Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands.

OBJECTIVE: National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18-65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors. METHODS: Based on the Primary Health Care database, a sample of adult women (aged 18-65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection. RESULTS: 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%-14.5%) and 11.1% (CI 10.3%-11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18-29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts. CONCLUSIONS: It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations.

Sobre un análisis incorrecto del concepto de ganglio centinela / On an incorrect analysis of the concept of sentinel node breast biopsy

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Utilidad y ventajas de la inyección subareolar única del trazador en la biopsia selectiva del ganglio centinela en el cáncer de mama / Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer

Introducción. La biopsia selectiva del ganglio centinela (BSGC) ha demostrado ser eficaz para determinar el estadio de los ganglios linfáticos en pacientes con cáncer de mama. Es un procedimiento mínimamente invasivo que permite evitar la linfadenectomía en pacientes sin afectación ganglionar. Presentamos el proceso de validación de la BSGC realizado con inyección subareolar única de 99mTc-nanocoloides. Material y método. Durante 2 años se estudió a 100 pacientes con cáncer de mama en estadios iniciales (T1 y T2). A todas ellas se les realizó, el mismo día de la intervención, una gammagrafía con inyección subareolar de 99mTc-nanocoloides para la localización del ganglio centinela (GC). Tras la visualización de los GC, y una vez realizado el marcaje en la piel, se procedió a la tumorectomía seguida de la BSGC utilizando una sonda detectora de rayos gamma. Una vez extirpado el GC se completó el vaciamiento axilar en todos los casos. En el análisis anatomopatológico del GC se utilizó la tinción con hematoxilina-eosina (HE), y con citoqueratinas (CK). Resultados. Se identificó el GC en todos los casos, y se extrajo una media de 1,95 ganglios por paciente. En 44 de ellas el GC presentaba metástasis, y en 15 de estos casos también se encontró extensión al resto de los ganglios axilares. En las 56 pacientes restantes el GC estaba libre de enfermedad, y tan sólo en 2 de ellos existía afectación ganglionar axilar (4,5% falsos negativos). La sensibilidad global de la técnica fue del 95,65% (44/46), y la especificidad del 100% (54/54), con un valor predictivo positivo de 100% y un valor predictivo negativo de 96,4% (54/56). Conclusiones. La BSGC en pacientes con cáncer de mama en estadios iniciales es un proceso seguro y eficaz que proporciona una estadificación al alza de la enfermedad y disminuye la morbilidad asociada a la cirugía axilar. La inyección subareolar presenta las siguientes ventajas: es única, no precisa otras técnicas de imagen para localizar el tumor, permite una rápida visualización del GC y evita la superposición de imágenes cuando el tumor está localizado cerca de la axila (AU)

Introduction. Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. Material and method. We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. Results. The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). Conclusions. SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla (AU)

[Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer]. / Utilidad y ventajas de la inyección subareolar única del trazador en la biopsia selectiva del ganglio centinela en el cáncer de mama.

INTRODUCTION: Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. MATERIAL AND METHOD: We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. RESULTS: The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). CONCLUSIONS: SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla.