Risk Factors for Persistence or Recurrence of High-Grade Cervical Squamous Intraepithelial Lesions.

OBJECTIVES: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence of the lesion. METHODS: a cross-sectional, observational, retrospective study of patients submitted to cold knife conization (CKC) or the loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2 or 3. The colposcopic lesion size, age, surgical method, involvement of the surgical margins, and p16/Ki-67 immunomarker expression were analyzed in relation to lesion persistence and recurrence. RESULTS: seventy-one women were treated with cold knife conization and 200 were treated with loop electrosurgical excision. Of these, 95 had cervical intraepithelial neoplasia 2, 173 had cervical intraepithelial neoplasia 3, 183 had free surgical margins, 76 had compromised margins, and 12 showed damage by processing artifact or fragments. Among the 76 cases with positive margins, 55, 11, and 10 showed endocervical margin involvement, ectocervical margin involvement, and both endocervial and ectocervical margin involvement, respectively. Of the 264 followed-up patients, 38 had persistent or recurrent disease. A multiple logistic regression indicated that positive endocervical margins are the only independent risk factor for the persistence/recurrence of cervical intraepithelial neoplasia. No significant association was identified between the colposcopic lesion size, age, surgery type, or p16/Ki-67 immunomarker expression and lesion persistence or recurrence.

Risk Factors for Persistence or Recurrence of High-Grade Cervical Squamous Intraepithelial Lesions / Fatores de risco na persistência ou recidiva da Lesão escamosa intraepitelial de alto grau (LIEAG)

ABSTRACT Objectives: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence of the lesion. Methods: a cross-sectional, observational, retrospective study of patients submitted to cold knife conization (CKC) or the loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2 or 3. The colposcopic lesion size, age, surgical method, involvement of the surgical margins, and p16/Ki-67 immunomarker expression were analyzed in relation to lesion persistence and recurrence. Results: seventy-one women were treated with cold knife conization and 200 were treated with loop electrosurgical excision. Of these, 95 had cervical intraepithelial neoplasia 2, 173 had cervical intraepithelial neoplasia 3, 183 had free surgical margins, 76 had compromised margins, and 12 showed damage by processing artifact or fragments. Among the 76 cases with positive margins, 55, 11, and 10 showed endocervical margin involvement, ectocervical margin involvement, and both endocervial and ectocervical margin involvement, respectively. Of the 264 followed-up patients, 38 had persistent or recurrent disease. A multiple logistic regression indicated that positive endocervical margins are the only independent risk factor for the persistence/recurrence of cervical intraepithelial neoplasia. No significant association was identified between the colposcopic lesion size, age, surgery type, or p16/Ki-67 immunomarker expression and lesion persistence or recurrence.

RESUMO Objetivos: avaliar se o status das margens, idade, tamanho da lesão colposcópica, tipo de cirurgia e expressão dos marcadores p16/Ki-67 são fatores de risco na persistência ou recidiva da LIEAG. Métodos: um estudo de corte transversal, observacional com coleta de dados retrospectivos de pacientes submetidas a conização a frio (CF) ou exérese da zona de transformação por cirurgia de alta frequência EZT por NIC2/3. Foram analisados os seguintes fatores em relação a persistência ou recidiva: comprometimento das margens, idade, tamanho da lesão, tipo de cirurgia e coexpressão dos imunomarcadores p16 e Ki-67. Resultados: 271 mulheres tratadas com CF (71) e EZT (200), onde 95 apresentavam NIC 2 e 173 NIC 3, 183 apresentaram margens cirúrgicas livres, 76 comprometidas e 12 prejudicadas por artefatos ou fragmentação. Das 76 pacientes com margens comprometidas, 55 foram endocervical, 11 ectocervical e 10 ambas as margens. Das 264 pacientes que tiveram seguimento, 38 persistiram ou recidivaram a doença. A regressão logística múltipla indicou ser a margem endocervical comprometida o único fator independente de risco de persistência/recorrência da NIC (p<0,001). Não houve associação significativa entre a idade, o tamanho da lesão colposcópica, o tipo de cirurgia e a expressão dos imunomarcadores p16/Ki-67 e a persistência ou recorrência da doença. Conclusão: entre os fatores estudados associados com persistência ou recorrência, somente a margem endocervical comprometida provou ser significativamente um fator risco para persistência ou recorrência da lesão.

EPIDEMIOLOGICAL ASSESSMENT AND EXPRESSION OF MARKERS P16/KI67 AS RISK FACTORS IN PERSISTENCE OR RECURRENCE OF HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION / AVALIAÇÃO EPIDEMIOLÓGICA E EXPRESSÃO DOS MARCADORES P16/KI67 COMO FATORES DE RISCO NA PERSISTÊNCIA OU RECIDIVA DA LESÃO INTRAEPITELIAL DE ALTO GRAU

Background: Even when pre-neoplastic lesions are treated, there is a risk that the disease will persist or recur. Objectives: Assess whether the status of the surgical margins, the age, the colposcopic lesion size,type of surgery and the expression of the P16 and KI67 markers are risk factors for the persistence or recurrence of high-grade squamous intraepithelial lesion after CIN 2 and CIN 3 treatment. Methods: A cross-sectional, observational study with retrospective data collection of patients undergoing cold knife( CKC) or Loop electrosurgical excision procedure (LEEP) for CIN 2 or CIN 3. The following factors were analyzed in relation to recurrence: compromised margins, age, lesion size, type of surgery and staining of immunomarkers P16 and KI67. Results: Among the 271 women, aged between 17 and 67 years, 71 had CKC and 200 LEEP, 95 had CIN 2 and 173 CIN 3, regarding the status of the margins, 183 patients had free surgical margins, 76 compromised and 12 damaged by artifacts or fragmentation. Of the 76 with compromised margins, 55 were endocervical, 11 ectocervical and 10 both margins. Of the 264 who completed followup, 38 persisted or relapsed the disease. A hundred-five reactions with the P16 marker were performed. As for the analysis of the P16 color intensity, 8 cases were mild, 32 moderate and 65 were strong. Regarding the analysis of immunostained epithelial thickness, 7 had 1/3 of the epithelium stained, 36 stained 2/3 and 62 stained the entire epithelium. A total of 113 reactions with the 67 KI marker were performed. As for the analysis of staining intensity, 3 cases were mild, 24 moderate and 86 strong. Regarding the analysis of immunostained epithelial thickness, 6 occurred in 1/3 of the epithelium, 48 in 2/3 and 59 in the entire epithelium. Conclusion: Only the status of the endocervical margins was associated with the persistence or recurrence of the lesion. Age, colposcopic lesion size, type of surgery and expression of P16/KI67 markers were not associated with recurrence or persistence of the lesion.

Introdução: Mesmo quando as dificuldades pré-neoplásicas são tratadas, existem os riscos de persistência ou recorrência da doença. Objetivos: Avaliar se o status das margens, idade, tamanho da lesão colposcópica, tipo de operação e expressão dos marcadores p16/ki67 são fatores de risco na persistência ou recidiva da lesão intraescamosa de alto3. Estudos: Estudos de transformação de dados transversais, observacionais de pacientes de dados de processamento de alta frequência (EZT) ou exercícios de análise de dados de alta frequência (EZT) ou NIC com 2 ou 3. Método NIC com 2 ou 3. relação a recidiva: comprometimento das margens, idade da lesão colpo, tipo de operação e tamanho com imunomarcadores P16 e KI67. 2 Resultados: Dentre as 271 mulheres, de 17 a 67 anos, 71 outros CF e 200EZT;95 apresentaram NIC 2 e 173 NIC 3; em relação ao status das margens,183 tiveram como margens, 76 prejudicadas por ameaças ou fragmentação. Das 76 com margens esquerdas, 55 foram endovicais, 11 e 10 as margens. Das 64 que a continuação ou 38 persistiram da persistência da doença completa. Foram realizadas 105 reações com o marcador P16. Quantos casos à análise da intensidade da identificação do P16, 8 foram leves, 32 moderados e 65 fortes. Referente a análise da espessura epitelial imunocorada, 7 tiveram 1/3 do epitélio, 36 coraram 2/3 e 62 todo o epitélio. Foram realizadas 113 reações com o marcador KI67. Quanto à análise da identificação da identificação, 3 casos foram moderados e 86 fortes.Em relação a análise da espessura epitelial imunocorada, 48 e pitélio em 1/3, 59 em todo o epitélio. Apenas conclusão: Apenas conclusão endovicais se associam com persistência ou a recidiva da recidiva. A idade, o tamanho da lesão colposcópica, o tipo de procedimento cirúrgico e a expressão dos marcadores P16/KI67 não tiveram associação com a recidiva ou persistência da lesão

Citologia oncótica cervicovaginal na população lésbica e transgêneros / Cervicovaginal oncotic cytology in the lesbian and transgender population

O câncer de colo uterino causa a morte de milhares de mulheres no mundo. Entre essas mulheres, há grupos como o de lésbicas e transgêneros que têm dificuldade no rastreio devido à discriminação e ao desconhecimento. As lésbicas e transgêneros masculinos que não fizeram histerectomia total devem se manter no rastreio da mesma forma que as mulheres cisgêneros. Transgêneros femininos devem ser seguidas, porém ainda não há protocolos definidos.(AU)

Cervical cancer causes the death of thousands of women worldwide. Among these women, there are groups, like lesbians and transgenders that present difficulty in screening due to discrimination and lack of knowledge. The lesbians and transgenders men who didn´t have total hysterectomy, must keeping in screening the same way as cisgenders. Transgender woman must be followed, but there aren't definitive guidelines.(AU)

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia.

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.

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia / Número de fragmentos, status das margens e artefatos térmicos de peças conizadas de cirurgia com alças de ondas de alta frequência no tratamento da neoplasia intraepitelial cervical

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.