RESUMO
OBJECTIVE: To study the clinical value of optoelectronic cervical cancer screening system (TruScreen, TS) in the screening of cervical cancer in comparison with cervical cytology test. METHODS: A total of 392 patients were screened by TS, Pap, TCT, and HPV using the pathological and colposcopical results as the golden standard. The sensitivity, specificity, Kappa value and the area of under ROC of each method and their combinations (parallel tests) were compared. RESULTS: The sensitivity of TS, Pap, TCT and HPV were 32.2%, 42.2%, 74.4% and 47.8%, with specificity of 96.7%, 93.7%, 78.8% and 84.8% in detecting cervical cancer, respectively. The sensitivity of the parallel tests, namely TCT/HPV, TCT/TS, Pap/TS and HPV/TS were 65.6%, 87.8%, 82.2% and 86.7%, with the specificity of 81.1%, 74.5%, 75.8% and 67.2%, respectively. In light of the areas of under ROC, significant differences were noted between the parallel tests of TS/Pap and TS/TCT (P<0.05), but not between TCT/Pap and TCT/TS (P>0.05); significant differences were found between the parallel tests with TS and those without TS (P<0.05), but not between TS alone and the parallel tests incorporating TS (P>0.05), nor between the 4 parallel tests (P>0.05). CONCLUSION: As a new modality for early screening of cervical carcinoma, TS offers a means for real-time cancer detection with better diagnostic efficacy than Pap and HPV and equivalent efficacy to TCT. The combination of TS and cytological tests can further enhance the diagnostic accuracy.
Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Adolescente , Adulto , Idoso , Citodiagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Esfregaço Vaginal , Adulto JovemRESUMO
OBJECTIVE: To evaluate long term effect and related factors in patients with menorrhagia treated by microwave endometrial ablation (MEA). METHODS: Total of 334 women with menorrhagia were treated by MEA, the range of age was from 29 to 59 years old. Among them, 59 cases were complicated by adenomyosis. All the patients were followed up on the change of menstrual cycle, the amount of flow, improvement of anaemia and complication. Fifty-three women underwent outpatient diagnostic hysteroscopy, the biopsy tissue was taken from the endometrium for histopathological examination. The mean duration of follow-up was 64.7 months (3 - 96 months). RESULTS: The overall curative rate was 91.3% (305/334), of which amenorrhea rate was 49.7% (166/334), menstruation reduction rate was 41.6% (139/334) ; 71.1% (140/197) of the cases who previously had dysmenorrhea had relieved their pelvic pain and the satisfactory rate was 91.9% (307/334). Among patients > 40 years, 92.9% (196/211) of operation effective rate, 93.8% (198/211) of satisfactory rate and 64.9% (137/211) of amenorrhea rate were obtained, while patients = 40 years, 88.6% (109/123) of operation effective rate, 88.6% (109/123) of satisfactory rate and 23.6% (29/123) of amenorrhea rate were obtained. There was significant difference in rate of operation effectiveness, satisfaction and amenorrhea (P < 0.05). Forty-two cases required subsequent treatment due to recurrence, of which 9 cases were given by secondary MEA and 33 cases (9.9%, 33/334) underwent hysterectomy indicated by frequent menorrhagia, adenomyosis or leiomyoma. A completely destroyed endometrium was observed by hysteroscopy after MEA, pathologic characteristics of MEA showed two zones of necrotic tissue: the inner zone was coagulation necrosis and the outer zone of necrosis was hypocellular hyalinized myometrium. CONCLUSIONS: MEA is the safe and efficacious management to treat menorrhagia. Incomplete removal of endometrium was the major reason resulting in postoperative recurrence. Young age and complicated with adenomyosis were the main factors influencing long term clinical effect of MEA.