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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.
Rev. Assoc. Méd. Rio Gd. do Sul ; 65(3): 01022105, Jul-Set 2021.
Article in Portuguese | LILACS | ID: biblio-1369368

ABSTRACT

RESUMO Objetivo: Realizar uma breve revisão bibliográfica que mostre as mais recentes evidências científicas que permitam determinar se há benefícios em vacinar contra o HPV (Papilomavírus Humano) mulheres que já realizaram conização para tratamento de lesões pré- -malignas do colo do útero. Método: Foram revisados 5 artigos atualizados e específicos ao tópico, além de estudos em outras fontes bibliográficas. Resultados: Todos os artigos estudados revelaram forte fator protetivo da vacina em relação à recorrências de apresentação da patologia. Conclusão: Nossa revisão não indicou efeito terapêutico próprio da vacinação, mas indicou que há papel adjuvante ao tratamento cirúrgico, sendo uma associação em favor da proteção da mulher já tratada para a patologia relacionada ao HPV. PALAVRA-CHAVE: Conização, vacina, HPV, NIC, LEEP


ABSTRACT Objective: To carry out a brief literature review showing the latest scientific evidence to determine whether women who have already undergone conization for the treatment of pre-malignant lesions of the cervix are benefited from the vaccine against HPV (Human Papillomavirus). Method: Five updated and topic-specific articles were reviewed, as well as studies in other bibliographic sources. Results: All articles studied revealed a strong protective factor of the vaccine in relation to recurrent presentation of the pathology. Conclusion: Our review did not indicate a therapeutic effect of vaccination itself, but it indicated that there is an adjuvant role to surgical treatment, being a combination in favor of protecting women who have already been treated for HPVrelated pathology. KEYWORDS: Conization, vaccine, HPC, CIN, LEEP


Subject(s)
Humans , Female , Papillomaviridae , Vaccines , Conization
3.
Femina ; 49(7): 425-432, 20210731. ilus
Article in Portuguese | LILACS | ID: biblio-1290592

ABSTRACT

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)


Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)


Subject(s)
Humans , Female , Uterine Cervical Neoplasms/pathology , Cervix Uteri/surgery , Carcinoma, Endometrioid/pathology , Conization , Adenocarcinoma in Situ/surgery , Adenocarcinoma in Situ/pathology , Colposcopy , Cytodiagnosis/methods
4.
Rev. bras. ginecol. obstet ; 42(5): 266-271, May 2020. graf
Article in English | LILACS | ID: biblio-1137827

ABSTRACT

Abstract Objective To observe if the histopathological result of a conization performed after cervical adenocarcinoma in situ diagnosis is compatible with the histopathological analysis of a subsequent hysterectomy. Methods The present descriptive and observational research consisted of the analysis of the medical records of 42 patients who were diagnosed with in situ adenocarcinoma postconization. The analysis consisted of whether there was compatibility between the histopathological reports of conization and hysterectomy and if there was an association between adenocarcinoma in situ and another neoplasia (squamous disease). Interpretation of any immunohistochemistry reports obtained was also performed. In addition, clinical and epidemiological data were also analyzed. Results A total of 42 conizations were performed, 33 (79%) were cold knife conizations and 9 (21%) were loop electrosurgical excision procedures (LEEPs). Of the patients analyzed, 5 (10%) chose not to undergo subsequent hysterectomy to preserve fertility or were < 25 years old. Out of the 37 patients with adenocarcinoma in situ who underwent subsequent hysterectomy, 6 (16%) presented with residual disease. This findingprovedincompatiblewiththe finding of the conizations, which had ruled out invasive cancer. Conclusion The prevalence of adenocarcinoma in situ increased in the past years. There is still a large part of the medical literature that advocates the use of conservative treatment for this disease, even though it is common knowledge that it is a multifocal disease. However, the majority of studies advocate that hysterectomy should remain the preferred treatment for women who have already completed their reproductive purpose.


Resumo Objetivo Observar se o resultado proveniente de uma conização realizada após o diagnóstico de adenocarcinoma cervical in situ é compatível com a análise histopatológica da histerectomia. Métodos A pesquisa foi descritiva e observacional e consistiu na análise de prontuário de 42 pacientes que tiveram o diagnóstico de adenocarcinoma in situ obtidas por conização. Foram analisados se havia compatibilidade entre os laudos de conização e histerectomia, margens do cone, se havia associação com outra patologia (doença escamosa) e interpretação de eventuais laudos histoquímicos obtidos. Além disso, também foram analisados dados clínico-epidemiológicos. Resultados Foram realizadas 42 conizações, sendo 33 (79%) por cone clássico e 9 (21%) por cirurgia de alta frequência. Das pacientes analisadas, 5 (10%) não foram submetidas a histerectomia por desejarem manter a fertilidade ou por terem idade < 25 anos. Das 37 pacientes com adenocarcinoma in situ no exame prévio realizado e que foram submetidas à histerectomia posteriormente, 6 (16%) apresentaram doença residual após o procedimento cirúrgico, apresentando laudos do anatomopatológico pós-histerectomia incompatíveis com o achado na conização que atestava margens livres. Conclusão A prevalência do adenocarcinoma in situ vemaumentando cada vez mais. Ainda há uma grande parte da literatura que defende o uso do tratamento conservador para esta doença, mesmo sabendo que ela é uma doença multifocal e que pode estar presente mesmo em situações nas quais o anatomopatológico evidencie margens livres. Tendo em vista essas características, a maioria preconiza que a histerectomia continua a ser o tratamento preferencial nas mulheres que já completaram o seu intuito reprodutivo.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Adenocarcinoma/pathology , Uterine Cervical Neoplasms/pathology , Conization , Neoplasm Invasiveness/diagnosis , Adenocarcinoma/surgery , Uterine Cervical Neoplasms/surgery , Medical Records , Predictive Value of Tests , Hysterectomy , Neoplasm Invasiveness/pathology
5.
Article in English | WPRIM | ID: wpr-811219

ABSTRACT

OBJECTIVE: To investigate pathologic discrepancies between colposcopy-directed biopsy (CDB) of the cervix and loop electrosurgical excision procedure (LEEP) in women with cytologic high-grade squamous intraepithelial lesions (HSILs).METHODS: We retrospectively identified 297 patients who underwent both CDB and LEEP for HSILs in cervical cytology between 2015 and 2018, and compared their pathologic results. Considering the LEEP to be the gold standard, we evaluated the diagnostic performance of CDB for identifying cervical intraepithelial neoplasia (CIN) grades 2 and 3, adenocarcinoma in situ, and cancer (HSIL+). We also performed age subgroup analyses.RESULTS: Among the study population, 90.9% (270/297) had pathologic HSIL+ using the LEEP. The diagnostic performance of CDB for identifying HSIL+ was as follows: sensitivity, 87.8%; specificity, 59.3%; balanced accuracy, 73.6%; positive predictive value, 95.6%; and negative predictive value, 32.7%. Thirty-three false negative cases of CDB included CIN2,3 (n=29) and cervical cancer (n=4). The pathologic HSIL+ rate in patients with HSIL− by CDB was 67.3% (33/49). CDB exhibited a significant difference in the diagnosis of HSIL+ compared to LEEP in all patients (p<0.001). In age subgroup analyses, age groups <35 years and 35–50 years showed good agreement with the entire data set (p=0.496 and p=0.406, respectively), while age group ≥50 years did not (p=0.036).CONCLUSION: A significant pathologic discrepancy was observed between CDB and LEEP results in women with cytologic HSILs. The diagnostic inaccuracy of CDB increased in those ≥50 years of age.


Subject(s)
Adenocarcinoma in Situ , Biopsy , Cervical Intraepithelial Neoplasia , Cervix Uteri , Colposcopy , Conization , Dataset , Diagnosis , Early Detection of Cancer , Female , Humans , Papanicolaou Test , Retrospective Studies , Sensitivity and Specificity , Squamous Intraepithelial Lesions of the Cervix , Uterine Cervical Neoplasms
6.
Rev. saúde pública (Online) ; 54: 27, 2020. tab, graf
Article in English | LILACS | ID: biblio-1094408

ABSTRACT

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


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


Subject(s)
Humans , Female , Uterine Cervical Neoplasms/surgery , Cryotherapy/methods , Cervical Intraepithelial Neoplasia/surgery , Conization/methods , Electrocoagulation/methods , Postoperative Complications , Uterine Cervical Neoplasms/pathology , Risk , Risk Factors , Cervical Intraepithelial Neoplasia/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/pathology
7.
Rev. cuba. obstet. ginecol ; 45(3): e479, jul.-set. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093654

ABSTRACT

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


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


Subject(s)
Humans , Female , Radiosurgery/methods , Conization/methods , Epidemiology, Descriptive , Cross-Sectional Studies
8.
Article in English | WPRIM | ID: wpr-764962

ABSTRACT

BACKGROUND: Little research based on the artificial neural network (ANN) is done on preterm birth (spontaneous preterm labor and birth) and its major determinants. This study uses an ANN for analyzing preterm birth and its major determinants.


Subject(s)
Adenomyosis , Biopsy , Body Mass Index , Conization , Diabetes Mellitus , Female , Forests , Humans , Hypertension , Korea , Logistic Models , Machine Learning , Mass Screening , Myoma , Obstetric Labor, Premature , Parity , Parturition , Placenta Previa , Pregnancy , Premature Birth , Seoul
9.
Article in English | WPRIM | ID: wpr-741739

ABSTRACT

Loop electrosurgical excision procedure (LEEP) is commonly performed for the management of cervical intraepithelial neoplasia. Although LEEP is considered to be a relatively simple procedure, several unexpected complications have been reported in the literature. Herein, we report a case of hemoperitoneum caused by uterine perforation following LEEP. Blood collection in pelvic cavity and two small defects of the uterus were confirmed by diagnostic laparoscopy. The defects were sutured and the patient recovered well after the operation.


Subject(s)
Cervical Intraepithelial Neoplasia , Conization , Hemoperitoneum , Humans , Laparoscopy , Uterine Perforation , Uterus
10.
Article in English | WPRIM | ID: wpr-740196

ABSTRACT

OBJECTIVE: To show noninferiority of a limited-excision (resection of the dysplastic lesion only) vs. classical Large Loop Excision of the Transformation Zone (LLETZ). METHODS: In this prospective, randomized, multicenter trial, women with human papillomavirus (HPV) positive cervical intraepithelial neoplasia grade 3 were randomized into two groups (1:1). Primary outcome was the rate of negative HPV tests after 6 months, secondary outcomes included cone size, complete resection rates as well as cytological and histological results after 6 and 12 months. A sample size of 1,000 was calculated to show noninferiority of the limited-excision compared to the LLETZ group using a noninferiority margin of 5%. Enrollment was stopped after 100 patients due to slow accrual. RESULTS: Patients in the limited-excision group did not show a lower number of negative HPV tests (78% [LLETZ]−80% [limited-excision]=−2%; 90% confidence interval=−15%, 12%). The limited-excision resulted in a substantially lower cone size (LLETZ: 1.97 mL vs. limited-excision: 1.02 mL; p < 0.001) but higher numbers of involved margins (LLETZ: 8% vs. limited-excision: 20%). Although postoperative cytological results slightly differed, histological results were similar in both groups. One limited-excision patient received immediate re-conisation, whereas one patient in each group was scheduled for re-conisation after 6 months. CONCLUSION: The limited-excision could represent a promising option to reduce the surgical extent of conisations while maintaining oncological safety. The trial was not sufficiently powered to reach statistical significance due to early termination. Nevertheless, the study provides important insights in the feasibility of a limited-excision and could serve as a pilot study for future trials. TRIAL REGISTRATION: German Clinical Trials Register Identifier: DRKS00006169


Subject(s)
Cervical Intraepithelial Neoplasia , Conization , Female , Humans , Multicenter Studies as Topic , Pilot Projects , Premature Birth , Prospective Studies , Sample Size
11.
Rev. chil. obstet. ginecol. (En línea) ; 83(2): 130-138, abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959497

ABSTRACT

RESUMEN Fundamento: La persistencia del virus papiloma posterior a la conización del cuello uterino, se ha considerado un factor de riesgo para la persistencia de lesiones intra epiteliales (LIE) causadas por virus papiloma. Para determinar la asociación entre persistencia de lesión cervical y la presencia del virus papiloma posterior a la conización del cuello uterino, se realizó un estudio observacional prospectivo en un grupo de 123 pacientes portadoras de lesiones intraepiteliales de alto grado (LIEAG) tratadas con conización. Material y métodos: Se siguieron a 123 pacientes portadoras de LIEAG, ingresadas a la Unidad de Patología Cervical entre Abril de 2013 y Abril de 2014, las que fueron seguidas por 2 años hasta Abril de 2016. Se realizó genotipificación antes, y entre 4 a 6 meses posterior a la conización. Los datos se tabularon considerando la edad, paridad, tipo de virus, persistencia de LIE, reconización o requerimiento de histerectomía posterior. Resultados: La mediana de la edad fue de 37 años, el 91% fueron multíparas, y solo el 9% fueron nulíparas. El 56% ingresó por NIE III y el 44% por NIE II. Los virus más frecuentes fueron el 16, 31,58, 52 y 56. La persistencia de virus papiloma se constató en el 37% de las pacientes conizadas. La persistencia de LIE se observó en el 27% de las pacientes que fueron positivas para virus papiloma posterior a la conización, en comparación a sólo el 5% en las que fueron negativas. Del total de pacientes positivas para virus papiloma posterior a la conización, 12 de ellas presentaron persistencia de lesión confirmadas histológicamente por biopsia cervical, 8 pacientes requirieron recono por LIE de alto grado, 2 pacientes fueron a histerectomía y en 2 casos se realizó seguimiento estricto por NIE I. Cuando la tipificación post cono fue negativa solamente 3 pacientes requirieron conización y en sólo una se realizó seguimiento estricto por NIE I. Conclusión: La persistencia del virus papiloma posterior a la conización se asocia a mayor persistencia de LIEAG, mayor frecuencia de reconización o histerectomía posterior.


ABSTRACT Backgroud: The persistence of papilloma virus after conization of the cervix has been considered a risk factor for the persistence of cervical intra epithelial lesion (CIN) caused by papilloma virus. Aim: In order to determine the association between cervical lesion persistence and the presence of papilloma virus after conization, a prospective observational study was performed in a group of 123 patients with intraepithelial lesions treated with conization. Material and methods: We followed 123 patients with high grade CIN who were admitted to the Cervical Pathology Unit, between April 2013 and April 2014; they were followed for 2 years until April 2016. Viral genotyping was done before, and among the 4 to 6 months after the LEEP. Data were tabulated considering age, parity, type of virus, persistence of CIN, reconization or requirement of posterior hysterectomy. Results: The median age was 37 years, 91% were multiparous, and only 9% were nulliparous. 56% had NIE III and 44% NIE II. The most frequent viruses were 16, 31, 58, 52 and 56. The persistence of papillomavirus was present in 37% of patients. The persistence of CIN was observed in 27% of patients who were positive for papilloma virus after conization, compared to only 5% in those who were negative. Of the total number of patients positive for papilloma virus, in 12 of them had intra epitelial lesions were confirmed by cervical biopsy, 8 patients required recone for high grade CIN, 2 patients underwent hysterectomy, and 2 patients underwent follows up strictly by CIN I. When post cone typing was negative only 3 patients required conization and only one was followed strictly by CIN I.


Subject(s)
Humans , Female , Adult , Middle Aged , Young Adult , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/virology , Conization , Papillomavirus Infections/pathology , Papillomaviridae/physiology , Biopsy , Uterine Cervical Neoplasms/complications , Prospective Studies , Follow-Up Studies , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/pathology , Colposcopy , Cytodiagnosis , Papillomavirus Infections/genetics , Observational Study
12.
Article in English | WPRIM | ID: wpr-716105

ABSTRACT

OBJECTIVE: To determine factors affecting voiding recovery on the day of Foley catheter removal (postoperative day 7, POD7) after nerve-sparing radical hysterectomy (NSRH) for early-stage cervical cancer. METHODS: Early-stage cervical cancer patients, who underwent type C1 radical hysterectomy between January 2006 and June 2016 were included. Clinical and pathological data were reviewed. Association between inability to attain adequate voiding function on POD7 and potential predicting factors were evaluated in univariate and multivariate analysis. RESULTS: Of 755 patients, 383 (50.7%) resumed adequate voiding function on POD7 while 372 (49.3%) did not. Tumor size was larger in patients whose voiding function was inadequate (2.5 vs. 2.0 cm, p=0.001). Lengths of resected parametria and adjacent vagina were more extensive in patients with inadequate voiding function (p 4 cm (p 4 cm, postoperative urinary tract infection, and primary surgeon were significantly associated with inability to attain adequate voiding function on POD7. CONCLUSION: Extent of disease represented by tumor size, urinary tract infection as well as individual surgeon's technique independently predict resumption of adequate voiding function on POD7 following NSRH.


Subject(s)
Catheters , Conization , Humans , Hysterectomy , Multivariate Analysis , Urinary Tract Infections , Uterine Cervical Neoplasms , Vagina
13.
Article in English | WPRIM | ID: wpr-716101

ABSTRACT

OBJECTIVE: Because villoglandular adenocarcinoma (VGA) of the uterine cervix has favorable features and outcomes, patients receive less radical surgery and young women preserve their ovaries. We aimed to evaluate the clinicopathological features and outcomes of VGA and to see if the ovarian preservation is safe in young women with VGA. METHODS: We retrospectively reviewed medical records and identified patients with VGA, who had been treated and followed from January 2004 to December 2015. RESULTS: This study consisted of 17 patients with VGA, including 9 premenopausal women. International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease was found in 12 patients (70.6%), IA1 in 2, IA2 in 1, IB2 in 1, and IIA1 in 1. Of the 12 women diagnosed with stage IB1 disease, a young woman received only conization and she has not showed a recurrence. During a median follow-up of 58 months (range: 12–116), 4 patients, who had undergone radical surgery for stage IB1 disease, had a recurrence and one of them died due to disease progression. Among patients with stages IB–IIA disease, 2 premenopausal women did not receive simultaneous oophorectomy or chemoradiation therapy. Both of them had a recurrent tumor at adnexa. CONCLUSION: This study revealed favorable features and outcomes of VGA. However, the appropriate treatment for young women with early-stage VGA must be cautiously selected. Ovarian preservation might not be safe when young women with stages IB–IIA VGA undergo surgical procedures.


Subject(s)
Adenocarcinoma , Adenocarcinoma, Papillary , Cervix Uteri , Conization , Disease Progression , Female , Fertility Preservation , Follow-Up Studies , Gynecology , Humans , Medical Records , Obstetrics , Ovariectomy , Ovary , Recurrence , Retrospective Studies , Treatment Outcome , Uterine Cervical Neoplasms
14.
Article in English | WPRIM | ID: wpr-716094

ABSTRACT

OBJECTIVE: To evaluate the clinical efficiency of identifying patients with suspicious severe lesions by conization among prediagnosed cervical intraepithelial neoplasia (CIN) 1 and 2 patients in Japan. METHODS: The data in a Japanese nation-wide registry for cervical cancer (2009 and 2011) was collected to analyze the clinical efficacy of pre- and postdiagnosis for 13,215 Japanese women who underwent treatment by conization. Their preoperative and postoperative histologic findings and clinical outcomes were evaluated using standard statistical procedures including clinical and demographic characteristics. RESULTS: Almost half of 1,536 women who were treated by conization after the prediagnosis of CIN1 and 2 because the lesions showed no evidence of natural regression actually contained CIN1–2 (45.0%), CIN3 (47%), or invasive cancer (2.7%) in their cervical tissue. They underwent conization either for therapeutic (treatment) (78.5%) or diagnostic (21.5%) reasons. Invasive disease was diagnosed postoperatively more often in diagnostic cases (6.1%) than in therapeutic cases (2.8%). All the patients survived their diagnostic and therapeutic conization after approximately 30 months of follow up. CONCLUSION: Our study shows that the continuous observation of the prediagnosed CIN1 and 2 cases by the combination of cytology, colposcopy and histology in Japan has worked successfully to identify severe lesions by using conization as well in the process.


Subject(s)
Asians , Cervical Intraepithelial Neoplasia , Colposcopy , Conization , Female , Follow-Up Studies , Humans , Japan , Treatment Outcome , Uterine Cervical Neoplasms
15.
Article in English | WPRIM | ID: wpr-715706

ABSTRACT

OBJECTIVE: This study aimed to determine the factors affecting pathologic discrepancy and final diagnosis between colposcopic biopsy and pathology by loop electrosurgical excision procedure (LEEP). METHODS: Between 2004 and 2016, 1,200 patients who underwent LEEP were enrolled for this study. 667 underwent cervical cytology, human papillomavirus (HPV) test, colposcopic biopsy, and LEEP. We analyzed patient's age, menopausal status, number of delivery, abortion times, cervical cytology, number of punch biopsies, HPV type, LEEP, and interval between colposcopic biopsy and LEEP. RESULTS: Logistic regression analysis of the final diagnosis showed that age 30–39 years and other high HPV group types were associated with cancer diagnosis, whereas atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL), and HPV type 16 affected the diagnosis of cervical intraepithelial neoplasia (CIN) 2. The overall concordance rate of histopathology between punch biopsy and LEEP was 43.3%. The rates of detecting a more severe lesion by LEEP than those by biopsy were 23.1%. The rates of a less severe lesion detected by LEEP than those by biopsy were 33.6%. Factors related with biopsy underestimation were as follows: < 1 vaginal delivery, HSIL, number of punch biopsies and HPV type. Punch biopsy number is a unique factor of biopsy overestimation. CONCLUSION: Patients with ASC-H, HSIL, and HPV type 16 may undergo conization immediately without colposcopic biopsy. We suggest that colposcopically directed 3 to 5 punch biopsies may be used to determine the need for conization.


Subject(s)
Atypical Squamous Cells of the Cervix , Biopsy , Cervical Intraepithelial Neoplasia , Cervix Uteri , Conization , Diagnosis , Female , Humans , Logistic Models , Papanicolaou Test , Pathology , Squamous Intraepithelial Lesions of the Cervix
16.
Article in English | WPRIM | ID: wpr-714685

ABSTRACT

OBJECTIVE: Impaired local cellular immunity contributes to persistent human papillomavirus (HPV) infection and development of cervical intraepithelial neoplasia (CIN). Programmed death-1 (PD-1) and its ligands PD-ligand-1 (L1) and PD-L2 are negative regulators of T cell activity in various cancers, but few studies exist. The aim of this study was to determine the clinicopathologic and immunologic parameters (PD-1, PD-L1, and PD-L2) related to the persistence/recurrence of CIN after conization. METHODS: Medical records of 652 patients diagnosed with CIN and underwent conization were reviewed. The associations between clinicopathologic parameters (e.g., age, parity, initial HPV load, etc.) and persistence/recurrence of CIN were analyzed. Expression of PD-1, PD-L1, and PD-L2 was assessed on 100 conization specimens by immunohistochemistry (IHC) in women matched for propensity-score (50 with persistence/recurrence and 50 without). RESULTS: Initial HPV load (>1,000 relative light unit) and positive margin were shown to be significantly associated with CIN persistence/recurrence (p=0.012 and p < 0.001, respectively). Multivariate analysis showed that margin status was an independent predictor of persistence/recurrence (hazard ratio=8.86; 95% confidence interval=1.67–16.81; p < 0.001). On IHC analysis, none of the patients expressed PD-L1. PD-1+ T cells were observed in 25 of 100 patients. Also, PD-1+ T cells were significantly correlated with increasing grade of CIN (p=0.031). In addition, patients with persistence/recurrence had increased expression of PD-1 compared with those without (36% vs. 14%, respectively; p=0.020). Although PD-L2 expression did not differ between 2 groups, it was significantly higher in patients with high-grade CIN compared to low-grade (34.7% vs. 12%, respectively; p=0.041). CONCLUSION: Positive surgical margin and expression of PD-1+ T cells were associated with CIN persistence/recurrence after conization.


Subject(s)
Cervical Intraepithelial Neoplasia , Conization , Female , Humans , Immunity, Cellular , Immunohistochemistry , Ligands , Medical Records , Multivariate Analysis , Papillomaviridae , Parity , Recurrence , T-Lymphocytes
17.
Article in Chinese | WPRIM | ID: wpr-775309

ABSTRACT

OBJECTIVE@#To establish a prognostic model for preterm birth in women after cervical conization, and to evaluate its effectiveness.@*METHODS@#Seventy three women after cervical conization in Women's Hospital of Zhejiang University were included for this retrospective study. The influencing factors of preterm delivery were analyzed by Logistic regression analysis and a prognostic model was created. Receiver operating characteristic (ROC) curve was used for evaluation of the predictive ability of the model. Forty five women who underwent cervical conization were included for testing the validity of the model.@*RESULTS@#For women after cervical conization, mother's age (=1.20, 95%:1.01-1.43, <0.05) and cervical length during middle pregnancy (=0.06, 95%:0.01-0.21,<0.01) were independent predictors for preterm birth. The regression model was Logit ()=1.408-2.903×cervical length+0.186×age. The areas under the ROC curve (AUC) of the training dataset was 0.93 (95%:0.87-0.99). The sensitivity, specificity, Youden index, positive predictive value (PPV), negative predictive value (NPV) and accuracy with the cutoff value of -1.512 were 91.7%, 81.5%, 0.732, 68.8%, 95.7% and 84.5% respectively. The AUC of the testing dataset was 0.94 (95%:0.86-1.00). The sensitivity, specificity, Youden index, PPV, NPV and accuracy with the cutoff value of -0.099 were 92.9%, 90.3%, 0.832, 81.3%, 96.5% and 91.1%, respectively.@*CONCLUSIONS@#The model based on the age and cervical length during middle pregnancy can effectively predict preterm delivery in pregnant women after cervical conization.


Subject(s)
Cervix Uteri , General Surgery , Conization , Female , Humans , Models, Biological , Pregnancy , Premature Birth , Diagnosis , Prognosis , ROC Curve , Retrospective Studies
18.
MedUNAB ; 21(1): 100-114, 2018.
Article in Spanish | LILACS | ID: biblio-994479

ABSTRACT

Introducción. El cáncer de cuello uterino es la segunda causa de muerte más frecuente mundialmente; por ello, existen terapias tanto invasivas como poco invasivas que buscan impactar la supervivencia de la enfermedad. Entre los diferentes métodos de tratamiento se encuentran la radioterapia externa, la braquiterapia, la quimioterapia, la conización, la traquelectomía y la histerectomía radical. Objetivo. Revisar las características de cada uno de los métodos de tratamiento disponibles para el manejo del cáncer de cuello uterino. Metodología. Se realizó una búsqueda, en las bases de datos PUBMED y LILACS, de artículos publicados entre los años 2013 y 2016 que tuvieran como tema central el cáncer de cuello uterino y su tratamiento; luego de aplicar criterios de inclusión y exclusión, se seleccionaron 41 artículos para la revisión. Resultados. Para el manejo del cáncer de cérvix se plantean, como métodos poco invasivos: la conización, con supervivencia a cinco años de 95.1% en cáncer microinvasor; la radioterapia de haz externo, con supervivencia total de 92.2% a cinco años; la quimioterapia, con supervivencia similar a la radioterapia, pero con disminución de la necesidad de cirugía; y la braquiterapia combinada con quimioterapia, que logró respuesta en 64% de pacientes con cáncer estadio IA, IIA y IB. En relación con métodos más invasivos, se encuentran la traquelectomía en cáncer temprano sin compromiso local o a distancia, alcanza supervivencia del 95%, con tasas de embarazo de 50% posteriores al tratamiento y la histerectomía radical, con supervivencia total de 100% a cinco años en cáncer estadio IA2 y IB1, requiriendo algunas veces combinación con otros métodos. Para las técnicas quirúrgicas se han desarrollado nuevos abordajes y variantes. Conclusiones. Los tratamientos en cáncer de cérvix han mostrado resultados alentadores en cuanto a supervivencia, además, la conización y traquelectomía permiten preservar la fertilidad. La quimioterapia, la radioterapia de haz externo y la braquiterapia logran buen control del cáncer de cérvix en estadios tempranos y se pueden usar como coadyuvantes de los métodos quirúrgicos. Sin embargo, la histerectomía radical es el estándar esencial para manejo del cáncer de cérvix, con buenos resultados en supervivencia; sus variantes, además, han logrado disminuir las complicaciones. [Suárez-Cadena FC. Terapéutica del cáncer de cuello uterino, una revisión de la literatura. MedUNAB. 2018;21(1):100-114.doi: 10.29375/01237047.2583].


Introduction. Worldwide, cervical cancer is the second most frequent cause of death, and because of its existence, there are several kinds of therapies that range between invasive to non-invasive ones. The purpose of these procedures is to impact disease survival within the human body. Thus, among those treatment methods used for cervical cancer treatment, we can find the following: external beam radiotherapy, brachytherapy, chemotherapy, cervical conization, trachelectomy, and radical hysterectomy. Objective. To review the characteristics of each one of the available methods for treating cervical cancer. Methodology. Published articles between 2013 and 2016 were collected using the databases PUBMED and LILACS. These articles had as a central topic cervical cancer and its treatment. After applying certain inclusion and exclusion criteria within the research, 41 articles were selected to be reviewed. Results. As non-invasive treatment methods for cervical cancer, the following are proposed: cervical conization method, which has a 5-year survival rate of 95.1% when treating micro-invasive cancer; external beam radiotherapy method, which has an overall 5-year survival rate of 92.2%; chemotherapy method, whose survival rate is similar to external beam radiotherapy method's one, but with a slight diminishing of surgery risk; and finally brachytherapy method, which combined with chemotherapy method achieves 64% of response among patients in cancer stages IA, IIA and IB. On the other hand, more invasive treatment methods are presented as follows: trachelectomy method when treating early cancer stages (with no local involvement or distant spreading) reaches a survival rate of 95% and a post-treatment pregnancy rate of 50%, and radical hysterectomy method has a 5-year survival rate of 100% among patients in cancer stage IA2 and IB1, in spite in some occasions this method requires to be combined with other treatment techniques. New therapeutic approaches and variations have been developed for surgical techniques. Conclusions.Cervical Cancer treatments have shown promising results regarding survival rate and in some procedures, such as conization and trachelectomy, preservation of fertility rate. Methods such as chemotherapy, external beam radiotherapy, and brachytherapy have a great control of cervical cancer in early stages, and they can also be used as adjuvant therapies for surgical interventions. Nonetheless, radical hysterectomy is the standard and essential medical procedure for managing cervical cancer. This method has shown good results regarding survival rates and its variants have helped to diminish associated complications. [Suárez-Cadena FC.Cervical cancer therapeutics: a literature review. MedUNAB. 2018;21(1):100-114.doi: 10.29375/01237047.2583]


Introdução. O câncer de colo do útero é a segunda causa de morte mais frequente no mundo e por isso, existem terapias invasivas e minimamente invasivas que buscam impactar na sobrevivência da doença. As principais opções de tratamento para o câncer de colo do útero são: a radioterapia externa, a braquiterapia, a quimioterapia, a conização, a traquelectomia e a histerectomia radical. Objetivo. Revisar as características de cada um dos métodos disponíveis para o tratamento do câncer de colo do útero. Métodos. Pesquisa feita nas bases de dados PUBMED e LILACS, de artigos publicados entre 2013 e 2016 com o assunto principal: tratamento do câncer de colo do útero e tratamiento. Foram selecionados 41 artigos para revisão, após a aplicação dos critérios de inclusão e exclusão. Resultados. Para o tratamento do câncer de colo de útero, os seguintes métodos são considerados minimamente invasivos: a conização, com sobrevida em cinco anos equivalente a 95,1% no câncer microinvasor; a radioterapia externa, com sobrevida total de 92,2% em cinco años; a quimioterapia, com sobrevida semelhante à radioterapia, mas com diminuição da necessidade de cirurgia; e a braquiterapia combinada com quimioterapia, que obteve resposta em 64% dos pacientes com estádio IA, IIA e IB. Em relação aos métodos mais invasivos, a traquelectomia no câncer precoce sem comprometimento 102local, ou à distância, atinge 95% de sobrevida, com 50% de taxas de gestação após o tratamento e histerectomia radical, com sobrevida total de 100% a cinco anos no estádio IA2 e IB1, requerendo às vezes combinação com outros métodos. Para técnicas cirúrgicas, novas abordagens e variantes foram desenvolvidas. Conclusões. Os tratamentos de câncer de colo do útero mostraram resultados encorajadores em termos de sobrevida, além disso, a conização e traquelectomia permitem preservar a fertilidade. A quimioterapia, a radioterapia externa e a braquiterapia conseguem um bom controle do câncer de colo do útero em estádios iniciais e podem ser usadas como coadjuvantes dos métodos cirúrgicos. Entretanto, a histerectomia radical é o padrão essencial para o tratamento de câncer de colo do útero, com bons resultados na sobrevida; suas variantes, além disso, conseguiram reduzir as complicações. [Suárez-Cadena FC.Terapêutica do câncer de colo do útero, uma revisão de literatura. MedUNAB. 2018;21(1):100-114.doi: 10.29375/01237047.2583].


Subject(s)
Uterine Cervical Neoplasms , Radiotherapy , Brachytherapy , Conization , Drug Therapy , Trachelectomy , Hysterectomy
19.
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
20.
Rev. bras. ginecol. obstet ; 39(6): 288-293, June 2017. tab
Article in English | LILACS | ID: biblio-898869

ABSTRACT

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


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


Subject(s)
Humans , Female , Precancerous Conditions/diagnosis , Biomarkers, Tumor/analysis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/chemistry , Ki-67 Antigen/analysis , Cyclin-Dependent Kinase Inhibitor p16/analysis , Neoplasm Recurrence, Local/diagnosis , Case-Control Studies , Uterine Cervical Neoplasms/surgery , Predictive Value of Tests , Retrospective Studies , Risk Factors , Conization/methods , Electrosurgery , Neoplasm Grading
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