estimate , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
15.
Einstein (Säo Paulo) ; 10(4): 466-472, Oct.-Dec. 2012. ilus, tab
Article in English | LILACS | ID: lil-662473

ABSTRACT

OBJECTIVE: To compare two oncotic cervical cytology techniques, the conventional and the liquid-based cytology, in low risk patients for uterine cervical cancer. METHODS: Comparative prospective study with 100 patients who came to their annual gynecological exam, and were submitted simultaneously to both techniques. We used the McNemar test, with a significance level of p<0.05 to compare the results obtained related to adequacy of the smear quality, descriptive diagnosis prevalence, guided biopsy confirmation and histology. RESULTS: Adequacy of the smear was similar for both methods. The quality with squamocolumnar junction in 93% of conventional cytology and in 84% of the liquid-based cytology had statistical significance. As for the diagnosis of atypical cells they were detected in 3% of conventional cytology and in 10% of liquidbased cytology (p=0.06). Atypical squamous cells of undetermined significance were the most prevalent abnormality. The liquid-based cytology performance was better when compared with colposcopy (guided biopsy), presenting sensitivity of 66.7% and specificity of 100%. There was no cytological and histological concordance for the conventional cytology. CONCLUSIONS: Liquid-based cytology had a better performance to diagnose atypical cells and the cytohistological concordance was higher than in the conventional cytology.


OBJETIVO: Comparar duas técnicas de colpocitologia oncótica, a convencional e a em meio líquido, em pacientes de baixo risco para carcinoma de colo uterino. MÉTODOS: Trata-se de estudo prospectivo e comparativo, em que foram avaliadas cem mulheres que compareceram à consulta médica de rotina e foram submetidas simultaneamente à coleta pelas duas técnicas de citologia. Os resultados obtidos em relação à adequabilidade, à qualidade dos esfregaços, à prevalência nos diagnósticos descritivos e à confirmação com biópsia dirigida e histologia foram comparados pelo teste de McNemar, com nível de significância de p<0,05. RESULTADOS: A adequabilidade dos esfregaços mostrou-se semelhante. A qualidade, com presença de elementos da junção escamo-colunar em 93% das citologias convencionais e 84% das citologias em meio líquido, teve significância estatística. Nos diagnósticos de atipias, elas foram detectadas em 3% das citologias convencionais e em 10% das citologias em meio líquido (p=0,06), sendo as atipias em células escamosas de significado indeterminado a alteração mais prevalente. Quando comparadas à colposcopia com biópsia dirigida, o desempenho da citologia em meio líquido foi superior, com sensibilidade de 66,7% e especificidade de 100%, enquanto que, para a citologia convencional, não houve concordância cito-histológica. CONCLUSÃO: O desempenho em diagnosticar atipias e a concordância cito-histológica da citologia em meio líquido foram superiores ao da citologia convencional.


Subject(s)
Female , Humans , Cervix Uteri/pathology , Colposcopy/methods , Uterine Cervical Neoplasms/pathology , Vagina/pathology , Vaginal Neoplasms/pathology , Vaginal Smears/methods , Prospective Studies , Sensitivity and Specificity
16.
Rev. obstet. ginecol. Venezuela ; 72(3): 161-170, sep. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-664612

ABSTRACT

Evaluar la citología y la colposcopia como métodos diagnósticos de patología vaginal. Estudio prospectivo y descriptivo que incluyó 100 pacientes. Se realizó citología, colposcopia y biopsia dirigida o del tercio superior de vagina, cuando no había lesiones. La edad media de las pacientes fue 37,7 años. Hubo patología vaginal en 81 pacientes: 19 (23,4. por ciento) neoplasias intraepiteliales vaginales I y 62 (76,5 por ciento) lesiones no neoplásicas, entre ellas 47 (75,8. por ciento) con infección por virus de papiloma humano y 15 (24,2 por ciento) con otras lesiones. Entre las 37 pacientes con cambios colposcópicos, 56,8 por ciento tenían epitelio acetoblanco fino, 45,9 por ciento de los cambios estaban en el tercio superior. Hubo 5 casos de lesiones multifocales. Dos citologías presentaron cambios por virus de papiloma humano. En 66 pacientes hubo cambios histológicos compatibles con infección por este virus, 19 con neoplasia. La sensibilidad y especificidad de la citología para lesiones neoplásicas intraepiteliales fue 0 por ciento y 100 por ciento, de la colposcopia 47 por ciento y 78 por ciento y de ambos 75 por ciento y 16 por ciento, respectivamente. Los factores de riesgo significativos para infección por virus de papiloma humano y neoplasia intraepitelial fueron: edad, patología cervical y vulvar previa, uso de anticonceptivos orales y tabaquismo. Existe asociación significativa entre patología cervical o vulvar y el diagnóstico de infección por virus de papiloma humano en vagina. La citología no debe ser usada aisladamente como método de pesquisa de lesiones neoplásicas de la vagina; se recomienda asociarla a la colposcopia vaginal


To evaluate the colposcopy and cytology as vaginal pathology diagnostic methods. Prospective and descriptive study involving 100 patients. Cytology, colposcopy and directed biopsy, or in the upper vagina third when there was no injuries, was conducted. The average age of the patients was 37.7 years. There was vaginal pathology in 81 patients: 19 (23.4 percent) vaginal intraepithelial neoplasia I and 62 (76.5 percent) injuries non neoplastic, including 47 (75.8. percent) with infection by human papillomavirus and 15 (24.2 percent) with other injuries. Among the 37 patients with colposcopy changes, 56.8 percent had fine acetoblanco epithelium, 45.9 percent of the changes were in the upper third. There were 5 cases of multifocal lesions. Two PAP submitted changes for human papillomavirus. In 66 patients there were histological changes consistent with infection by this virus, 19 with neoplasia. The sensitivity and specificity of cytology for intraepithelial neoplastic lesions was 0 percent and 100 percent, for the colposcopy 47 per cent and 78 per cent, and for both methods, 75 percent and 16 percent, respectively. Significant risk factors for infection of human papillomavirus and intraepithelial neoplasia were: age, prior cervical and vulvar disease, use of oral contraceptives and smoking. There is significant association between cervical or vulvar pathology and the diagnosis of infection of human papillomavirus in vagina. Cytology should not be used alone as a method of investigation of neoplastic lesions of the vagina; It is recommended to associate it with the vaginal colposcopy


Subject(s)
Humans , Adult , Female , Colposcopy/methods , Vaginal Diseases/diagnosis , Vaginal Diseases/pathology , Cytological Techniques/methods , Gynecology
17.
Rev. cuba. obstet. ginecol ; 38(1): 93-98, ene.-mar. 2012.
Article in Spanish | LILACS | ID: lil-617289

ABSTRACT

Introducción: la deciduosis representa el cuadro colposcópico más peculiar del embarazo. El término indica una ectopia decidual Objetivo: presentar el caso clínico de una gestante con una lesión cervical que resultó una deciduosis tipo ulcerada. Resultados: mediante la colposcopia y posteriormente una biopsia por ponchamiento se confirmó el diagnóstico de deciduosis tipo ulcerada en gestante de 22,5 sem. Conclusiones: ante toda gestante con una lesión cervical sospechosa o no de malignidad, se puede utilizar la colposcopia como método diagnóstico, realizada por un personal entrenado y biopsia dirigida según el caso en particular


Introduction: The deciduosis is the more typical colposcopy picture of pregnancy. This term indicates a decidual ectopia. Objective: To present the clinical case of a pregnant presenting with a cervical lesion led to an ulcerated deciduosis. Results: By means of a colposcopy and later by a punch biopsy the diagnosis of ulcerated deciduosis was confirmed in a pregnant of 22.5 weeks. Conclusions: In front of that each pregnant with a cervical lesion suspected or not of malignancy, the colposcopy could be used as a diagnostic method provided that is performed by trained staff and a biopsy directed according to the case in particular


Subject(s)
Humans , Female , Pregnancy , Adolescent , Colposcopy/methods , Cervix Uteri/pathology , Uterine Cervical Diseases/pathology , Biopsy/methods
18.
Rev. centroam. obstet. ginecol ; 17(1): 25-30, ene.-mar. 2012. ilus
Article in Spanish | LILACS | ID: lil-734042

ABSTRACT

El presente artículo tiene como objetivos capacitar al ginecólogo en el correcto manejo de la citología anormal en situaciones especiales y en el tratamiento de la Neoplasia Intra-epitelial Cervical. Destaca las limitaciones de la Colposcopía, el buen uso de la cirugía con ondas de radio, la utilidad de la prueba de VPH y la importancia de promover la vacunación. Orienta al ginecólogo en el adecuado diagnóstico del carcinoma in situ escamoso y glandular...


Subject(s)
Female , Colposcopy/methods , Colposcopy , Papilloma/diagnosis , Papilloma/prevention & control
19.
Femina ; 40(1)jan.-fev. 2012. tab, ilus
Article in Portuguese | LILACS | ID: lil-652200

ABSTRACT

O diagnóstico precoce e o rastreamento das lesões precursoras do câncer do colo uterino são de extrema importância. O diagnóstico citológico ainda é a principal ferramenta para a prevenção. O uso de testes para detectar o DNA-HPV associado à citologia tem sido proposto, visto que existem evidências epidemiológicas de que o papilomavírus humanos (HPV) é causa necessária para a ocorrência do câncer cervical. De acordo com a classificação de Bethesda 2001, células escamosas atípicas (ASC) são alterações citológicas sugestivas de lesão intraepitelial, qualitativa ou quantitativamente insuficientes para uma interpretação definitiva. Elas são subdivididas em ASC-US (células escamosas atípicas de significado indeterminado possivelmente não neoplásicas) e ASC-H (células escamosas atípicas não sendo possível excluir lesão intraepitelial de alto grau). O seguimento ideal para mulheres com diagnóstico de ASC é controverso e existem dúvidas sobre como realizá-lo, bem como qual o tratamento mais apropriado. O objetivo desta revisão consiste em avaliar o seguimento e tratamento das mulheres com diagnóstico citológico de ASC. Foi realizada revisão da literatura de estudos indexados em banco de dados como MEDLINE, PubMed e LILACS.


Early diagnosis and screening of precursor lesions of cervical cancer are extremely important. The cytological diagnosis is still the main tool to prevention. The use of tests to detect DNA-HPV combined with cytology has been proposed, since there are epidemiological evidences that human papillomavirus (HPV) is a necessary cause for the occurrence of cervical cancer. According to the 2001 Bethesda classification atypical squamous cells (ASC), there are cytological changes suggestive of squamous intraepithelial lesion that are qualitatively or quantitatively insufficient for a definitive interpretation. It is subdivided into ASC-US (atypical squamous cells of undetermined significance may not neoplastic) and ASC-H (atypical squamous cells is not possible to exclude high-grade intraepithelial lesion). The ideal follow-up for women diagnosed with ASC is controversial and there are doubts about how to accomplish it and the most appropriate treatment. The objective of this review is to evaluate the monitoring and treatment of women with cytological diagnosis of ASC. We performed a literature review of studies indexed in databases such as MEDLINE, PubMed and LILACS.


Subject(s)
Humans , Female , Carcinoma, Squamous Cell/pathology , Cervical Intraepithelial Neoplasia/diagnosis , Cervical Intraepithelial Neoplasia/pathology , Uterine Cervical Neoplasms/pathology , Cytodiagnosis , Colposcopy/methods , DNA, Viral/analysis , Early Diagnosis , Papillomavirus Infections/diagnosis , Mass Screening , Papillomaviridae/isolation & purification , DNA Probes, HPV/economics , Cytological Techniques/methods
20.
Säo Paulo med. j ; 130(2): 92-96, 2012. tab
Article in English | LILACS | ID: lil-625335

ABSTRACT

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.


CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp). MÉTODOS: Foram revisados prontuários e laudos histopatológicos de 118 mulheres que foram submetidas a conização por cirurgia de alta frequência no período de 1999 a 2007. Idade, número de fragmentos, grau da lesão, grau de artefatos térmicos e qualidade das margens foram avaliados. RESULTADOS: A idade média das pacientes foi de 27,14 anos; 63,6% tinham diagnóstico de NIC II e 36,4% de NIC III. A lesão foi retirada com um fragmento em 79,6%. As margens estavam livres de neoplasia em 85,6% e comprometidas na margem endocervical em 6,8%. Fragmentos prejudicados por artefatos ocorreram em 2,5%. Artefatos de grau severo ocorreram em 22,8%. Mulheres com idade igual ou superior a 30 anos apresentaram mais casos de NIC III (P < 0,0004). O comprometimento neoplásico de margens cirúrgicas e artefatos de grau severo ocorreram mais vezes nos casos em que foram retirados dois ou mais fragmentos e em pacientes com idade igual ou superior a 30 anos. CONCLUSÃO: NIC III em mulheres com idade superior a 30 anos, quando retiradas em dois ou mais fragmentos na CAF, apresentaram maior número de margens comprometidas e grau severo de artefatos térmicos.


Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Artifacts , Conization , Cervical Intraepithelial Neoplasia/surgery , Cervix Uteri/pathology , Uterine Cervical Neoplasms/surgery , Age Factors , Cross-Sectional Studies , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Electrosurgery/adverse effects , Electrosurgery/methods , Retrospective Studies , Treatment Outcome , Uterine Cervical Neoplasms/pathology
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