ABSTRACT
BACKGROUND: Lymph mapping with sentinel node biopsy is the standard procedure for lymph node staging in patients with cutaneous melanoma with a tumor thickness of 1 mm or greater. Patients who have metastases in sentinel node must undergo complementary lymphadenectomy; however, it has not been shown to improve survival. OBJECTIVE: To know the prevalence in our setting of metastases in the product of complementary lymphadenectomy in patients with metastatic sentinel node. METHOD: Evaluation of a descriptive, retrospective, observational and analytical cohort of patients with metastatic sentinel node submitted to lymphadenectomy. Multivariate analysis of tumor thickness, neural invasion, location, sentinel node number, serum DHL level, lymph nodes dissected and extracapsular spread. RESULTS: 67 patients, 35 women and 32 men with a mean of 66 years, 22% had metastases in lymph nodes from complementary lymphadenectomy, 19% of them with extracapsular spread; no relationship with the Breslow level. Extracapsular spread in the sentinel node, lymphadenectomy time, and perineural invasion in the primary tumor were prognostic factors for non-sentinel node metastasis. CONCLUSIONS: In this series, 22% of the patients with a sentinel node-positive have metastases in the non-sentinel nodes, 19% of them with extracapsular spread, which justifies complementary lymphadenectomy.
ANTECEDENTES: El mapeo linfático con biopsia del ganglio centinela es el procedimiento estándar de estadificación ganglionar en pacientes con melanoma cutáneo con grosor tumoral de 1 mm o mayor. Los pacientes que tienen metástasis en él deben ser sometidos a linfadenectomía complementaria; sin embargo, esta no ha mostrado mejorar la superviviencia. OBJETIVO: Conocer la prevalencia en nuestro medio de metástasis en el producto de linfadenectomía complementaria en pacientes con ganglio centinela metastásico. MÉTODO: Evaluación de una cohorte descriptiva, retrospectiva, observacional y analítica de pacientes con ganglio centinela metastásico sometidos a linfadenectomía, con análisis multivariado de grosor tumoral, invasión neural, localización, número de ganglios centinela, concentración sérica de deshidrogenasa láctica, ganglios disecados en linfadenectomía y ruptura capsular. RESULTADOS: Hubo 67 pacientes (35 mujeres y 32 hombres), con una media de 66 años de edad, en el 22% hubo metástasis en ganglios de linfadenectomía complementaria y en el 19% ruptura capsular; sin relación con el nivel de Breslow. La ruptura capsular en el ganglio centinela, el tiempo de linfadenectomía y la invasión perineural fueron factores pronóstico de metástasis en ganglios no centinela. CONCLUSIONES: En esta serie, el 22% de los pacientes tuvieron metástasis en ganglios no centinela, el 19% de ellos con ruptura capsular, lo cual justifica la linfadenectomía complementaria.
Subject(s)
Melanoma , Skin Neoplasms , Female , Humans , Lymph Node Excision , Lymphatic Metastasis , Male , Melanoma/pathology , Neoplasm Staging , Retrospective Studies , Sentinel Lymph Node Biopsy , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: The Official Mexican Norm for the prevention, treatment and control of Cervical Cancer (CC) indicates that the Papanicolau (Pap) is the procedure for the detection of this neoplasia; therefore, it is of interest to know the prevalence of suspected cases by this technique in Mexican population. In this study, we show the diagnosed cases in the State of Jalisco, México. METHODS: A retrospective study was made to the samples that arrived for their analysis to the Laboratorio Regional de Citología Exfoliativa (LARCE), of the Instituto Mexicano del Seguro Social (IMSS) in Guadalajara, Jalisco. We considered all cases from January 2010 to December 2012. RESULTS: We analyzed 188 095 cases, from which 5.3 % had a diagnosis of low dysplasia, 0.18 % of moderated dysplasia and 0.05 % of high dysplasia. Microinvasive and invasive cancer showed a low frequency (0.03 %). CONCLUSIONS: The frequency of abnormal findings identified by vaginal cervical cytology is relatively low. The number of inadequate and limited samples for cytological assessment is high; there is a high proportion of women attending for the first time in life to cytology evaluation in older age groups.
Introducción: La Norma Oficial Mexicana para la prevención, tratamiento y control del Cáncer Cérvico Uterino (CaCU) indica que el Papanicolaou (Pap) es el procedimiento de elección para la detección oportuna de esta neoplasia, por lo que es de interés conocer la prevalencia de casos tamizados mediante esta técnica en la población mexicana. En la presente investigación se muestran los casos que se identificaron como sospecha para CaCU por tamizaje en el estado de Jalisco, México. Métodos: se realizó un estudio retrospectivo de las muestras que llegaron para su análisis al Laboratorio Regional de Citología Exfoliativa (LARCE) del Instituto Mexicano del Seguro Social (IMSS) en Guadalajara, Jalisco. Se consideraron todos los casos de enero de 2010 a diciembre de 2012. Resultados: se analizaron 188 095 casos, de los cuales el 5.3 % se reportaron con sospecha de displasia leve, el 0.18 % de displasia moderada y el 0.05 % de displasia grave. En cáncer microinvasor e invasor se observó una baja frecuencia (0.03 %). Conclusiones: la frecuencia de hallazgos anormales identificados por citología cervicovaginal es relativamente baja. El número de muestras inadecuadas más limitadas para valoración citológica es alto; existe una elevada proporción de mujeres que asisten por primera vez en la vida a estudio citológico en grupos de edad avanzados.
Subject(s)
Papanicolaou Test , Squamous Intraepithelial Lesions of the Cervix/epidemiology , Uterine Cervical Dysplasia/epidemiology , Uterine Cervical Neoplasms/epidemiology , Vaginal Smears , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Mexico/epidemiology , Middle Aged , Prevalence , Retrospective Studies , Squamous Intraepithelial Lesions of the Cervix/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/pathology , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/pathologyABSTRACT
The World Health Organization (WHO) reported more than 6 million cases of cancer worldwide in women during 2008; 57.2 % of those cases occurred in less developed countries. Cervical cancer (CC) ranks third in the world in all cancers affecting women, with an estimated of 530 000 new cases. CC has multiple causes and it arises by the association of various risk factors. The main factor is related to the human papillomavirus infection (HPV), which acts as a necessary but not sufficient cause. Also, the interaction with other cofactors has an impact on the development and severity of this neoplasm. Survival is related to the timeliness of care and, therefore, to more access to health services. CC is a neoplasm considered a preventable cancer; thus, it is possible to save more than 150 000 lives by 2030 if control measures are applied with opportunity. The aim of this work is to review the CC in different geographical areas and to make an analysis of risk factors related to this neoplasm.
La Organización Mundial de la Salud (OMS) reportó en 2008 más de 6 millones de casos de cáncer en mujeres; el 57.2 % de esos casos ocurrió en países menos desarrollados. El cáncer cervicouterino (CaCU) ocupa el tercer lugar de las neoplasias malignas que afectan a la mujer, con un número estimado de 530 000 casos nuevos. El CaCU es multicausal y obedece a la asociación de diferentes factores de riesgo. El principal de ellos es la infección por virus de papiloma humano (VPH), que actúa como una causa necesaria pero no suficiente. Asimismo, la interacción con otros cofactores incide en el desarrollo y la severidad de esta neoplasia. La sobrevida se encuentra relacionada con la oportunidad de atención y por lo tanto con mayor accesibilidad a los servicios de salud. El CaCU es una neoplasia considerada como un cáncer prevenible, así que es factible salvar más de 150 mil vidas para 2030 si las medidas de control se aplican con oportunidad. El objetivo de este trabajo es revisar el comportamiento del CaCU en diferentes ámbitos geográficos, así como realizar un análisis de los factores de riesgo relacionados con esta neoplasia.
Subject(s)
Papillomavirus Infections/epidemiology , Uterine Cervical Neoplasms/epidemiology , Female , Genetic Predisposition to Disease , Global Health , Humans , Papillomavirus Infections/genetics , Papillomavirus Infections/virology , Risk Factors , Uterine Cervical Neoplasms/genetics , Uterine Cervical Neoplasms/virologyABSTRACT
Infection with human papillomavirus (HPV), mainly HPV type 16, is the major etiologic factor associated with cervical cancer (CC), but HPV infection alone is not sufficient for progression of precursor lesions. Host genetic susceptibility may lead to abnormal immune response resulting from virus persistence. Several studies have suggested a possible association with specific human leukocyte antigen (HLA) class I and II alleles and CC, but results are not consistent. The association of genetic HLA class I (A and B) and HLA class II (DR*B1 and DQ*B1) haplotypes with HPV16-positive CC (n = 104) and base population controls (n = 104) was evaluated in this Mexican population study. Sequence-specific primer HLA genes were determined by polymerase chain reaction (PCR)-based methods in peripheral blood cell counts (PCR sequence-specific oligonucleotides). The cervical swabs of 208 women were tested for HPV16 by Hybrid Capture II. Allele and haplotype HLA frequencies, Hardy-Weinberg tests, and a haplotype homogeneity test were estimated using the Arlequin software v. 3.01. Odds ratio (OR) was calculated to compare cases and control women. Consistent associations across other studies in women with CC and infected by HPV16 were observed for HLA-DRB1*15 (OR, 3.9; 95% CI, 1.6-10.2) and the haplotype DRB1*15 DQB1*0602 (OR, 4.1; 95% CI, 1.4-12.7) compared with control women. The HLA-A2-B44-DR4-DQ*0302, HLA-A24-B35-DR16-DQ*0301, and HLA-A2-B40-DR4-DQ*0302 haplotypes showed a positive association with CC (OR, >1), whereas HLA-A2-B39-DR4-DQ*0302, HLA-A24-B35-DR4-DQ*0302, and HLA-A68-B40-DR4-DQ*0302 showed a negative association (OR, <1). These results support the hypothesis that some HLA class I and II haplotypes could be involved with susceptibility for developing CC.
Subject(s)
Carcinoma/genetics , Genetic Predisposition to Disease , Histocompatibility Antigens Class II/genetics , Histocompatibility Antigens Class I/genetics , Human papillomavirus 16 , Uterine Cervical Neoplasms/genetics , Adult , Aged , Carcinoma/pathology , Carcinoma/virology , Case-Control Studies , Female , Gene Frequency , Haplotypes , Human papillomavirus 16/genetics , Humans , Mexico , Middle Aged , Neoplasm Invasiveness , Papillomavirus Infections/complications , Papillomavirus Infections/genetics , Polymorphism, Genetic , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/virologyABSTRACT
OBJECTIVE: Our objective was to determine the association between viral load of high risk human papilloma virus (HPV) using the Hybrid Capture II (HC II) system and cervical intraepithelial neoplasia (CIN) lesion stage. METHODS: A total of 182 consecutive women with confirmed diagnoses of CIN 1-3 and 182 healthy women with negative Pap were included. All subjects underwent structured interviews focused on socioeconomic and reproductive factors. HC II testing was used to detect human papilloma virus (HPV) DNA. Viral load was measured by light measurements expressed as relative lights unit (RLU) ratio (specimens/control). Log(10)RLU ratios were categorized for analysis into four groups: negative (
