ABSTRACT
Objetivo: Determinar la incidencia de recurrencia/persistencia de neoplasia intraepitelial cervical (NIC) en pacientes sometidos a procedimiento de escisión electroquirúrgica en asa (cono LEEP) en el Servicio de Ginecología Oncológica del Instituto Nacional de Enfermedades Neoplásicas (INEN). Materiales y métodos: Estudio de cohorte, retrospectivo en el cual se revisaron las historias clínicas de pacientes sometidos a cono LEEP durante el periodo de enero del 2002 a diciembre del 2003. Los pacientes fueron divididos en un grupo con margen comprometido y otro con margen negativo después del procedimiento de cono LEEP. El seguimiento de los pacientes se realizó cada 3 meses con examen físico, PAP y colposcopía. El desenlace fue la recurrencia de NIC. Para valorar el riesgo de recurrencia de NIC entre los grupos de estudio se calculó el riesgo relativo (RR) con su respectivo intervalo de confianza (IC) al 95%. Resultados: En total 451 pacientes fueron sometidos a cono LEEP durante el periodo de estudio. La edad promedio fue 35.32 años, el promedio de parejas sexuales fue 2.1 y el promedio de hijos fue 2.7. Presentaron margen comprometido 109 (25%) y margen negativo 342 (75%). De ellos solo 94 y 102, respectivamente, cumplían los criterios de elegibilidad y fueron seguidos. La media de seguimiento fue de 21.74 meses. La incidencia de recurrencia/persistencia dentro de los pacientes con margen comprometido fue 5.5% mientras que la incidencia de recurrencia en un grupo de pacientes con margen negativo fue 1.96% No encontramos diferencias significativas en el riesgo de padecer recurrencia de NIC en el grupo de pacientes con margen comprometido versus los pacientes con margen negativo. RR= 2.7; IC 95% (0.41 a 33.8). Conclusión: No se encontró diferencia significativa en la incidencia de neoplasia intracervical para pacientes con margen comprometido y los pacientes con margen negativo.
Objective: To determine the incidence of recurrence/persistence of cervical intraepithelial neoplasia (CIN) in patients who underwent a loop electrosurgical excision procedure (LEEP) at the Department of Gynecologic Oncology of Instituto Nacional de Enfermedades Neoplásicas (INEN). Materials and methods: A retrospective cohort study in which medical records of patients who underwent a LEEP conization from January 2002 to December 2003 were examined. After the LEEP conization, patients were divided into two groups: one with positive margin and another one with negative margin. Follow-up was performed every 3 months and consisted of a physical examination, Pap test and colposcopy. The outcome was recurrence of CIN. To assess the risk of CIN recurrence among the study groups, relative risk (RR) and its respective 95% confidence interval (CI) were calculated. Results: A total of 451 patients underwent a LEEP conization during the study period. The mean age was 35.32 years old, the mean number of sexual partners was 2.1 and the mean number of children was 2.7. One hundred and nine (109) patients (25%) showed a positive margin and 342 (75%) showed a negative one. Out of these subjects, only 94 and 102, respectively, met the eligibility criteria and were followed. The mean follow-up period was 21.74 months. The incidence of recurrence/persistence in patients with positive margin was 5.5%, while the incidence of recurrence/persistence in the group of patients with negative margin was 1.96%. We found no significant differences in the risk of CIN recurrence in the group of patients with positive margin versus patients with negative margin. RR = 2.7, 95% CI (0.41 to 33.8). Conclusion: There was no significant difference in the incidence of cervical intraepithelial neoplasia between patients with positive margin and patients with negative margin.
ABSTRACT
Cervical cancer originates with human papillomavirus (HPV) infection and progresses via histologically-defined premalignant stages. Here we compare normal cervical epithelium and patient-matched high grade squamous intraepithelial lesions (HSIL) with cervical carcinoma tissue from the same patient population (n=10 per group). Specimens were analyzed by combined laser capture microdissection and 2D-DIGE. Significant expression changes were seen with 53 spots resulting in identification of 23 unique proteins at the molecular level. These include eight that uniquely distinguish normal epithelium and HSIL and four that uniquely distinguish HSIL and carcinoma. In addition, one protein, cornulin, distinguishes all three states. Other identified proteins included differentiation markers, oncogene DJ-1, serpins, stress and interferon-responsive proteins, detoxifying enzymes, and serum transporters. A literature review, performed for all identified proteins, allowed most changes to be assigned to one of three causes: direct or indirect HPV oncoprotein interactions, growth selection during latency, or interactions in the lesion microenvironment. Selected findings were confirmed by immunohistochemistry using either frozen sections from the same cohort or formalin fixed paraffin embedded samples from a tissue microarray. Novel markers described here have potential applications for increasing the predictive value of current screening methods.
