Correlación entre hallazgos histeroscópicos y reportes histopatológicos en pacientes con sangrado uterino anormal / Correlation between hysteroscopic and histopathological reports in patients with abnormal uterine bleeding

Resumen OBJETIVO: determinar la sensibilidad, especificidad, valores predictivos positivos y negativos de la histeroscopia; evaluar su correlación con los reportes histopatológicos en pacientes con sangrado uterino anormal. MATERIALES Y MÉTODOS: estudio descriptivo y observacional, al que se incluyeron los registros de procedimientos histeroscópicos de pacientes con sangrado uterino anormal y posmenopáusico, atendidas en el Hospital Integral de la Mujer del Estado de Sonora (HIMES). Se clasificaron los hallazgos histeroscópicos e histopatológicos de las alteraciones endometriales. Para calcular la sensibilidad y especificidad de la histeroscopia las pacientes se agruparon en dos categorías: endometrio normal (mujeres sanas) y endometrio anormal (pacientes con pólipo endometrial, mioma submucoso, adenomiosis, hiperplasia endometrial, cáncer de endometrio, entre otras alteraciones). El análisis estadístico se realizó con el programa SPSS V. 22, para Windows 10.0. La sensibilidad y especificidad se calcularon con intervalos de confianza al 95%, para calcular el coeficiente de correlación se utilizó el método de Pearson. RESULTADOS: se registraron 400 pacientes, con media de edad de 45.2 (± 11.04) años; los diagnósticos más frecuentes fueron los pólipos (26%) y el cáncer endometrial (8%). Se registró una sensibilidad de 0.95 (IC95%: 0.93-0.97) y especificidad de 0.85 (IC95%: 0.82-0.89) para la histeroscopia. Para la detección de las causas de sangrado uterino anormal por histeroscopia se registró un valor predictivo positivo de 0.97 (IC95%: 0.95-0.98) y negativo de 0.79% (IC95%: 0.75-0.83). La correlación entre histopatología e histeroscopia fue de 77.8% (Pearson; p = 0.000), cuando el diagnóstico se establece como endometrio normal o anormal. CONCLUSIÓN: la histeroscopia es una técnica con elevada sensibilidad y especificidad para establecer el diagnóstico de alteraciones endometriales benignas y malignas; además, se observó excelente correlación entre los hallazgos histeroscópicos y los resultados histopatológicos.

Abstract OBJECTIVE: To determine the sensitivity and specificity, predictive value positive and negative and estimate the correlation coefficient between hysteroscopy and endometrial histopathological outcomes in patients with abnormal uterine bleeding. MATERIALS AND METHODS: Descriptive, observational, a series of consecutive cases was performed at the Hysteroscopy Clinic of the "Hospital Integral de la Mujer del Estado de Sonora" were included with abnormal uterine bleeding. The hysteroscopy and histopathological findings of the endometrial alterations were classified. In order to calculate the sensitivity and specificity of the hysteroscopy, the patients were grouped into two categories: normal endometrium (healthy women) and abnormal endometrium (patients with endometrial polyp, submucous myoma, adenomyosis, endometrial hyperplasia, endometrial cancer, among other alterations). Statistical analysis was performed using the SPSS program V. 22, for Windows 10.0; the sensitivity and specificity was calculated with 95% confidence intervals, the correlation coefficient was estimated by Pearson method. RESULTS: We registered 400 patients; the average age was 45.2 (±11.04). The most frequent diagnosis by hysteroscopy and histopathological was endometrial polyp. The sensitivity was 0.95 (95%CI = 0.93-0.97) and specificity of 0.85 (95%CI = 0.82-0.89) as cause of abnormal uterine bleeding by hysteroscopy, the positive predictive value was 0.97 95%CI = 95-98) and negative predictive value of 0.79%. (CI95% = 0.75-0.83). The Pearson correlation coefficient was 77.8% (p = 0.000) between hysteroscopy impression and histopathology diagnosis, when the result was classified as normal or abnormal. CONCLUSION: Hysteroscopy is a high sensitivity and specificity technique to diagnosis of benign and malignant endometrial alterations; in addition, an excellent correlation was observed between the hysteroscopy findings and the histopathological findings.

Cetuximab concomitant with gemcitabine and radiotherapy in advanced squamous cell carcinomas of upper aerodigestive tract: a pilot study

PURPOSE: To explore the response and toxicity of advanced non-metastatic squamous cell carcinomas of upper aerodigestive tract (SCC-UADT) to a combination of cetuximab concomitant with gemcitabine and radiotherapy. METHODS: We managed patients with concomitant treatment of cetuximab (400 mg/m(2) as uploading dose, then 250 mg/m(2), IV) concomitant with gemcitabine (50 mg/m(2)) weekly for seven courses, and radiotherapy in classical fractionation until completion of 70 Gy. Primary endpoints were complete response (CR) to treatment and toxicity. We evaluated patients for toxicity on a weekly basis; evaluation of response included physical examination, endoscopy, computed tomography (CT) scan and biopsy when indicated, and was performed 6 weeks after completion of radiotherapy. Additional evaluations were done every 3 months to document disease status. Between November 2004 and November 2005, 20 patients were included. RESULTS: CR was 82.4%, overall response was 100%. Neck disease reached CR in 61.5% and partial in 38.5% of patients. The main toxicities were nausea, lymphopenia, neutropenia and mucositis. Grade 3 and 4 side effects were presented in 70.6% of patients, but mucositis, and lymphopenia without clinical repercussions, occurred in 88.2% of patients. Gastrostomy was required in 11.8% of patients to maintain nutrition. Radioepithelitis developed in 76.5%, but only three of these (23.1%) were grade III. Median overall survival was 53 months (range 6-55 months) and median progression-free survival has not yet been reached at the time of evaluation. CONCLUSIONS: Although toxicity is important, this approach has interesting activity and deserves further investigation (AU)

[Prognostic factors of mortality in the malignant biliary obstruction unresectable after the insertion of an endoscopic stent]. / Factores pronósticos de mortalidad en la estenosis biliar distal maligna irresecable después de la colocación de una prótesis endoscópica.

OBJECTIVE: To determine the factors prognostics of early mortality in the malignant billary estenosis after the endoscopic derivation. BACKGROUND DATA: The surgical, percutaneous or endoscopic derivation is the alternative of palliative treatment in the biliary obstruction unresectable. The factors prognostic the early mortality after surgical derivation are: hemoglobin < 10 g/dL, serum bilirubin > 10 mg/dL and serum albumin < 2.5 g/dL; for the percutaneous derivation they are the sanguineous urea more of 4.3 mmol/L and hemoglobin < 10.9 g/dL; whereas in the single endoscopic derivation type 3 of Bismuth and the infectious complications after the endoscopic colangiography and the absence of the clinical success were factors prognoses of early mortality. METHODS: Descriptive and retrospective analysis of 97 cases with malignant biliary obstruction. The factors were evaluated prognoses of early mortality. Univariated and bivaried analysis and of survival by the method of Kaplan-Meier was made curved. RESULTS: 97 cases were included that presented/displayed unresectable disease and had a biochemical control subsequent to the drainage. They were 58 women and 39 men. More frequent symptoms: ictericia, pain and prurito. 61 cases of distal obstruction and 36 with proximal obstruction. Twenty deaths (25.9%) happened within the 30 later days to the treatment. The bilirubin > 14 mg/dL and the proximal location were like predicting of early mortality. CONCLUSIONS: The obstruction biliary more frequent is located in choledocho distal and is of pancreatic origin. The main factors associated to early mortality are: the bilirubin > of 14 mg/dL and the proximal location reason why is important the suitable selection of patient candidates to endoscopic derivation. The survival is better in the distal obstruction.

Significance of microvascular density (MVD) in cervical cancer recurrence.

The purpose of this retrospective study of 118 patients with squamous cell cervical cancer from January 1990 to December 1993 was to evaluate angiogenesis as predictive factor of recurrence in cervical cancer stages II-III treated with standard radiotherapy. Microvessel density (MVD) was evaluated and correlated with other prognostic factors. MVD was greater than 20 in 67.8% of patients with recurrence (P = 0.002) in comparison to 39% of patients without. Disease-free survival was shorter in stage IIA and MVD >20 (P = 0.0193) as well as for stage IIB (P < 0.05 ), but not for IIIB (P = 0.1613 ). Global survival was significantly shorter when MVD was >20 (P = 0.0316). For stage IIA and MVD >20 survival was shorter (P = 0.0008) for stage IIB (P < 0.05) but not for IIIB (P = 0.14). Patients younger than 40 years and MVD >20 had poorer disease-free interval and survival (P = 0.0029). MVD in patients with squamous cell cervical cancer stage II and age younger than 40 may play a role in predicting recurrence and survival.

Tumor angiogenesis as a prognostic factor in oral cavity carcinomas.

Currently, lymph node metastasis and thickness of the tumor are the gold standard as a predictor of survival in patients with oral cavity squamous cell carcinoma (OSCC). However, there is a significant correlation between microvessel density and the development of cervical metastases or recurrence. Previous studies have demonstrated that head and neck cancers are able to induce an angiogenic response in experimental models. This factor shows a strong correlation with regional recurrence. In this study we propose to use angiogenesis as an independent prognostic indicator of recurrence. We evaluated the expression of tumor angiogenesis in OSCC and determinated its possible usefulness as a prognostic factor. Thirty-three cases with diagnosis of OSCC were identified from January 1985 to January 1997 in the Head and Neck Department of the Instituto Nacional de Cancerología in Mexico City. These cases were analyzed retrospectively for a minimum period of six months. All of them received a conventional complete treatment to the primary tumor and lymph node metastasis. Paraffin-embedded tumor specimens were available in all patients. The tumors were scanned and the areas of highest microvessel density (MVD) were immunostained for CD-34 using QBEnd/10 antibody. Statistical analysis included descriptive statistics, Wilcoxon test curves, and Cox's proportional hazards model for multivariate analysis. We identified 33 patients with OSCC, 16 were men and 17 women. The mean age among all patients was 58.9 years old. Based on tumor size 33.3% were T1, 27.3% T2, 12.1% T3, and 27.3% T4. The median microvessel count was 32.5. The mean percentage of MVD was 37 in patients with regional recurrence and in those patients without regional metastasis was 29 (p<0.05). 57.9% of the patients who presented recurrence had vessel counts over the median (p<0.01). In fact, 6 patients (46%) who showed more than 20% of angiogenesis expression and higher MVD presented with recurrence. Only 3 patients (23%) who had less than 20% of angiogenesis expression and lower MVD developed recurrence (p<0.01). Higher MVD was seen with increasing T and N stages; however, it did not show correlation with survival. In this study, angiogenesis expression demonstrated to be an independent factor of recurrence in patients with OSCC. It is suggested that it should be used as an independent prognostic indicator. In concordance with previous reports, we observed a significant correlation between MVD determination and recurrence of the tumor, followed by lymph node metastases and tumor size.

Accuracy of fine-needle aspiration biopsy of the thyroid combined with an evaluation of clinical and radiologic factors.

Fine-needle aspiration biopsy (FNAB) of thyroid nodules is an operator-interpreter-dependent procedure whose diagnostic accuracy has deficiencies, especially concerning indeterminate and negative results. There are reports in the literature of up to a 15% definitive diagnosis of carcinoma in the first category of cytology and an 11% false-negative rate in the second category. With these facts in mind, a prospective study was done at the Instituto Nacional de Cancerología, Mexico City, to determine whether one or several clinicoradiologic factors were associated with a final pathologic diagnosis of carcinoma, thereby increasing the diagnostic accuracy of thyroid FNAB. In total, 200 cases were reviewed, and 159 patients underwent surgery. Our study group comprises these 159 patients. The only clinical factor associated with false-negative results was size > or = 4 cm, with no statistical significance for the other factors analyzed. A comparison was done between clinical factors of patients who had indeterminate results in the aspirate and those of patients who had a definitive diagnosis by permanent section of the thyroid carcinoma, where an association was found between malignancy and tumor size > or = 4 cm, irregular borders, fixed lesions, and heterogeneity on ultrasound. We conclude that in the presence of a negative cytology result, with tumor size > or = 4 cm, close follow-up is indicated, and a new thyroid FNAB should be performed in 6 months. If the nodule persists or grows, a surgical procedure should be considered. In the case of an indeterminate cytology result and in the absence of those factors associated more frequently with a pathologic result of carcinoma, a conservative approach could be indicated with clinical follow-up and repeat thyroid FNAB in 6 months to 1 year.

The impact of preoperative tracheotomy on T3 transglottic carcinomas of the larynx.

To evaluate the impact of the practice of a preoperative tracheotomy and different prognostic factors reported in the literature in patients with transglottic carcinoma of the larynx, a retrospective study was performed in the Instituto Nacional de Cancerologia, Mexico City. In all, 90 cases with T3 transglottic squamous cell carcinoma requiring a total laryngectomy as primary treatment were studied. Prognostic factors such as the Karnofsky index, tumor differentiation, surgical margins and preoperative tracheotomy were analyzed by a Cox's proportional hazards model. The Kaplan-Meier method and log rank test were used to evaluate the disease-free intervals and survival curves. Thirty-two patients had preoperative tracheotomies, while 58 did not. Eighty percent of the patients in the non-preoperative tracheotomy group were alive after 5 years versus 20% of those with preoperative tracheotomies (P < 0.001). Although possibly controversial, our findings indicate that a pretreatment tracheotomy should be avoided in T3 transglottic obstructive lesions. In patients with these lesions and a subglottic extension < or = 3 cm we recommend an emergency total laryngectomy when possible to increase survival and decrease surgical morbidity.

[Descriptive epidemiology cancer in the National Cancer Institute of Mexico]. / Epidemiología descriptiva de cáncer en el Instituto Nacional de Cancerología de México.

OBJECTIVE: To analyze the descriptive epidemiology of cancer at the Instituto Nacional de Cancerología of Mexico, and describe the characteristics of the growing demand for medical care. MATERIAL AND METHODS: A review of the 10 year experience of the Hospital Cancer Registry from 1985 to 1994 was done. RESULTS: During the study period a total of 28591 patients was registered with the histological confirmation of cancer. There were 8984 (31.4%) men, being the testicle (8.3%), the lung (7.4%), non-Hodgkin's lymphoma (7.1%) and the prostate (5.5%) the more frequent malignancies. In women a total of 19597 (68.6%) cases were seen; together, invasive cervical cancer (30.6%) and breast cancers (20.6%) represent more than 50% of all patients. In 1996, 108876 outpatient services were given, 6492 hospitalizations, 36388 sessions of radiotherapy and 9116 of chemotherapy. Only 30% of this population comes from Mexico City, the remaining lives in the 31 different states of Mexico. CONCLUSIONS: Supporting the development of the Centros Estatales de Cancerología for the referral of patients is necessary, this will avoid the rapid saturation of medical care at the institute. Also, stimulate the development of hospital registries and collaborate with the Ministry of Health to improve the early cancer detection programmes in Mexico.

[Expression of cathepsin D in breast cancer and its clinical and histopathological correlations]. / Expresión de catepsina D en carcinoma mamario y sus correlaciones clínicas e histopatológicas.

BACKGROUND: Cathepsin D is a lysosomal protease which is overexpressed in some cases of breast cancer. Several studies done in tumor cytosol have shown that high levels of cathepsin D are associated with poor prognosis in patients with breast cancer but the results are not conclusive using immunohistochemistry methods to assay cathepsin D. OBJECTIVE: To evaluate if cathepsin D, assayed by a immunohistochemical technique using a polyclonal antibody, can be considered an independent prognostic factor in breast cancer. PATIENTS AND METHODS: Paraffine embedded sections of 68 tumor specimens from breast cancer patients in stages I to IV seen at the Instituto Nacional de Cancerologia during the period from 1985 to 1986. RESULTS: From the 68 patients, 35 (51%) had an intense positive staining for cathepsin D, 19 (28%) han mild staining and 14 (21%) were negative. Ten patients with mild staining had artifacts due to deficiencies in the tissue fixation technique. Cathepsin D expression did not have a prognostic value nor association with other clinical and histopathological prognostic factors well established in breast cancer. CONCLUSION: Cathepsin D determined by immunohistochemistry has no prognostic value in breast cancer.

Misoprostol prophylaxis for high-dose chemotherapy-induced mucositis: a randomized double-blind study.

From April 1993 to September 1993, 15 patients with lymphoid or solid neoplasms underwent 16 non-cryopreserved peripheral stem cell transplantation courses using the ICE (ifosfamide, carboplatin, etoposide) program. They were randomized in a double-blind clinical trial to received oral misoprostol or placebo for mucositis prophylaxis. The active drug or placebo administration began jointly with chemotherapy at day -4 and was continued until day 16. The mucositis incidence and severity was significantly higher in patients who received misoprostol. We found no differences regarding myelosuppression, infections or other chemotherapy complications. Our results do not support the use of oral misoprostol as administered in this study, for high-dose chemotherapy-induced mucositis prophylaxis.

Cancer of the mobile tongue in Mexico. A retrospective study of 170 patients.

Histological reports of 170 patients with cancer of the mobile tongue between 1977 and 1989 were identified at the Instituto Nacional de Cancerología (INCan), in Mexico City. Demographic, clinical and histological information was retrospectively reviewed. Chi-square, Student's t-test and Wilcoxon rank-sum test were applied for comparisons, and Kaplan-Meier curves, log-rank test and Cox proportional hazards for survival analysis. Of the 161 patients with mobile tongue squamous cell carcinoma (MTSCC), 104 (65%) were males and 57 (35%) were females. The mean age was 60 years old (range 19-91). T1 and T2 lesions comprised 35%, T3 and T4 lesions 65%. There was a statistically significant association between size of the tumour and lymph node involvement (P < 0.0001). The proportion of cases with advanced disease was 80% for males and 57% for females (P = 0.008). The 5-year survival rate was 16% (CI 10.2-22.8%). Cancer of the mobile tongue in Mexico still has a poor prognosis. Efforts should be made to reduce the delay in diagnosis of MTSCC, in order to increase the cure rates and improve the quality of life of the patients.

Gastric carcinoma: curative resection and adjuvant chemotherapy.

A retrospective study of gastric adenocarcinoma treated with surgery as curative attempt was performed at the Oncology Service, in the Hospital Regional 20 de Noviembre, ISSSTE. Morbidity and mortality of the surgical procedures were evaluated, the significance of several risk factors and the survival impact of adjuvant chemotherapy with 5-fluorouracil (5-FU) and mitomycin C (MMC). In the period from 1975 to 1991 a total of 483 new cases were seen. In only 54 patients (11.2%) was it possible to undertake a curative resection. The patients were assigned to three groups of treatment: surgery alone (14 cases), surgery + 5-FU (19 cases), and surgery + 5-FU+MMC (21 cases). Three different types of surgical techniques are regularly performed in our service for gastric cancer treatment: Billroth II distal gastrectomy, total gastrectomy with Roux-En-Y reconstruction, and esophagogastrectomy with esophagogastrostomy. Surgical morbidity and mortality was low, with 9% of duodenal stump fistulas and 27% with partial stenosis of esophagojejunostomy; the operative mortality was zero. Chemotherapy toxicity was transient and low, no related deaths were recorded. The prognostic factors associated significantly with survival were lymph node status and tumor penetration. The histologic differentiation as well as the tumor location and type of surgery had no significance. The estimated 5-year survival of the patients treated with surgery alone was 62%, while that of the patients treated with surgery plus chemotherapy was 38%. These groups were not comparable, however, because of important differences in their prognostic factors. The groups treated with 5-FU alone or in combination with MMC had no survival difference between them.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy of a new in vitro test (Phadiatop paediatric) for the diagnosis of allergy in children]. / Eficacia de una nueva prueba in vitro (Phadiatop paediatric) para el diagnóstico de alergia en la edad pediátrica.

An investigation was done to know specificity and sensitivity of one in vitro test useful for diagnosis of allergy in pediatric age (Phadiatop paediatric), in 65 children in two groups. Group 1 (35 children) with diagnosis of respiratory allergy (asthma, rhinitis, or both) based on clinical history, eosinophils, IgE and skin tests; and group 2 (control) with no allergy diagnosis. In both groups IgE was measured and Phadiatop test was done. In group 1, Phadiatop paediatric was positive in 28 children (80%) while in group 2 was positive in 2 children (6.6%) that means a 67.5% sensitivity and 88.0% specificity, for this test.