Correlación Citocolposcópica e Histopatológica de Lesiones Pre e invasivas de Cuello Uterino en las pacientes que acuden a la Consulta Ginecológica del Centro de Salud Francisco Morazán, Managua I semestre de 2015

El presente estudio tiene como objetivo establecer la correlación citológica e histopatológica de lesiones pre e invasivas de cuello uterino en las pacientes que acuden a la consulta ginecológica del centro de salud francisco Morazán en el municipio de Managua en el I semestre 2015. Es una investigación de tipo descriptiva de corte transversal, donde la muestra fue 100 pacientes que acudieron a la consulta ginecológica de dicha unidad de salud, las cuales fueron captadas mediante información anotada en el libro de registro de citologías y biopsia que se llevaba en la unidad de salud en estudio lo que permitió identificar los expedientes de las pacientes. En los resultados encontrados se compararon las pruebas de tamizaje de PAP y colposcopia con la biopsia y se estableció el grado de correlación y por lo tanto la sensibilidad de las mismas en las diferentes lesiones. Las 100 mujeres presentaron diagnostico citológico y anatomopatológico, no así colposcópico apareciendo el diagnostico de lesión pre maligna y maligna en 54 pacientes, sin embargo todas presentaron mapeo colposcópico; se compararon las pruebas individualmente. Los grupos etarios predominantes fueron 21-30 años y 31-40 años con 31% de incidencia cada uno, la escolaridad predomino la secundaria con 45%, 73% de las participantes eran amas de casa, 47% estaban casadas, 58% inicio vida sexual antes de los 16 años. La correlación entre PAP y biopsia es baja, sin embargo es buena para detectar lesiones de alto grado; se reportó 69 casos de LIEBG por citología de los cuales se confirmaron 40 para un 57%, 22 casos de LIEAG se confirmaron por biopsia 16 para un 72.7%, 9 casos de ASCUS reportados ninguno confirmado por biopsia. Hubo buena correlación entre colposcopia y biopsia, de 26 casos de LIEBG por colposcopia 20 se confirmaron por biopsia para un 76.9%, de 27 casos de LIEAG 25 se confirmaron por biopsia para un 92.5% y 1 caso de carcinoma invasor por colposcopia el cual se confirmó por biopsi

Síndrome nefrótico

- Definiciones. - Diagnóstico. - Clasificación. - Tratamiento. - Interconsulta. - Indicaciones de biopsia renal. - Vacunas

Molecular targets in lung cancer: study of the evolution of biomarkers (EGFR and PI3K) associated with treatment with tyrosine kinase inhibitors

Traballo fin de mestrado (UDC.CIE). Biotecnoloxía avanzada. Curso 2017/2018[Resumen] La necesidad de conocer y controlar con más efectividad el cáncer nos lleva a seguir buscando y experimentando con técnicas preventivas, diagnósticas y terapéuticas que sean más precisas y eficaces. La búsqueda de biomarcadores específicos son una nueva y prometedora aproximación. Alteraciones en el gen de EGFR en cáncer de pulmón no microcítico identifican una subpoblación de pacientes con unas características clínicas y de respuesta al tratamiento particulares. Existen mutaciones que derivan en un aumento de sensibilidad al tratamiento dirigido contra estas alteraciones genéticas, así como mutaciones que confieren resistencia a los mismos. Estos datos nos han llevado al planteamiento de este trabajo, estudiar nuevas dianas moleculares en cáncer de pulmón: EGFR y PI3K asociadas a la respuesta a ITKs. Mediante la detección de mutaciones en ambas dianas, tanto en biopsia tisular como líquida, hemos evaluado la presencia de mutaciones de EGFR de sensibilidad y resistencia a ITKs en ADN libre circulante en plasma de 49 pacientes con CPCNP a tratamiento oncológico. Estudiamos el papel de mutaciones de PKI3CA en cáncer de pulmón y su implicación en la resistencia adquirida al tratamiento con EGFR-ITKs; y analizamos el papel de la biopsia líquida como método de diagnóstico no invasivo.[Abstract] The need to know and control cancer more effectively leads us to continue searching and experimenting with preventive, diagnostic and therapeutic techniques that are more precise and effective. The search for specific biomarkers is a new and promising approach. Alterations in the EGFR gene in non-small cell lung cancer identify a subpopulation of patients with particular clinical characteristics and response to treatment. There are mutations that lead to an increase in sensitivity to treatment directed against these genetic alterations, as well as mutations that confer resistance to them. These data have led us to the approach of this work, to study new molecular targets in lung cancer: EGFR and PI3K associated with the response to ITKs. By detecting mutations in both targets, both in tissue and fluid biopsies, we have evaluated the presence of EGFR mutations of sensitivity and resistance to ITKs in circulating free DNA in plasma of 49 patients with NSCLC under oncological treatment. We studied the role of PKI3CA mutations in lung cancer and their involvement in acquired resistance to treatment with EGFR-ITKs; and we analyzed the role of liquid biopsy as a non-invasive diagnostic method

Diagnóstico de cáncer de próstata con un mayor número de muestras tisulares, obtenidas por biopsia transrectal guiada por ecografía en pacientes con indicación de biopsia o rebiopsia, teniendo en cuenta el PSA, tamaño prostático y hallazgos altacto rectal, en pacientes que asistieron al hospital militar central de Bogotá y al dispensario médico Gilberto Echeverry Mejía del Ejército Nacional de Colombia, desde junio de 2008 a junio 2010

El estudio pretende demostrar que la biopsia transrectal de próstata guiada por ecografía realizada con el protocolo del Hospital Militar Central de Bogotá y del dispensario Gilberto Echeverry Mejía del Ejercito Nacional de Colombia en Bogotá, que establece la toma de 12 muestras de la zona periférica en paciente llevados a primer set de biopsias y 4 cuatro muestras adicionales de la zona centro-transicional, se asocia a un aumento importante en la proporción de positividad para el diagnóstico de cáncer de próstata en pacientes de estas instituciones con sospecha de cáncer de próstata, tomando como parámetros el tacto rectal anormal, antígeno prostático específico elevado y aumento en la velocidad del antígeno prostático específic

Le lesioni mammarie a potenziale neoplastico incerto (B3) diagnosticate su Core Needle Biopsy (CNB): inquadramento clinico, out come e valutazione dell’opzione chirurgica

TITLE: "Uncertain malignant potential breast lesion (B3) diagnosed on core needle biopsy (CNB): clinical presentation, outcome and evaluating surgical option" INTRODUCTION Core needle biopsy (CNB) have been introduced to increase the accuracy of diagnosis of breast cancer and to exclude from surgery benign lesions, with savings of injured tissues. However, a fair percentage of CNB are still classified, according to European guidelines, in the B3 category, which includes a heterogeneous group of lesions with uncertain malignant potential. The aim of this study is to evaluate the positive predictive value (PPV) on excisional biopsies (EB) after the diagnosis of B3 in our experience at Campus Bio-Medico of Rome and compare them with data in the literature to evaluate the possibility of a different treatment for each histological subgroup. MATERIALS AND METHODS: From May 2003 to May 2011 were performed 808 CNB, stereo as well as US guided, at the Breast Unit of the Campus Bio-Medico. One hundred and sixteen of these (14.4%) were classified as B3. Ninety-five patients (81.9%) underwent BE. RESULTS It was confirmed the diagnosis of CNB in 47 cases (49.5%), in 31 (32.6%) definitive histology was of benign lesions, in 14 cases (14.7%) cancer in situ , ductal or lobular, was diagnosed, and in three (3.1%) an invasive cancer was detected. Overall, the PPV is of 17.9%. In particular, all malignant lesions were associated with atypia. Lobular Intraepithelial Neoplasia (LIN) grade 2 and 3 showed, at histological examination of EB, respectively PPV of 54.5% and of 66.7%, while LIN1 of 15.8%. In our series Ductal Intraepithelial Neoplasia (DIN) 1a and b have a PPV of 12.5% and 4%. Aftere the diagnosis of 6 papillary lesions, EB showed foci of carcinoma in situ inone case (PPV 16.7%). Two/8 radial scars, both associated with DIN1, were tumors in situ at the excisional biopsy. Excisional biopsy confirmed the other types of lesions (Phyllodes tumors, Fibroepithelial lesions). DISCUSSION AND CONCLUSIONS The European Guidelines for the Diagnosis of breast cancers define B3 "lesions that may be benign on histology of BE, but it is known that heterogeneity can show, or have an increased risk (although low) to be associated in malignant lesions. " In our series the PPV was 17.9% and is associated in all cases but one (papillary lesions) with ductal or lobular intraepithelial neoplasia (LIN and DIN1-b). At a review of the literature, we believe that with a diagnosis of B3 at the CNB is mandatory a EB if is present LIN2 and 3 and recommended in LIN1 and DINA-b. We also propose that should be sent to EB every atypical papillary lesions and phyllodes tumor, because of the natural history of these tumors. Instead the opportunity of EB in other types of lesions classified B3 should be discussed in multidisciplinary meetings. REFERENCES Bianchi S. “Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy” Breast 2011; 20; 264-270 European Commission Working Group on Breast Screening Pathology. Quality assurance guidelines for pathology. Perry N. Ed. Luxemburg: Office for official publications of the European Communities; 2006: 219-31

Estudio de las complicaciones infecciosas asociadas a la biopsia hepática en el trasplante hepático ortotópico

Analizamos un total de 669 biopsias hepáticas (557 percutáneas y 92 transyugulares) realizadas en 286 pacientes receptores de trasplante hepático con la intención de identificar factores de riesgo para el desarrollo de complicaciones infecciosas en relación a la biopsia hepática. Identificamos un total de 25 complicaciones en 24 pacientes (incidencia global de 3,7%). De ellas, 14 correspondieron a complicaciones infecciosas (2,09%). El principal factor de riesgo en nuestra serie fue el hecho de que los pacientes se encontrasen hospitalizados en el momento del procedimiento, reflejo de la mayor gravedad de esta población. Dentro de la población nosocomial, obtuvimos diferencias estadísticamente significativas en relación a los niveles de albúmina, con un riesgo estimado 3,7 veces mayor de desarrollar una infección en aquellos pacientes con niveles inferiores a 2,4 mg/dL.Vam analitzar un total de 669 biòpsies hepàtiques (557 percutànies i 92 transjugulars) realitzades en 286 pacients receptors de transplantament hepàtic amb la intenció de identificar factors de risc pel desenvolupament de complicacions infeccioses en relació a la biòpsia hepàtica. Vam identificar un total de 25 complicacions en 24 pacients (incidència global de 3,7%). D'aquestes, catorze van correspondre a complicacions infeccioses (2,09%). El principal factor de risc a la nostra sèrie va ser el fet de que els pacients estiguessin hospitalitzats en el moment del procediment, reflex d'una major gravetat d'aquesta població. Dins de la població nosocomial, vam obtenir diferències estadísticament significatives en relació als nivells d'albúmina, amb un risc estimat 3,7 vegades major de desenvolupar una infecció en aquells pacients que presentaven uns nivells inferiors a 2,4mg/dL

Ressonância Magnética Multiparamétrica na deteção do carcinoma da próstata

Trabalho final de mestrado integrado em Medicina, apresentado à Faculdade de Medicina da Universidade de Coimbra.Introdução O carcinoma da próstata é o segundo carcinoma mais frequente no homem. O diagnóstico é feito com base em análise histopatológica obtida em biopsia dirigida por ecografia transrectal. A baixa taxa de deteção da biopsia sistemática obriga à repetição da técnica aumentando os efeitos secundários deste procedimento invasivo. A Ressonância Magnética Multiparamétrica está indicada no estadiamento do carcinoma da próstata, e tem vindo a mostrar bons resultados na deteção e orientação da biopsia. Contudo, a variabilidade destes resultados têm impedido a sua indicação clara no diagnóstico. Com a criação do score PIRADS (Prostate Imaging Reporting and Data System) pela ESUR (European Society of Urogenital Radiology) foi dado um passo no sentido da normalização da técnica que, ainda assim, deve ser confirmada e aperfeiçoada. Objetivo Avaliar a utilidade dos diversos parâmetros da Ressonância Magnética, isoladamente e em conjunto, na deteção de carcinoma prostático em doentes com suspeita clinica e biopsias negativas. Materiais e Métodos No estudo foram incluídos 34 indivíduos com suspeita de carcinoma prostático e biopsias prévias negativas. Foram sujeitos a Ressonância Magnética Multiparamétrica e nova biopsia foi realizada posteriormente. Os doentes com baixa probabilidade de carcinoma e que não realizaram biopsia foram seguidos prospectivamente. Os parâmetros avaliados incluem a ponderação T2, ponderação em difusão, estudo dinâmico após contraste e espectroscopia. Os exames foram obtidos por um equipamento Magnetom Trio Tim, 3 Tesla, Siemens. Foi usada antena de coluna com 12 canais e “body phased array” com 16 canais. As imagens foram classificadas com base no score PIRADS. Com o objetivo de análise os scores foram dicotomizados: scores 4 e 5 foram considerados como resultado positivo e scores 1, 2 e 3 foram considerados negativos. Foi calculada a sensibilidade, especificidade, acuidade, valor preditivo positivo e negativo. Foi calculada a área sob a curva (AUC) para cada parâmetro, para a combinação de parâmetros excluindo a espectroscopia e para o resultado global da Ressonância Magnética. Para cada grau Gleason encontrado calculou-se a média de scores em cada parâmetro e as médias foram comparadas. Resultados Dos 34 doentes sujeitos a estudo foram identificados 8 carcinomas prostáticos após resultado positivo na Ressonância Magnética. Para o resultado global a sensibilidade foi de 88.89%, a especificidade de 80%, o valor preditivo negativo de 95.23%, o valor preditivo positivo de 61.54% e a acuidade de 82.35%. A AUC global foi de 0.887 (p=0.001). A espectroscopia foi o parâmetro que individualmente apresentou uma AUC mais elevada com um valor de 0.880 (p=0.006) seguida da ponderação T2 com 0.838 (p=0.015), ponderação em difusão com 0.741 (p=0.083) e por ultimo o estudo com contraste com 0.713 (p=0.125). A combinação da ponderação T2, difusão e estudo com contraste apresentou uma AUC de 0.856 (p=0.002). Na comparação de médias dos scores em cada grau Gleason não se encontrou diferenças estatisticamente significativas. 4 Conclusão A Ressonância Magnética Multiparamétrica de 3T com ponderação em T2, difusão, contraste dinâmico e espectroscopia é útil na deteção de carcinoma e na orientação da biopsia prostática. Estes resultados são assim mais um contributo no esclarecimento do potencial papel deste exame imagiológico no diagnóstico do carcinoma prostático.Introduction Prostate cancer is the second most frequent cancer in men. Diagnosis is made based on histophatologic analysis, obtained by transrectal ultrasound-guided prostate biopsy. The low rate of detection found in the systematic biopsy forces the repetition of the procedure, increasing the adverse effects of this invasive technique. Multiparametric Magnetic Resonance is indicated in prostate cancer staging, and has been showing good results in its detection and in guided biopsy. However, variable results have hampered a clear indication in diagnosis. With the creation of PIRADS (Prostate Imaging Reporting and Data System) score by ESUR (European Society of Urogenital Radiology), it was given a step forward in achieving the technique normalization, nevertheless, it should be confirmed and improved. Objectives The aim is to evaluate the utility of the several parameters included in Magnetic Resonance, singly and together, in detection of prostate cancer in patients with both clinical suspicion and negative biopsies. Methods In this study there were 34 patients with suspected prostate cancer and negative preview biopsies. They were subjected to Multiparametric Magnetic Resonance and a new biopsy was taken later. The patients with low probability of prostate cancer and whom, because of that, didn’t realize biopsy, were followed and analyzed prospectively. The combination of parameters includes T2-weighted images, diffusion-weighted, dynamic contrast-enhanced imaging and spectroscopy. The technique was made with an equipment Magneton Trio Tim, 3 Tesla, Siemens. It was used spine coil with 12 channels and body phased array with 16 channels. Resulting images were classified based on PIRADS score. For analysis, results were dichotomized: 4 and 5 were considered a positive result, and 1, 2 and 3 were considered as a negative result. It were determined sensitivity, specificity, accuracy, positive predictive value and negative predictive value. ROC curve was made and the area under the curve (AUC) was determinated for each parameter, for the parameters combination without spectroscopy, and for the global result of Magnetic Resonance. For each Gleason grade that was found, range scores in each parameter were calculated and the ranges were compared. Results Within these 34 patients there have been identified 8 prostate cancers after a positive result in Magnetic Resonance. For the global result, sensitivity was 88.89%, specificity 80%, negative predictive value 95.23%, positive predictive value 61.54% and accuracy of 82.35%. Global AUC was 0.887 (p=0.001). Spectroscopy was the parameter with the highest AUC with 0.880 (p=0.006) followed by T2-weighted with 0.838 (p=0.015), diffusion-weighted with 0.741 (p=0.083) and for last dynamic contrast-enhanced imaging 0.713 (p=0.125). The combination of T2-weighted images, diffusion-weighted and dynamic contrast-enhanced imaging revealed an AUC of 0.856 (p=0.002). The comparison of the ranges in each Gleason score didn’t show any statistically significant difference. Conclusion 3T Multiparametric Magnetic Resonance with inclusion of T2-weighted images, diffusionweighted, dynamic contrast-enhanced imaging and spectroscopy is a useful technique in 7 detection of cancer and guiding prostate biopsy. These results give a strong contribution in clarifying the potential rule of this imaging exam in the diagnosis of prostate cancer

Le lesioni mammarie a potenziale neoplastico incerto (B3) diagnosticate su Core Needle Biopsy (CNB): inquadramento clinico, out come e valutazione dell’opzione chirurgica

TITLE: "Uncertain malignant potential breast lesion (B3) diagnosed on core needle biopsy (CNB): clinical presentation, outcome and evaluating surgical option" INTRODUCTION Core needle biopsy (CNB) have been introduced to increase the accuracy of diagnosis of breast cancer and to exclude from surgery benign lesions, with savings of injured tissues. However, a fair percentage of CNB are still classified, according to European guidelines, in the B3 category, which includes a heterogeneous group of lesions with uncertain malignant potential. The aim of this study is to evaluate the positive predictive value (PPV) on excisional biopsies (EB) after the diagnosis of B3 in our experience at Campus Bio-Medico of Rome and compare them with data in the literature to evaluate the possibility of a different treatment for each histological subgroup. MATERIALS AND METHODS: From May 2003 to May 2011 were performed 808 CNB, stereo as well as US guided, at the Breast Unit of the Campus Bio-Medico. One hundred and sixteen of these (14.4%) were classified as B3. Ninety-five patients (81.9%) underwent BE. RESULTS It was confirmed the diagnosis of CNB in 47 cases (49.5%), in 31 (32.6%) definitive histology was of benign lesions, in 14 cases (14.7%) cancer in situ , ductal or lobular, was diagnosed, and in three (3.1%) an invasive cancer was detected. Overall, the PPV is of 17.9%. In particular, all malignant lesions were associated with atypia. Lobular Intraepithelial Neoplasia (LIN) grade 2 and 3 showed, at histological examination of EB, respectively PPV of 54.5% and of 66.7%, while LIN1 of 15.8%. In our series Ductal Intraepithelial Neoplasia (DIN) 1a and b have a PPV of 12.5% and 4%. Aftere the diagnosis of 6 papillary lesions, EB showed foci of carcinoma in situ inone case (PPV 16.7%). Two/8 radial scars, both associated with DIN1, were tumors in situ at the excisional biopsy. Excisional biopsy confirmed the other types of lesions (Phyllodes tumors, Fibroepithelial lesions). DISCUSSION AND CONCLUSIONS The European Guidelines for the Diagnosis of breast cancers define B3 "lesions that may be benign on histology of BE, but it is known that heterogeneity can show, or have an increased risk (although low) to be associated in malignant lesions. " In our series the PPV was 17.9% and is associated in all cases but one (papillary lesions) with ductal or lobular intraepithelial neoplasia (LIN and DIN1-b). At a review of the literature, we believe that with a diagnosis of B3 at the CNB is mandatory a EB if is present LIN2 and 3 and recommended in LIN1 and DINA-b. We also propose that should be sent to EB every atypical papillary lesions and phyllodes tumor, because of the natural history of these tumors. Instead the opportunity of EB in other types of lesions classified B3 should be discussed in multidisciplinary meetings. REFERENCES Bianchi S. “Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy” Breast 2011; 20; 264-270 European Commission Working Group on Breast Screening Pathology. Quality assurance guidelines for pathology. Perry N. Ed. Luxemburg: Office for official publications of the European Communities; 2006: 219-31