Comparación de los resultados oncológicos entre cirugía radical por laparotomía versus la de mínima invasión en cáncer temprano de cérvix / Comparison of oncologic outcomes between radical laparotomy surgery versus minimally invasive surgery for early cervical cancer

Introducción: la histerectomía radical con linfadenectomía pélvica es el tratamiento estándar para las pacientes con cáncer de cérvix en estadios tempranos que no desean preservar la fertilidad. Objetivos: comparar tasas de supervivencia global, periodo libre de enfermedad y recurrencia entre histerectomía radical por mínima invasión (CMI) versus cirugía abierta. Además analizar las características histopatológicas, complicaciones intraoperatorias, posoperatorias tempranas y tardías entre ambas técnicas. Metodología: estudio observacional de cohorte retrospectivo entre 2011 y 2017. Se incluyeron mayores de 18 años con diagnóstico de carcinoma de cuello uterino en estadios IA1 (invasión del espacio linfovascular) a IB1 (FIGO 2009) con seguimiento hasta diciembre 2020. Se hizo análisis bivariado utilizando chi cuadrado, prueba exacta de Fisher o U Mann Whitney para determinar las diferencias entre las técnicas quirúrgicas frente a características sociodemográficas, clínicas, complicaciones intraoperatorias, tempranas y tardías. Se calcularon tasas de supervivencia global y densidades de recurrencia con el tiempo aportado por las pacientes. Resultados: de 113 pacientes llevadas a histerectomía radical, 75 se excluyeron del análisis. La supervivencia global fue 100% para las del grupo de laparotomía versus 97.6% en CMI. La tasa de recurrencia global fue de 8 casos y la del grupo de CMI 14.1 por 1.000 personas/año de observación. El grupo de laparotomía no presentó recaídas. Hubo diferencia significativa en la mediana de sangrado intraoperatorio (600 cc laparotomía versus 100 cc laparoscopia, p= 0.002); 11.4% requirieron transfusión intraoperatoria (25% laparotomía versus 2.4% mínima invasión, p=0,006). Conclusiones: las pacientes llevadas a cirugía por laparoscopia tuvieron una mayor proporción de recurrencia y mortalidad en comparación con el abordaje por técnica abierta.

Introduction: radical hysterectomy with pelvic lymphadenectomy is the standard treatment for early cervical cancer patients who do not wish to preserve fertility. Objetives: this study compares overall survival, disease-free survival, and recurrence rates of patients undergoing minimally invasive radical hysterectomy (MIS) versus open surgery. Likewise, the histopathological characteristics, intraoperative complications, early and late postoperative complications, are analyzed for both techniques, Methodology: an observational retrospective cohort study between 2011 and 2017. Patients over 18 years of age diagnosed with cervical carcinoma in stages IA1 (lymph vascular space invasion) and IB1 (FIGO 2009) receiving follow-up care until December 2020, were included. The Chi-square test, Fisher ́s exact test or Mann Whitney U test were used for bivariate analysis, to determine the differences between the techniques with regards to sociodemographic, clinical characteristics and intraoperative early and late complications. Overall survival rates and recurrence densities were calculated with data provided by the patients. Results: of the 113 patients undergoing radical hysterectomy, 75 were excluded from the analysis. Overall survival was 100% in the laparotomy group versus 97.6% in the MIS group. The overall recurrence rate was of 8 cases, 14.1 per 1.000 person-years of observation in the MIS group. Patients in the laparotomy group developed no recurrences. There was a significant difference in median intraoperative blood loss (600 cc in laparotomy versus 100 cc in laparoscopy, p= 0.002); 11.4% of patients required intraoperative transfusion (25% in the laparotomy group versus 2.4% in the MIS group, p=0.006). Conclusions: patients who underwent laparoscopic surgery had a higher recurrence and mortality rate than that of open approach

Neoplasia cervical e infección por virus del papiloma humano como factores de riesgo para desarrollo de cáncer anal y lesiones precursoras / Cervical neoplasia and human papilloma virus infection as risk factors for the development of anal cancer and precursor lesions

RESUMEN La incidencia del cáncer anal ha presentado un incremento en los últimos 10 años, sobre todo en población considerada vulnerable. Las mujeres con antecedentes de infección por Virus del Papiloma Humano (VPH) en el tracto genital, tienen mayor riesgo de este tipo de cáncer. Se ha demostrado que, la infección con genotipos de VPH de alto riesgo (AR), en la región anogenital, desempeña un papel en la etiopatogenia de dicho cáncer. Se desconocen muchos aspectos de la historia natural de las lesiones anales, pero se considera que la zona de transición anal presenta un alto recambio celular, por lo que se ha planteado un mecanismo fisiopatológico de infección por VPH-AR y desarrollo de lesiones invasoras, similar al del cáncer cervical. El objetivo de este trabajo fue mostrar el estado actual sobre la información epidemiológica que vincula el riesgo de desarrollar cáncer anal en mujeres con lesiones precursoras de cáncer cervical asociadas a la infección por VPH. La relevancia de dicha información es proporcionar una base de recomendaciones para la detección oportuna de cáncer anal en mujeres consideradas de AR de padecerlo y, favorecer la realización de estudios prospectivos en la población.

ABSTRACT The incidence of anal cancer has increased in the last 10 years, especially in the population considered to be at risk. Women with a history of infection in the genital tract by Human Papillomavirus (HPV) have higher risk of developing this type of cancer. The presence of high-risk (HR) HPV genotypes in the anogenital region has been shown to play a role in the etiopathogenesis of anal cancer. Many aspects of the natural history of anal lesions are unknown, but the anal transition zone is considered to have a high cell replacement. This is why a pathophysiological mechanism of HR-HPV infection and development of invasive lesions similar to those of cervical cancer has been suggested. The aim of this work was to show the current status of the epidemiological information that links the risk of developing anal cancer in women with cervical cancer precursor lesions associated with HPV infection. The relevance of this information is to provide a basis of recommendations for the timely detection of anal cancer in women considered to be at HR of suffering it, and to encourage more prospective studies in this population.

Association of Swede Score and 2011 IFCPC Nomenclature in Women with Abnormal Cytology / A Associação entre o escore Swede e a nomenclatura IFCPC 2011 em mulheres com citologia anormal

Abstract Objective To assess the association between two colposcopic indices, the Swede score and the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Nomenclature as well as to determine the efficacy of the Swede score with cutoffs of 7 and 8. Methods In the present cross-sectional pilot study, 34 women who had at least 1 colposcopy-directed biopsy due to abnormal cytology were enrolled. The colposcopic findings were scored by both the Swede score and the 2011 IFCPC Nomenclature and were compared with each other. The Kappa coefficient and the McNemar test were used. Accuracy, sensitivity, specificity, and positive and negative predictive values (NPV and PPV, respectively) were calculated, as well as the effectiveness with cutoffs of 7 and 8 in identifying cervical intraepithelial neoplasm (CIN) 2+ when using the Swede score. Results The correlation between the 2 colposcopic indices was 79.41%. The Kappa coefficient and the McNemar p-value were 0.55 and 0.37, respectively. The IFCPC Nomenclature had sensitivity, specificity, accuracy, PPV, and NPV of 85.71, 55.00, 67.64, 57.14, and 84.61%, respectively. The Swede score had sensitivity, specificity, accuracy, PPV, and NPV of 100, 63.15, 79.41, 68.18, and 100%, respectively. A Swede score cutoff of 7 for CIN 2+ detection had a specificity of 94.73%, while with a cutoff of 8 it increased to 100%. The sensitivity for both values was 60%. The PPV and NPV for cutoffs of 7 and 8 were 90 and 75 and 100 and 76%, respectively. Conclusion Although both colposcopic indices have good reproducibility, the Swede score showed greater accuracy, sensitivity, and specificity in identifying CIN 2 + , especially when using a cutoff of 8.

Resumo Objetivo Avaliar a associação entre dois índices colposcópicos, o escore Swede e a Nomenclatura International Federation of Cervical Pathology and Colposcopy (IFCPC, na sigla em inglês) 2011, assim como determinar a eficácia do escore Swede com os pontos de corte 7 e 8. Métodos Trata-se de um estudo transversal, com 34 mulheres incluídas, que realizaram colposcopia com biópsia dirigida devido a uma citologia anormal. Os achados colposcópicos foram categorizados pelo escore Swede e pela Nomenclatura IFCPC 2011 e comparados um com o outro. Foram avaliados o coeficiente Kappa e o teste de McNemar e foram calculados a acurácia, a sensibilidade, a especificidade e valores preditivos negativos e positivos (VPN e VPP, respectivamente) de cada índice, assim como a eficácia com os pontos de corte 7 e 8 do escore Swede para determinar as lesões de neoplasia intraepitelial cervical (NIC) 2 + . Resultados A concordância entre os 2 índices foi de 79,41% e o coeficiente Kappa e o valor-p do teste de McNemar foram 0.55 e 0.37, respectivamente. Pela Nomenclatura IFCPC 2011, obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 85,71, 55,00, 67,64, 57,14 e 84,61%. Pelo escore Swede obtivemos como sensibilidade, especificidade, acurácia, VPP e VPN, respectivamente: 100, 63,15, 79,41, 68,18 e 100%. O uso do escore Swede para detecção das lesões NIC 2+ obteve como especificidade 94,73% com o valor de corte de 7, enquanto o valor de corte 8 obteve 100%. A sensibilidade para ambos os cortes foi de 60%. O VPP e o VPN com os cortes 7 e 8 foram, respectivamente: 90,00 e 75,00 e 100,00 e 76,00%. Conclusão Ambos os índices colposcópicos tiveram boa reprodutibilidade; no entanto, o escore Swede mostrou melhor acurácia, sensibilidade e especificidade em identificar as lesões NIC 2+ e o melhor ponto de corte para identificar as lesões NIC2+ foi com o valor 8.

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)

Profile of women with anal neoplasia associated with cervical neoplasia receiving care at a tertiary healthcare facility in northeastern Brazil / Perfil de mulheres com neoplasia anal associada à neoplasia cervical atendidas em um serviço de saúde terciário do nordeste do Brasil

Abstract Objective: To describe the epidemiological, clinical and laboratory profiles of women with anal neoplasia associated with cervical neoplasia attending a tertiary healthcare facility in northeastern Brazil. Methods: This epidemiological, descriptive study was conducted using a database from a cross-sectional study carried out between December 2008 and January 2016. Women with a diagnosis of cervical neoplasia associated with anal neoplasia were included in the present study. Results: Of the women with cervical neoplasia, 14% were found to have an anal intraepithelial lesion or anal cancer. Median age was 33 years, 68% were non-white, and 70% were from urban regions, had little schooling and low income. Most reported having had anoreceptive (73%) and unprotected intercourse (84%). Regarding symptoms, 7% reported bleeding and 11% pruritus. Overall, 10% of the sample tested positive for the human immunodeficiency virus. Anal cytology was abnormal in 92%. High-resolution anoscopy was abnormal in all cases. Histopathology revealed three cases of invasive carcinoma and high-grade lesions in 32% of the cases. Conclusion: Women with a diagnosis of anal and cervical neoplasia are often young, non-white women, who initiated their sexual life at an early age, were exposed to unprotected anoreceptive intercourse, live in urban centers, have little schooling and a low-income level.

Resumo Objetivo: Descrever os perfis epidemiológico, clínico e laboratorial de mulheres com neoplasia anal associada à neoplasia cervical atendidas em uma unidade de saúde terciária no nordeste do Brasil. Métodos: Este estudo epidemiológico e descritivo usou um banco de dados de um estudo transversal realizado entre dezembro de 2008 e janeiro de 2016. Mulheres com diagnóstico de neoplasia cervical associada à neoplasia anal foram incluídas no presente estudo. Resultados: Das mulheres com neoplasia cervical, 14% apresentaram lesão intra-epitelial anal ou câncer anal. A mediana de idade foi de 33 anos; 68% das pacientes não eram brancas e 70% eram provenientes de regiões urbanas, com baixa escolaridade e baixa renda. A maioria relatou histórico de relações sexuais anoreceptivas (73%) e desprotegidas (84%). Quanto aos sintomas, 7% relataram sangramento e 11% prurido. No geral, 10% das pacientes apresentaram serologia positiva para o vírus da imunodeficiência humana. A citologia anal foi anormal em 92% da amostra. A anuscopia de alta resolução foi anormal em todos os casos. A histopatologia revelou três casos de carcinoma invasivo e lesões de alto grau em 32% dos casos. Conclusão: As mulheres com diagnóstico de neoplasia anal e cervical geralmente são jovens, não brancas, que iniciaram sua vida sexual em idade precoce, foram expostas a relações sexuais anoreceptivas desprotegidas, moram em centros urbanos e têm baixa escolaridade e baixo nível de renda.

Management of atypical squamous cell cases: A prospective study of women seen at a private health service in northeastern Brazil / Conduta em casos de células escamosas atípicas: um estudo prospectivo de mulheres atendidas pelo serviço de saúde privado no nordeste do Brasil

Abstract Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p< 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p< 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p< 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Resumo Objetivo Avaliar a conduta adotada por ginecologistas após resultados citológicos apresentando células escamosas atípicas (ASCs) e os desfechos destes casos em mulheres brasileiras. Métodos Um estudo observacional prospectivo avaliou o manejo clínico inicial do ginecologista nos casos de 2.458 resultados citológicos apresentando ASCs coletados entre janeiro de 2010 e julho de 2016. Os respectivos desfechos citológicos, histológicos e de detecção do papilomavírus humano (HPV) foram comparados entre os subgrupos células escamosas atípicas de significado indeterminado (ASC-US) e células escamosas atípicas não podendo excluir lesão intraepitelial de alto grau (ASC-H). Resultados Nenhuma conduta foi adotada em 36,97% de citologias do tipo ASC-US e 40,5% do tipo ASC-H. A conduta mais escolhida foi a repetição da citologia, inclusive para acompanhamento de ASC-H, o que contraria as diretrizes nacionais. O tempo de realização de uma nova citologia para resultado do tipo ASC-US em mulheres com mais de 30 anos de idade foi de 13,03 meses, também em desacordo com as diretrizes (p< 0,0001). Resultados negativos para lesão intraepitelial ou neoplasia maligna (NILM), tanto citológicos (p = 0,0026) como histológicos (p = 0,0017), foram associados a ASC-US, enquanto que resultados negativos para lesões intraepiteliais escamosas de alto grau (HSILs), citológicos (p< 0,0001) e histológicos, foram associados a ASC-H (p< 0,0001). Dois carcinomas cervicais invasivos foram encontrados durante o acompanhamento para ASC-H e uma associação estatisticamente significante foi estabelecida (p = 0,0341). Um teste de HR-HPV positivo foi associado a ASC-H (p = 0,0075). Conclusão Os dados sugerem que mesmo para uma população de mulheres brasileiras atendidas em clínicas privadas, as recomendações das diretrizes clínicas nacionais para resultados citológicos apresentando ASCs não são seguidas.

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.

Histerectomia radical laparoscópica versus laparotomia no tratamento do câncer inicial do colo uterino / Radical hysterectomy by laparoscopy v by laparotomy for the treatment of early cervical cancer

O tratamento cirúrgico padrão para o câncer do colo do útero em estádio inicial é a histerectomia radical abdominal (HRA). Nos últimos anos, os avanços na cirurgia minimamente invasiva tornaram possível a realização de histerectomia radical com o uso da laparoscopia, com objetivo de reduzir a morbidade cirúrgica e promover uma recuperação mais rápida. Esta revisão compara a eficácia e a segurança da histerectomia laparoscópica (HRL) com a HRA em mulheres com estádios iniciais (I até IIa) do câncer de colo uterino. Fez-se a busca da literatura através de pesquisa na base de dados do MEDLINE/PubMed, LILACS, SciELO e Cochrane Library entre 2010 - 2015, com as palavras-chave: histerectomia, histerectomia laparoscópica, laparoscopia laparotomia, câncer cervical precoce. Foi constatado que a HRL está associada à menor morbidade cirúrgica em termos de perda sanguínea intraoperatória e menor permanência hospitalar quando comparada com a HRA. No entanto, estudos multicêntricos randomizados são necessários para que se tenha dados definitivos sobre a sobrevida global e livre de doença.(AU)

Standard surgical management for selected early-stage cervical cancer is radical abdominal hysterectomy (HRA). In recent years, advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery. This review compares the effectiveness and safety of laparoscopically (HRL) with a radical abdominal hysterectomy (HRA) in women with cervical cancer in early-stage (I to IIa). The literature review was performed using MEDLINE/PubMed, LILACS, SciELO e Cochrane Library for articles published between 2010 and 2015, and the keywords: hysterectomy, hysterectomy laparoscopic, laparoscopy, laparotomy, cervical cancer in early stages. When compared with HRA the HRL was associated with lower surgical morbidity, in terms of intraoperative blood loss and shorter hospital permanence. However, multicenter and randomized studies are needed for definitive data on overall survival and disease-free survival.(AU)

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)

Carcinoma epidermoide de cuello uterino con extensión superficial a endometrio / Squamous cell carcinoma of the cervix with superficial extension to the endometrium

El cáncer de cuello uterino es la neoplasia más frecuente del tracto genital femenino, que en su forma avanzada puede invadir localmente a tejido paracervical, vagina, vejiga y recto. Se presenta un caso, muy poco frecuente, de carcinoma cervical con extensión endometrial como neoplasia in situ, en una paciente de 76 años y que se manifestó clínicamente como piometra.

Cervical cancer is the most common malignant tumor of the female genital tract, which in its advanced stage can invade locally paracervical tissue, vagina, bladder and rectum. A case extremely rarely is reported of cervical carcinoma with in situ carcinoma involving to endometrium in a patient of 76 years old and clinically manifested as pyometra.

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.

The impact of under-recording on cervical cancer-related mortality rates in Colombia: an equity analysis involving comparison by provenance / Impacto del sub-registro en la mortalidad por cáncer cervical por procedencia, en Colombia. Un análisis de equidad

Objective Comparing cervical cancer mortality rates in Colombian departments, as well as in urban and rural areas and examining the potential causes of any differences. Methodology This was an ecologic study. Mortality due to cervical cancer was estimated from data collected between 2005 and 2008 by the Colombian National Statistics Bureau (DANE).This included overall mortality in Colombia, mortality by department and mortality by rural and urban area. DANE provided theunder-recording indicator for mortality by departments and the unmet basic needs index. Spearman correlation coefficient was estimated for average mortality by department, unmet basic needs and under-recording variables. Results The overall annual mortality rate from 2005 to 2008 due to cervical cancer in Colombia ranged from 10 to 11.1 per 100,000 females. Mortality reported in urban areas was higher than in rural areas (10.3-11.7 cf 7.6-8.7). The lowest average mortality was reported from the Chocó department (4.7) and the highest from Meta (18.2). An inverse correlation was found between average mortality by department and unmet basic needs. The ‘under-reporting' indicator had an inverse correlation with mortality, meaning that departments having recording issues also reported lower mortality rates. Conclusions Health systems must adopt strategies designed to improve information systems for supporting decision-making and optimise the use of health resources, particularly for vulnerable populations and populations having unmet basic needs. Comparing mortality amongst departments and areas will not lead to reliable conclusions in such under-recording conditions.

Objetivo Comparar las tasas de mortalidad por cáncer de cuello uterino en los departamentos de Colombia, tanto en las zonas urbanas como en las zonas rurales y examinar las posibles causas de las diferencias. Métodos Este fue un estudio ecológico. La mortalidad causada por cáncer de cuello uterino fue estimada a partir de los datos recolectados entre los años2005 y 2008 por el Departamento Administrativo Nacional de Estadística (DANE).La mortalidad global en Colombia, la mortalidad por departamento y la mortalidad por zonas rurales y urbanas fueron incluidas en estas cifras. El DANE proporcionó el indicador del sub registro de la mortalidad por departamentos y el índice de las necesidades básicas insatisfechas (NBI). El coeficiente de correlación de Spearman fue estimada por mortalidad promedio por departamento, NBI y las variables de sub registro. Resultados La tasa anual de mortalidad global desde el año 2005 hasta el año 2008, causado por cáncer de cuello uterino en Colombia, osciló entre 10 hasta 11,1 por 100.000 mujeres. La mortalidad registrada en las zonas urbanos tenía una tasa más alta que en los zonas rurales (10.3-11.7 cf 7.6-8.7). La tasa más baja de mortalidad promedio fue registrada en el departamento de Chocó (4.7) y la más alta del departamento de Meta (18.2). Se encontró una correlación inversa entre la mortalidad promedio por departamento y las NBI. El indicador del sub registro tenía una correlación inversa con la mortalidad, significando que los departamentos que tienen problemas relacionadas con el registro también registraron tasas más bajas de mortalidad. Conclusiones Los sistemas de salud deben adoptar estrategias encaminadas a mejorar los sistemas de información para apoyar a la toma de decisiones y optimizar el uso de los recursos sanitarios, particularmente para las poblaciones vulnerables y las poblaciones con necesidades básicas insatisfechas. Al comparar la mortalidad entre los departamentos y las zonas no conducirá a conclusiones confiables en tales condiciones de registro.

p16INK4a en el diagnóstico diferencial entre atrofia cervicouterina y neoplasia intraepitelial cervical de alto grado (NIC III): reporte de caso

Introducción: En pacientes posmenopáusicas los cambios atróficos del cérvix dificultan el diagnóstico colposcópico y cito-histológico, pues pueden simular lesiones premalignas, por lo cual, la detección inmunohistoquimica de p16INK4a sería útil como herramienta diagnóstica diferencial entre estos cambios; sin embargo, es necesario aportar evidencias desde la perspectiva clínica. Caso clínico: Paciente posmenopáusica con colposcopia insatisfactoria y hallazgos cito-histológicos sugestivos pero no conclusivos de neoplasia intraepitelial cervical de alto grado (NIC III). La detección inmunohistoquímica de p16INK4a fue negativa. El estudio histológico de la conización diagnóstica/terapéutica no reportó lesión intraepitelial o maligna. Este caso permite aportar evidencia a favor del p16INK4a como biomarcador diferencial entre cambios atróficos y premalignos, con lo cual se podrían evitar intervenciones innecesarias. Para el desarrollo del manuscrito se contó con consentimiento informado de la paciente objeto de estudio y consentimiento institucional de la Universidad de Cartagena y la subdirección científica de la E.S.E. Clínica "Maternidad Rafael Calvo".

Introduction: Uterine cervix atrophic changes in postmenopausic women can mimic premalignant lesions, difficulting colposcopy and citopathology diagnosis. Immunohistochemical detection of p16INK4a could be useful as a diagnostic tool to differentiate between these changes. However, clinical evidence must be provided in order to accept this technique. Case report: Postmenopausic patient with insatisfactory colposcopy and cyto-hystopathology findings suggestive but not conclusive of high grade cervical intraepithelial neoplasia. p16INK4a immunohistochemical detection was negative and hystology of diagnostic/therapeutic conization did not find intraepithelial lesion or malignancy. This case is a contribution favouring p16INK4a as a differential biomarker between atrophic and premalignant changes in order to avoid unnecessary interventions. Both patients informed consent and Universidad de Cartagena and E.S.E. Clinica "Maternidad Rafael Calvo" scientific subdirection institutional consent were obtained for the writing of this presentation.

Atipias escamosas de significado indeterminado: novas qualificações e importância na conduta clínica / Atypia in squamous cells of undetermined significance: news qualifications and importance in clinical conduct

O termo atipia escamosa de significado indeterminado (ASCUS) foi introduzido pelo Sistema de Bethesda em 1988, gerando diversas discussões a respeito do abuso deste diagnóstico e da conduta clínica mais apropriada a ser seguida. Após a introdução das novas qualificações das ASCUS (ASC-US e ASC-H), novas condutas foram preconizadas visando um tratamento mais objetivo em relação à lesão. O trabalho baseia-se na revisão da literatura para comparar dados e discutir a melhor conduta frente ao resultado de atipias escamosas. Dentre 62.323 colpocitologias realizadas em 2005 pelo laboratório em estudo, 197 casos (0,32%) corresponderamàs ASCUS. A porcentagem de retorno foi avaliada até junho de 2006, obtendo 53,3% de presença para a realização da citologia de repetição. O tempo gasto para repetir a colpocitologia variou entre 04 e 06 meses na maior parte (44,8%) dos retornos efetivados. A idade média das pacientes foi 47 anos, cujo seguimento mostrou maior número de lesões escamosas em mulheres com menos de 30 anos. Os dados obtidos através deste estudo se mostraram condizentes com a literatura, garantindo a boa qualidade dos exames realizados.No momento de decidir entre colposcopia, biópsia, repetição da colpocitologia e teste de hibridização para HPV no seguimento das ASCUS, deve-se considerar as subcategorias destas atipias, a fim de evitar o aparecimento de lesões mais graves.

Analysis of cervical cytological examination of 1946 cases in gestation and after delivery / 中国康复理论与实践

@#ObjectiveTo observe and evaluate the role of cervical cytological examination in 1946 cases in gestation, and at 2 months and 6 months after delivery, and treatment for abnormal cases.MethodsThe thinprep cytologic test samples of 1946 cases from external cervical orifice and cervical cavity were collected. The cytological diagnosis was performed according to TBS-diagnosis and classification system.ResultsIn 1946 samples, there were 160 inflammatory samples (8.2%), including bacterial vaginitis 51 cases (2.6%), trichomonal vaginitis 49 cases (25.%), candidal vaginitis 58 cases (3.0%); typical epithelial cells 105 cases (5.4%), including atypical squamous cells (ASUCS) 70 cases (3.6%), low-grade squamous intraepithelial lesions (LSIL) 29 cases (1.5%), high-grade squamous intraepithelial lesions (HSIL) 5cases (0.2%), the carcinoma in situ 1 case (0.05%); human papilloma virus (HPV) 32 cases (1.6%), including HPV combined with atypical squamous cells 21 cases (1.1%), HPV combined with LSIL 10 cases (0.5%). Large mass of cases with a abnormally result of cervical cytological examination had a normal childbearing, the cases that re-examination after birth showed carcinoma in situ and HSIL treated by conization, and others treated with physical treatment.ConclusionCervical cytology examination has positive effect on prevention and treatment of precancerous changes and carcinoma in gestational women. Cervical lesions less likely get worse during pregnancy. Conservative management is possible if regular cytology, copolscopy and bioposy performed when necessary. Re-examination at two and six months after birth is necessary for determining treatment method.

Papiloma virus humano y neoplasia cervical: relación histopatológica. Hospital Regional Teodoro Maldonado Carbo, 1999-2000 / Human papilomavirus and cervical neoplasia: histopathologic relationship. Teodoro Maldonado Carbo Regional Hospital 1999-2000

Se realizó un estudio de tipo analítico, transversal de caracter retrospectivo, no aleatorio, monocéntrico, en el hospital Teodoro Maldonado Carbo; cuyo objetivo principal fue demostrar el grado de asociación de la infección por Papiloma virus humano y neoplasia cervical en pacientes que acudieron al hospital durante los años 1999 y 2000. El resultado principal fue la demostración de la relación entre la infección por Papiloma virus humano y la neoplasia cervical, siendo la población urbana más afectada y su mayor incidencia en la cuarta década de la vida.Conclusiones: se demostró por medio del trabajo la alta asociación de la enfermedad en relación a la infección, siendo el riesgo relativo de 3.9, y la ocurrencia relativa de 5.8.

We realized an analytic, transversal, retrospective study character in the Teodoro Maldonado Carbo Hospital whose primary target was to demonstrate the degree of association of the infection by human papillomavirus and cervical neoplasia in patients who went to the hospital during years 1999 and 2000.The main result was demonstration of the relation between the infection by human papillomavirus and cervical neoplasia, being the urban population affected and its greater incidence in fourth decade of life.Conclusions: we show that there exists a high association of the infection with relation to the disease, being 3.96 the relative risk of the relative occurrence of 5.8.