Neoplasia intraepitelial vulvar: Cribado en población de riesgo / Vulvar intra-epithelial neoplasia: Screening in population at risk

Antecedentes: Las pacientes con neoplasias cervicales intraepiteliales (CIN) tienen mayor riesgo de desarrollar lesiones causadas por el virus del papiloma humano (VPH) en otras localizaciones del tracto genital inferior (entre ellas, la vulva). La vulvoscopia no está incluida en el seguimiento de las mujeres con CIN. Se propone estudiar la eficiencia de incluir la vulvoscopia en dicho seguimiento. Se analiza también la incidencia de la displasia vulvar de alto grado y la influencia de los factores protectores y de riesgo. Material y métodos: Se incluyeron 95 pacientes con diagnóstico de CIN (en pieza de conización). Se recogió toda la información relativa a sus características sociodemográficas y clínicas; se realizó vulvoscopia y, eventualmente, biopsia. Resultados y conclusiones: La media de edad de las pacientes fue de 40 años. El 62,1% de ellas eran o habían sido fumadoras (más de la mitad habían abandonado el hábito tabáquico en el momento del estudio). Solo el 21,1% declararon no utilizar método de barrera. Aunque el 78,9% de las estudiadas eran o habían sido usuarias de anticoncepción hormonal, solo ocho de ellas seguían utilizándola. Ochenta y ocho de las 95 mujeres (92,6%) estaban vacunadas contra el VPH (la mayoría postconización). No se diagnosticó ninguna displasia vulvar de alto grado. La modificación en el estilo de vida tras el diagnóstico de la patología cervical, la transitoriedad de la infección por el VPH y la mayor susceptibilidad del epitelio cervical a esta, se nos muestran como las causas más probables de la discordancia entre la prevalencia de la patología vulvar esperada y la encontrada en la población estudiada.(AU)

Background: Patients with cervical intraepithelial neoplasia (CIN) are more likely to develop lesions caused by the human papilloma virus (HPV) in other locations of the lower genital tract (including the vulva). Vulvoscopy is not included in the follow-up of women with CIN. It is proposed to study the efficiency of including vulvoscopy in follow-up. An analysis is also performed on incidence of high-grade vulvar dysplasia, as well as the influence of protective and risk factors analysed. Material and methods: The study included 95 patients with a diagnosis of CIN in the cone biopsy piece. All the information relative to their socio-demographic and clinical characteristics was collected and included, performing of the vulvoscopy as well as the biopsy. Results and conclusions: The mean age of the patients was 40 years. Just under two-thirds (62.1%) of them were or had been smokers (more than half of those had quit smoking at the time of the study). Only 21.1% said they were not using a barrier method. Although 78.9% of those studied were or had been users of hormonal contraception, only 8 out of the 95 continued using it. Most (88 out of the 95 women) were vaccinated against HPV. No high-grade vulvar dysplasia was diagnosed. The modification in the lifestyle after the diagnosis of the cervical disease, the transience of the HPV infection, and the greater susceptibility of the cervical epithelium to this, are indicated as the most probable causes of the discordance between the expected prevalence of vulvar disease and the effective rate found within the studied population.(AU)

Utilidad de la citología e inspección visual con ácido acético en la detección de lesiones neoplásicas de cuello uterino Centro Médico Oncomujer 2013-2014. Lima, Perú / Usefulness of Cytology and Visual Inspection with Acetic Acid in the Detection of Neoplastic Lesions of the Cervix at the Centro Médico Oncomujer During 2013-2014. Lima, Peru

Objetivo: Determinar la utilidad de la citología e inspección visual con ácido acético en la detección de lesiones neoplásicas de cuello uterino. Materiales y métodos: El estudio es de diseño observacional, retrospectivo, descriptivo y transversal. Se evaluó a la población de pacientes femeninas atendidas para despistaje de cáncer de cuello uterino con Pap e IVAA que acudieron al Centro Médico Oncomujer entre los años 2013 y 2014. Se incluyó a las mujeres con indicación de biopsia y positividad a una o ambas pruebas (Pap-IVAA). Resultados: La edad media fue de 41.66 años (rango: 20-50 años). Se evaluó con Pap e IVAA a 1108 pacientes: el 8.2% (92/1108) de las pacientes evaluadas por Pap fueron positivas y el 27.6% (306/1108) de las pacientes evaluadas por IVAA fueron positivas. En los resultados de la citología (Pap) frente a la biopsia se obtuvo una sensibilidad del 30.6% (IC95%: 23.7%-3.48%), especificidad del 88.4% (IC95%: 77.89.7%-94.51%), valor predictivo positivo del 85.9% (IC95%: 73.65%-999.48%) y valor predictivo negativo del 35.4% (IC95%: 28.43%-43.16%). Los resultados del IVAA frente a la biopsia determinaron una sensibilidad del 99.3% (IC95%: 96.04%-99.97%), especificidad del 5.8% (IC95%: 1.87%-14.93%), valor predicitvo positivo del 70.9% (IC95%: 64.49%-76.74%) y valor predictivo negativo del 80% (IC95%: 29.88%-98.953.16%). Conclusiones: La alta tasa de falsos positivos del IVAA puede generar sobretratamiento, independientemente de las ventajas que representan su uso, en especial para poblaciones alejadas y de bajos recursos

Objective: To determine the usefulness of cytology and visual inspection with acetic acid in the detection of neoplastic lesions of the cervix. Materials and methods: An observational, retrospective, descriptive and cross-sectional study. A population of female patients who attended the Centro Médico Oncomujer between 2013 and 2014 for a cervical cancer screening with Pap test and VIA was evaluated. Women referred for biopsy and with a positive result in one or both tests (Pap-VIA) were included in the study. Results: The mean age was 41.66 years old (range: 20-50 years). One thousand one hundred eight (1108) patients were evaluated with Pap smear and VIA: 8.2% (92/1108) of the patients evaluated by Pap smear had a positive result and 27.6% (306/1108) of those evaluated by VIA tested positive. The results of the cytology (Pap smear) against the biopsy showed a sensitivity of 30.6% (95% CI: 23.7%-3.48%), specificity of 88.4% (95% CI: 77.89.7%-94.51%), positive predictive value of 85.9% (95% CI: 73.65%-999.48%) and negative predictive value of 35.4% (95% CI: 28.43%-43.16%). The results of VIA against the biopsy showed a sensitivity of 99.3% (95% CI: 96.04%-99.97%), specificity of 5.8% (95% CI: 1.87%-14.93%), positive predictive value of 70.9% (95% CI: 64.49%-76.74%) and negative predictive value of 80% (95% CI: 29.88%-98.953.16%). Conclusions: The high false-positive rate of VIA can lead to overtreatment, regardless of the advantages of its use, especially in remote and low-income populations

Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions.

BACKGROUND: Little is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners. METHODS: A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA). RESULTS: The prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p=0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p<0.0001. CONCLUSIONS: Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions.

Caracterización de la neoplasia intraepitelial cervical en mujeres atendidas en el policlínico Jimmy Hirzel / Characterization of cervical intraepithelial neoplasia in women treated in Jimmy Hirzel Polyclinic

Fundamento: el cáncer de cuello uterino, después del cáncer de mama, es el que más frecuentemente afecta a la mujer. La detección y el tratamiento temprano de las neoplasias intraepiteliales cervicales garantizan la calidad de vida ante esta afección.Objetivos: caracterizar a las pacientes con neoplasias intraepiteliales cervicales, que son atendidas en el policlínico Jimmy Hirzel en el municipio de Bayamo, provincia Granma, en el período comprendido entre enero y diciembre de 2013.Métodos: se realizó un estudio descriptivo, retrospectivo, en un universo de 3450 pacientes, a las que se realizó citología vaginal en el período de referencia; la muestra fueron las 55 mujeres, cuyos exámenes resultaron positivos. Se midieron variables como tipo de neoplasia, edad, inicio de las relaciones sexuales, presencia de cervicitis, sepsis vaginal y hábitos de fumar. Los datos se procesaron por conteo simple, se tabularon utilizando valores absolutos y porcentajes.Resultados: la presencia de la neoplasia intraepitelial cervical fue de un 1,6 por ciento, predominando las de bajo grado (NIC 1). El grupo de edad más afectado fue el de 36 a 45 años. Otros factores asociados encontrados con relativa frecuencia, en orden decreciente, fueron: sepsis vaginal, inicio de las relaciones sexuales entre 15-20 años, cervicitis y el hábito de fumar.Conclusiones: existe poca incidencia de las neoplasias intraepiteliales en el área de salud y período estudiados (AU)

Background: cervical cancer is, after breast cancer, the one that most frequently affects women. The early detection and treatment of cervical intraepithelial neoplasia guarantee life quality when faced with this affection.Objective: to characterize those patients suffering from cervical intraepithelial neoplasias who are treated in Jimmy Hirzel polyclinic in Bayamo municipality, Granma province, from January to December, 2013.Methods: a descriptive and retrospective study was carried out in a universe of 3450 patients who underwent vaginal cytology in the period of reference; the sample comprised 55 women with positive results in their tests. The variables such as: type of neoplasia, age, beginning of sexual relations, cervicitis, vaginal sepsis and smoking habit, were measured. The data were processed by simple count and arranged using absolute values and percentages.Results: the presence of cervical intraepithelial neoplasia was of a 1,6 percent, prevailing those with low level (CIN I). The most affected age group was from 36 to 45 years old. Other relatively frequent risk factors were: vaginal sepsis, beginning of sexual relations between 15 and 20 years old, cervicitis and smoking habit.Conclusion: there is a little incidence of the cervical intraepithelial neoplasia in the health area during the period of study (AU)

Persistencia o recidivas de NIC en pacientes conizadas / Persistence or recurrence of CIN in patients cone biopsy

Objetivo: Evaluar la persistencia/recidiva de lesiones pos-cono, con bisturí frío en pacientes que presentaron neoplasia cervical intraepitelial, en el período 1986-1988. Métodos: Se realizó estudio retrospectivo y descriptivo con 136 pacientes conizadas con bisturí frío, período 1986-1988, en el Servicio de Ginecología del Hospital Central de Maracay. Se utilizaron las historias médicas de cada paciente para la elaboración de una ficha de recolección de datos con las variables estudiadas, tomando la información del Departamento de Historias Médicas del Hospital. Resultados: De 136 pacientes conizadas el 88,23 % se mantuvieron sin persistencia/recidiva y la presentaron 11,76 %. Del 8,08 % que desarrollaron recidiva, 3,67 % fueron NIC II diagnosticados entre 16 meses y 5 años, 2,20 % fueron NIC III desarrollados entre 2 a 5 años y 1,47 % fueron NIC I, presentes a los 8 y 20 años. Se diagnosticó un cáncer invasivo a los 3 años (0,73 %). El 3,67 % presentó persistencias, 1,47 % con NIC II diagnosticados a los 6 y 9 meses y 1,47 % con NIC III diagnosticados a 4 y 9 meses. Un caso (0,73 %) presentó cáncer invasivo al año, por lo que es recomendable seguimiento en pacientes conizadas por un período no menor de 5 años, manejándolas cito-colpo-histológicamente.

Objective: To evaluate persistence / recurrence of lesions post-cone, cold scalpel in patients with cervical intraepithelial neoplasia in the period 1986 to 2008. Methods: Analytical study was performed in 136 patients with slitting knife cone biopsy cold period from 1985 to 1988, the HCM gynecology service. We used the medical records of each patient to develop a data collection form with the variables, taking the information from the Department of Medical History of Hospital Central de Maracay. Data were analyzed numerically design tables and charts for respective analysis. Results: 136 patients cone biopsy of the 88.23 % remained without persistence / recurrence and the present 11.76 %. The 8.08 % who developed recurrence, 3.67 % were diagnosed with CIN II between 16 months and 5 years, 2.20 % CIN III were developed from 2 to 5 years and 1.47 % were CIN I, present at 8 and 20 years. Invasive cancer were diagnosed for 3 years (0.73 %). The 3.67 % was observed in persistence, 1.47.% with CIN II diagnosed at 6 and 9 months and 1.47 % with CIN III diagnosed at 4 and 9 months. One case (0.73 %) had invasive cancer per year, so it is advisable to follow patients cone biopsy for a period not less than 5 years, driven cyto-colpo-histological.