Subtipos Moleculares De Câncer De Mama Não Estão Associados Ao Subestadiamento Ou Ao Superestadiamento Do Câncer De Mama

Purpose to evaluate the agreement between the clinical and pathological stagings of breast cancer based on clinical and molecular features. Methods this was a cross-sectional study, in which clinical, epidemiological and pathological data were collected from 226 patients who underwent surgery at the Prof. Dr. José Aristodemo Pinotti Women’s Hospital (CAISM/Unicamp) from January 2008 to September 2010. Patients were staged clinically and pathologically, and were classified as: understaged, when the clinical staging was lower than the pathological staging; correctly staged, when the clinical staging was the same as the pathological one; and overstaged, when the clinical staging was greater than the pathological staging. Results understaged patients were younger (52.2 years; p < 0.01) and more symptomatic at diagnosis (p = 0.04) when compared with correctly or overstaged patients. Clinicopathological surrogate subtype, menopausal status, parity, hormone replace therapy and histology were not associated with differences in staging. Women under 57 years of age were clinically understaged mainly due to underestimation of T (tumor staging) (p < 0.001), as were the premenopausal women (p < 0.01). Patients whose diagnosis was made due to clinical complaints, and not by screening, were clinically understaged due to underestimation of N (lymph nodes staging) (p < 0.001). Conclusion the study shows that the clinicopathological surrogate subtype is not associated with differences in staging, while younger women diagnosed because of clinical complaints tend to have their breast tumors understaged during clinical evaluation. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.38523924

Cistos No Interior De Nódulo Mamários Benignos: Risco De Malignidade

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)The objective of this study is to assess whether the largest cyst diameter is useful for BI-RADS ultrasonography classification of predominantly solid breast masses with an oval shape, circumscribed margins, and largest axis parallel to the skin, which, except for the cystic component, would be likely classified as benign. Methods This study received approval fromthe local institutional review board. From March 2009 to August 2014, we prospectively biopsied 170 breast masses from 164 women. We grouped the largest cyst and mass diameters according to histopathological diagnoses. We used Student’s t-test, linear regression, and the area under the receiver operating characteristic curve (AUC) for statistical assessment. Results Histopathological examination revealed 143 (84%) benign and 27 (16%)malignant masses. The mean largest mass diameter was larger among malignant (mean ± standard deviation, 34.1 ± 16.6 mm) than benign masses (24.7 ± 16.7 mm) (P &lt; 0.008). The mean largest cyst diameter was also larger among malignant (9.9 ± 7.1 mm) than benign masses (4.6 ± 3.6 mm) (P &lt; 0.001). Agreement between measurements of the largest mass and cyst diameters was low (R2 = 0.26). AUC for the largest cyst diameter (0.78) was similar to the AUC for the largest mass diameter (0.69) (p = 0.2). A largest cyst diameter &lt; 3, ≥ 3 to &lt; 11, and ≥ 11 mm had a positive predictive value of 0, 15, and 52%, respectively. Conclusion A largest cystic component &lt; 3 mm identified within breast masses that show favorable characteristics may be considered clinically inconsequential in ultrasonography characterization. Conversely, masses with a largest cystic component ≥ 3 mm should be classified as BI-RADS-US category 4. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.3841701762012/15059-8, FAPESP, Fundação de Amparo à Pesquisa do Estado de São PauloFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Bayesian Estimation Of Performance Measures Of Cervical Cancer Screening Tests In The Presence Of Covariates And Absence Of A Gold Standard

In this paper we develop a Bayesian analysis to estimate the disease prevalence, the sensitivity and specificity of three cervical cancer screening tests (cervical cytology, visual inspection with acetic acid and Hybrid Capture II) in the presence of a covariate and in the absence of a gold standard. We use Metropolis-Hastings algorithm to obtain the posterior summaries of interest. The estimated prevalence of cervical lesions was 6.4% (a 95% credible interval [95% CI] was 3.9, 9.3). The sensitivity of cervical cytology (with a result of ≥ ASC-US) was 53.6% (95% CI: 42.1, 65.0) compared with 52.9% (95% CI: 43.5, 62.5) for visual inspection with acetic acid and 90.3% (95% CI: 76.2, 98.7) for Hybrid Capture II (with result of >1 relative light units). The specificity of cervical cytology was 97.0% (95% CI: 95.5, 98.4) and the specifi cities for visual inspection with acetic acid and Hybrid Capture II were 93.0% (95% CI: 91.0, 94.7) and 88.7% (95% CI: 85.9, 91.4), respectively. The Bayesian model with covariates suggests that the sensitivity and the specificity of the visual inspection with acetic acid tend to increase as the age of the women increases. The Bayesian method proposed here is an useful alternative to estimate measures of performance of diagnostic tests in the presence of covariates and when a gold standard is not available. An advantage of the method is the fact that the number of parameters to be estimated is not limited by the number of observations, as it happens with several frequentist approaches. However, it is important to point out that the Bayesian analysis requires informative priors in order for the parameters to be identifiable. The method can be easily extended for the analysis of other medical data sets.63346Begg, C.B., Greenes, R.A., Assessment of diagnostic tests when disease verification is subject to selection bias (1983) Biometrics, 39, pp. 207-215Zhou, X., Maximum likelihood estimators of sensitivity and specificity corrected for verification bias (1983) Commun Statis Theory Meth, 22, pp. 3177-3198Hui, S.L., Walter, S.D., Estimating the error rates of diagnostic tests (1980) Biometrics, 36, pp. 167-171Joseph, L., Gyorkos, T.W., Coupal, L., Bayesian estimation of disease prevalence and the parameters of diagnostic tests in the absence of a gold standard (1985) Am J Epidemiol, 141, pp. 263-272Hitt, E., Cancer in the Americas (2003) Lancet Oncol, 4, p. 9Brasil. Ministério da Saúde. Secretaria Nacional de Assistência à Saúde. Instituto Nacional do Câncer. Estimativas da incidência e mortalidade por câncer no Brasil. Rio de Janeiro: INCA2002. Available on website: 〈http://www.inca.org.br/cancer/ epide miologia/estimativa2002/estimativas.html〉Mitchell, M.F., Schottenfeld, D., Tortolero-Luna, G., Cantor, S.B., Richards-Kortum R. Colposcopy for the diagnosis of squamous intraepithelial lesions: A meta-analysis (1998) Obstet Gynecol, 91, pp. 626-631Hopman, E.H., Kenemans, P., Helmerhorst, T.J., Positive predictive rate of colposcopic examination of the cervix uteri: An overview of literature (1998) Obstet Gynecol Surv, 53, pp. 97-106Begg, C.B., Biases in the assessment of diagnostic tests (1987) Stat Med, 6, pp. 411-423Hui, S.L., Zhou, X.H., Evaluation of diagnostic tests without gold standards (1998) Stat Methods Med Res, 7, pp. 354-370Zhou, X.H., Correcting for verification bias in studies of a diagnostic test's accuracy (1998) Stat Methods Med Res, 7, pp. 337-353McCrory, D.C., Matchar, D.B., Bastian, L. et al. 1999. Evaluation of cervical cytology. Evidence report/technology assessment n.5. (Prepared by Duke University under Contract n. 290-97-0014). AHCPR publication n. 99-E010. Rockville: Agency for Health Care Policy and ResearchDendukuri, N., Joseph, L., Bayesian approaches to modelling the conditional dependence between multiple diagnostic tests (2001) Biometrics, 57, pp. 208-217Faraone, S.V., Tsuang, M.T., Measuring diagnostic accuracy in the absence of a "gold standard (1994) Am J Psychiatry, 151, pp. 650-657Qu, Y., Tan, M., Kutner, M.H., Random effects models in latent class analysis for evaluating accuracy of diagnostic tests (1996) Biometrics, 52, pp. 797-810Hadgu, A., Qu, Y., A biomedical application of latent models with random effects (1998) Appl Statist, 47, pp. 603-616Tanner, M., Wong, W., The calculation of posterior distributions by data augmentation (1987) J Am Statist Ass, 82, pp. 528-550Gelfand, A.E., Smith, A.F.M., Sampling Based Approaches to Calculating Marginal Densities (1990) J Am Stat Assoc, 85, pp. 398-409Gelfand, A.E., Gibbs sampling (2000) J Am Stat Assoc, 95, pp. 1300-1304Syrjanen, K., Naud, P., Derchain, S., Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study (2005) Anticancer Res, 25, pp. 3469-3480Sarian, L.O., Derchain, S.F., Naud, P., Evaluation of visual inspection with acetic acid (VIA), Lugol's iodine (VILI), cervical cytology and HPV testing as cervical screening tools in Latin America. This report refers to partial results from the LAMS (Latin AMerican Screening) study (2005) J Med Screen, 12, pp. 142-149Solomon, D., Davey, D., Kurman, R., The 2001 Bethesda System: Terminology for reporting results of cervical cytology (2002) JAMA, 287, pp. 2114-2119Blumenthal, P., Sanghvi, H., (1997) Atlas for unaided visual inspection of the cervix, , Baltimore and Harare: JHPIEGO Corporation and University of Zimbabwe Medical SchoolNanda, K., McCrory, D.C., Myers, E.R., Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review (2000) Ann Intern Med, 132, pp. 810-819Belinson, J.L., Pretorius, R.G., Zhang, W.H., Wu, L.Y., Qiao, Y.L., Elson, P., Cervical cancer screening by simple visual inspection after acetic acid (2001) Obstet Gynecol, 98, pp. 441-444Visual inspection with acetic acid for cervical-cancer screening: Test qualities in a primary care setting (1999) Lancet, 353, pp. 869-873. , University of Zimbabwe/JHPIEGO Cervical Cancer ProjectSchiffman, M., Herrero, R., Hildensheim, A., HPV DNA testing in cervical cancer screening: Results from women in a high-risk province of Costa Rica (2000) JAMA, 283, pp. 87-93Wright Jr, T.C., Lynette, D., Kuhn, L., Pollack, A., Lorincz, A., HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer (2000) JAMA, 283, pp. 81-86Box, G.E.P., Tiao, G.C., (1992) Bayesian Inference in Statistical Analysis, , Reprint edition. New York: Wiley-InterscienceAltman, D.G., Bland, J.M., Diagnostic tests 2: Predictive values (1994) BMJ, 309, p. 102Franco, E.L., Primary screening of cervical cancer with human papillomavirus tests (2003) J Natl Cancer Inst Monogr, 31, pp. 89-96Geweke J. 1992. Evaluating the accuracy of sampling-based approaches to calculating posterior moments. Bayesian Statistics 4Bernardo, J.M.Berger, J.O.Dawid, A.P and.Smith, A.F.M., Eds.Clarendom Press: Oxford, 169-94Carlin, B.P., Louis, T.A., (2000) Bayes and empirical Bayes methods for data analysis, , 2nd ed. London: Chapman and Hall/CRCKoss, L.G., Human papillomavirus testing as a screening tool for cervical cancer (2000) JAMA, 283, p. 2525Shlay, J.C., Dunn, T., Byers, T., Barón, A.E., Douglas, J.M., Prediction of cervical intraepithelial neoplasia grade 2-3 using risk assessment and human papillomavirus testing in women with atypia on Papanicolaou Smears (2000) Obstet Gynecol, 96, pp. 410-416Spiegelhalter, D.J., Best, N.G., Carlin, B.P., van der Linde A Bayesian measures of model complexity and fit (with discussion) (2002) J Roy Statist Soc B, 64, pp. 583-640Franco, E.L., Ferenczy, A., Assessing gains in diagnostic utility when human papillomavirus testing is used as an adjunct to papanicolaou smear in the triage of women with cervical cytologic abnormalities (1999) Am J Obstet Gynecol, 181, pp. 382-386Macaskill, P., Walter, S.D., Irwig, L., Franco, E.L., Assessing the gain in diagnostic performance when combining two diagnostic tests (2002) Statis Med, 21, pp. 2527-2546Brenner, H., How independent are multiple "independent" diagnostic classifications? Stat MedEspeland, M.A., Handelman, S.L., Using latent class models to characterize and assess relative error in discrete measurements (1989) Biometrics, 45, pp. 587-599Yang, I., Becker, M.P., Latent variable modeling of diagnostic accuracy (1997) Biometrics, 53, pp. 948-958Ratman, S., Franco, E.L., Ferenczy, A., Human papillomavirus testing for primary screening of cervical cancer precursors (2000) Cancer Epidemiol Biomarkers Prev, 9, pp. 945-951Coste, J., Cochand-Priollet, B., de Cremoux, P., Cross sectional study of conventional cervical smear, monolayer cytology and human papillomavirus DNA testing for cervical cancer screening (2003) BMJ, 326, p. 733Schiffman, M., Hildesheim, A., Herrero, R., Bratti, M., In reply: Human papillomavirus testing as a screening tool for cervical cancer (2000) JAMA, 283, pp. 2525-2526Londhe, M., George, S.S., Seshadri, L., Detection of CIN by naked eye visualization after application of acetic acid (1997) Indian J Cancer, 34, pp. 88-91Sankaranarayanan, R., Wesley, R., Somanathan, T., Visual inspection of the uterine cervix after the application of acetic acid in the detection of cervical carcinoma and its precursors (1998) Cancer, 83, pp. 2150-2156Sankaranarayanan, R., Shyamalayumary, B., Wesley, R., Sreedevi Amma, N., Parkin, D.M., Nair, M.K., Visual inspection with acetic acid in the early detection of cervical cancer and precursors (1999) Int J Cancer, 80, pp. 161-163Denny, L., Kuhn, L., Pollack, A., Wainwright, H., Wright Jr., T.C., Evaluation of alternative methods of cervical cancer screening in resource-poor settings (2000) Cancer, 89, pp. 826-833Denny, L., Kuhn, L., Pollack, A., Wright Jr., T.C., Direct visual inspection for cervical cancer screening: An analysis of factors influencing test performance (2002) Cancer, 94, pp. 1699-1707Parmigiani, G., Measuring uncertainty in complex decision analysis models (2002) Stat Methods Med Res, 11, pp. 513-537Koss, L.G., Human papillomavirus testing as a screening tool for cervical cancer (2000) JAMA, 283, pp. 2525-2526Smith, A.F.M., Roberts, G.O., Bayesian Computation via the Gibbs Sampler and Related MCMC Methods (1993) J R Stat SocB, 55, pp. 3-2

Prophylactic Hpv Vaccines [vacinas Profiláticas Para O Hpv]

[No abstract available]296281284Munoz N, Castellsague X, de Gonzalez AB, Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006;24 Suppl 3:S1-S10Lazcano-Ponce, E., Alonso, P., Ruiz-Moreno, J.A., Hernandez-Avila, M., Recommendations for cervical cancer screening programs in developing countries. The need for equity and technological development (2003) Salud Publica Mex, 45 (SUPPL. 3), pp. S449-S462Lowy, D.R., Schiller, J.T., Prophylactic human papillomavirus vaccines (2006) J Clin Invest, 116 (5), pp. 1167-1173Tewari, K.S., DiSaia, P.J., Primary prevention of uterine cervix cancer: Focus on vaccine history and current strategy (2002) Obstet Gynecol Clin North Am, 29 (4), pp. 843-868Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol. 2005;6(5):271-8Villa LL, Ault KA, Giuliano AR, Costa RL, Petta CA, Andrade RP, et al. Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18. Vaccine. 2006;24(27-28):5571-83Harro, C.D., Pang, Y.Y., Roden, R.B., Hildesheim, A., Wang, Z., Reynolds, M.J., Safety and immunogenicity trial in adult volunteers of a human papillomavirus 16 L1 virus-like particle vaccine (2001) J Natl Cancer Inst, 93 (4), pp. 284-292Koutsky, L.A., Ault, K.A., Wheeler, C.M., Brown, D.R., Barr, E., Alvarez, F.B., A controlled trial of a human papillomavirus type 16 vaccine (2002) N Engl J Med, 347 (21), pp. 1645-1651Harper, D.M., Franco, E.L., Wheeler, C., Ferris, D.G., Jenkins, D., Schuind, A., Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: A randomised controlled trial (2004) Lancet, 364 (9447), pp. 1757-1765Harper, D.M., Franco, E.L., Wheeler, C.M., Moscicki, A.B., Romanowski, B., Roteli-Martins, C.M., Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial (2006) Lancet, 367 (9518), pp. 1247-1255Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;369(9574):1693-702Ault, K.A., Future II Study Group. Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: A combined analysis of four randomised clinical trials (2007) Lancet, 369 (9576), pp. 1861-1868Schiller JT, Nardelli-Haefliger D. Chapter 17: second generation HPV vaccines to prevent cervical cancer. Vaccine. 2006;24 Suppl 3:S147-53Franco EL, Cuzick J, Hildesheim A, de Sanjose S. Chapter 20: issues in planning cervical cancer screening in the era of HPV vaccination. Vaccine. 2006;24 Suppl 3:S171-7Zimmerman, R.K., Ethical analysis of HPV vaccine policy options (2006) Vaccine, 24 (22), pp. 4812-4820Goldie SJ, Kim JJ, Myers E. Chapter 19: cost-effectiveness of cervical cancer screening. Vaccine. 2006;24 Suppl 3:S164-70Goldie, S.J., Grima, D., Kohli, M., Wright, T.C., Weinstein, M., Franco, E., A comprehensive natural history model of HPV infection and cervical cancer to estimate the clinical impact of a prophylactic HPV-16/18 vaccine (2003) Int J Cancer, 106 (6), pp. 896-90

Oncologic Colpocytology Collected In The Public Health And Reference Services In The Diagnostic Of The Severity Of Intraepithelial Cervical Lesion [comparação Entre A Colpocitologia Oncológica De Encaminhamento E A Da Gravidade Das Lesões Cervicais Intra-epiteliais]

Objective The study was designed to compare the Pap smear results, performed on the public health service, with: the results of Pap smear collected on the reference service; the colposcopy and punch biopsy results. Methods The total of 213 women assisted at the women's hospital - from January 1989 to April 1991, and followed until July 1998 were selected. Ninety were referred because a Pap smears suggestive of Human Papillomavirus (HPV) induced lesion or cervical intraepithelial neoplasia (CIN) grade 1, and 123, CIN 2 or 3. Results Among the 90 women referred because of HPV/CIN 1.49% presented CIN 2 or 3 in the Pap smears performed at this service. At the colposcopy, 16/90 women did not present suspicious lesions, and in 10 women, the scamous colunar junction was not observed. At biopsy, 42 (46%) presented CIN 2 or 3. Out of the 123 women referred with Pap smear of CIN 2 or 3.54% presented CIN 2 or 3 at this service. At the colposcopy, 24 women did not present suspicious lesions and the scamous colunar junction was not observed in 12. About biopsy, 61 (49%) presented CIN 2 or 3. Conclusions The expectant conduct in cases of Pap smear with HPV/CIN 1, should follow a criterion, involving qualified professionals to collect the Pap smear, and should provide people awareness as to control follow-up.342120125Cuzick, J., Terry, G., Ho, L., Hollingwort, T., Anderson, M., Type-specific human papillomavirus DMA in abnormal smears as a predictor of high-grade cervical intraepithelial neoplasia (1994) Br J Cancer, 69, pp. 167-171Dudding, N., Sutton, J., Lane, S., Koilocitosis: An indication for conservative management (1996) Cytopathology, 7, pp. 32-37Evander, M., Edlund, K., Gustafsson, A., Jonsson, M., Karlson, R., Rylander, E., Human papillomavirus infection is transient in young women: A population-based cohort study (1995) J Infect Dis, 171, pp. 1026-1030Ferenczy, A., Management of the atypical squamous cells of undetermined significance (ASCUS) smear: What are the option (1998) Genital Infect Neoplasia (Eurogyn), 1, pp. 12-13Frable, W.J., Austin, R.M., Greening, S.E., Collins, R.J., Hillman, R.L., Kobler, T.P., Medical affairs. International Academy of Cytology Task Force summary. Diagnostic cytology towards the 21st century: An International Expert Conference and Tutorial (1998) Acta Cytol, 82, pp. 76-119Koss, L.G., Error rates in cervical cancer screening: Cause and consequence (1997) New Developments in Cervical Cancer Screening and Prevention, pp. 163-168. , Franco E, Monsonego J, editors. Londres: Blackwell Science(1996) Manual de Elaboração de Protocolos Clínico-terapêuticos, , Ministério da Saúde. Instituto Nacional do Câncer. Coordenação de Pesquisa. Rio de Janeiro(Normas e Manuals Técnicos)(1996) Viva Mulher: Programa Nacional de Controle Do Câncer Do Colo Uterino, , Ministério da Saúde. Instituto Nacional de Câncer. Fundação Ary Frauzino para Pesquisa e Controle do Cancer. Rio de Janeiro;(1998) Programa Nacional de Combate Ao Câncer: Diretrizes Básicas Para a Organização Do Programa, pp. 1-5. , Ministério da Saúde. Secretaria de Políticas de Saúde. Programa Nacional de Combate ao Câncer de Colo Uterino. Núcleo de Coordenação Nacional. Brasília;The 1988 Bethesda system for reporting cervical/vaginal cytologic diagnoses (1989) JAMA, 262, pp. 931-934. , National Cancer Institute Workshop I1988 Dec 12-13Bethesda, MarylandÖstor, A.G., Natural history of cervical intraepithelial neoplasia: A critical review (1993) Int J Gynecol Pathol, 12, pp. 186-192Richart, R.M., Wright, T.C., Controversies in the management of low-grade cervical intraepithelial neoplasia (1993) Cancer, 71 (4 SUPPL.), pp. 1413-1421Roteli-Martns, C.M., Panetta, K., Alves, V.A.F., Siqueira, A.S., Syrjänen, K.J., Derchain, S.F.M., Cigarette smoking and high-risk HPV-DNA as predisposing factors for high-grade cervical intraepithelial neoplasia (CIN) in young Brazilian women (1998) Acta Obstet Gynecol Scand, 77, pp. 678-682Schiffman, M.H., Liaw, K.L., Herrero, R., Sherman, M.E., Hildesheim, A., Epidemiologic suport for a simplified view of cervical carcinogenesis (1998) Genital Infect Neoplasia (Eurogyn), 1, pp. 2-6(1998) Estratégia Para Redução Da Mortalidade Por Câncer de Colo de Útero No Estado de São Paulo, pp. 1-16. , São Paulo

Prevalence Of Hpv 16, 18, 45 And 31 In Women With Cervical Lesions [prevalência Dos Hpv 16, 18, 45 E 31 Em Mulheres Com Lesão Cervical]

Purpose: To determine the prevalence of HPV 16, 18, 31 and 45 in cervical screening samples of women with cellular changes and/or colposcopy suggestive of persistent high grade or low grade lesion who were submitted to conization. Methods: A total of 120 women were included in the study. Histological analysis of the cervical cones revealed 7 cases of cervicitis, 22 of CIN1, 31 of CIN2, 54 of CIN3, and 6 invasive carcinomas. The cervical screening samples were analyzed before conization for the presence of HPV-DNA by PCR using the consensus primers PGMY09/11. HPV-DNA-positive samples were tested for the presence of HPV16, 18, 31 and 45 using type-specific primers for these HPV. Results: HPV-DNA was detected in 67.5% of the studied women. HPV 16 (40%) was the most prevalent type in most ilesions, followed by HPV 31 (13.3%), 45 (13.3%), and 18 (4.1%). Multiple infections occurred in 15% of the cases and infections with other HPV types were detected in 14% of the sample. Conclusions: HPV 16 and 18 infections do not always occur as a single infection, and may be associated with other HPV types on different occasions.327315320(2009) Estimativa 2010: Incidência de câncer no Brasil, , http://www.inca.gov.br/estimativa/2010/estimativa20091201.pdf, Brasil. Ministério da Saúde. Instituto Nacional de Câncer [Internet], Rio de Janeiro: INCA, [citado 2009 Dez 10]. Disponível emSima, N., Wang, S., Wang, W., Kong, D., Xu, Q., Tian, X., Antisense targeting human papillomavirus type 16 E6 and E7 genes contributes to apoptosis and senescence in SiHa cervical carcinoma cells (2007) Gynecol Oncol., 106 (2), pp. 299-304Bosch, F.X., de Sanjosé, S., Chapter 1: Human papillomavirus and cervical cancer-burden and assessment of causality (2003) J Natl Cancer Inst Monogr., (31), pp. 3-13Muñoz, N., Bosch, X.F., de Sanjosé, S., Herrero, R., Castellsagué, X., Shah, K.V., Epidemiologic classification of human papillomavirus types associated with cervical cancer (2003) N Engl J Med., 348 (6), pp. 518-527Manavi, M., Hudelist, G., Fink-Retter, A., Gschwantler-Kaulich, D., Pischinger, K., Czerwenka, K., Human papillomavirus DNA integration and messenger RNA transcription in cervical low- and high-risk squamous intraepithelial lesions in Austrian women (2008) Int J Gynecol Cancer., 18 (2), pp. 285-294Clifford, G.M., Rana, R.K., Franceschi, S., Smith, J.S., Gough, G., Pimenta, J.M., Human papillomavirus genotype distribution in low-grade cervical lesions: Comparison by geographic region and with cervical cancer (2005) Cancer Epidemiol Biomarkers Prev., 14 (5), pp. 1157-1164de Sanjosé, S., Diaz, M., Catellsagué, X., Clifford, G., Bruni, L., Muñoz, N., Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: A meta-analysis (2007) Lancet Infect Dis., 7 (7), pp. 453-459Smith, J.S., Lindsay, L., Hoots, B., Keys, J., Franceschi, S., Winer, R., Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: A meta-analysis update (2007) Int J Cancer., 121 (3), pp. 621-632Harper, D.M., Franco, E.L., Wheeler, C.M., Moscicki, A.B., Romanowski, B., Roteli-Martins, C.M., Sustained efficacy up to 4-5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial (2006) Lancet., 367 (9518), pp. 1247-1255Clifford, G., Franceschi, S., Diaz, M., Muñoz, N., Villa, L.L., Chapter 3: HPV type-distribution in women with and without cervical neoplastic diseases (2006) Vaccine, (24 SUPPL 3), pp. 26-34Gravitt, P.E., Peyton, C.L., Alessi, T.Q., Wheeler, C.M., Coutlée, F., Hildesheim, A., Improved amplification of genital human papillomaviruses (2000) J Clin Microbiol., 38 (1), pp. 357-361Swan, D.C., Tucker, R.A., Tortolero-Luna, G., Mitchell, M.F., Wideroff, L., Unger, E.R., Human papillomavirus (HPV) DNA copy number is dependent on grade of cervical disease and HPV Type (1999) J Clin Microbiol., 37 (4), pp. 1030-1034Scully, R.E., Bonfiglio, T.A., Kurman, R.J., Silverberg, S.G., Wilkinson, E.J., (1994) Histological typing of female genital tract tumours [WHO International Histological Classification of Tumours, 13], , 2nd ed. Berlin: Springer-VerlagWheeler, C.M., Hunt, W.C., Schiffman, M., Castle, P.E., Human papillomavirus genotypes and the cumulative 2-year risk of cervical precancer (2006) J Infect Dis., 194 (9), pp. 1291-1299. , Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions Triage Study GroupDehn, D., Torkko, K.C., Shroyer, K.R., Human papillomavirus testing and molecular markers of cervical dysplasia and carcinoma (2007) Cancer., 111 (1), pp. 1-14Trottier, H., Franco, E.L., The epidemiology of genital human papillomavirus infection (2006) Vaccine, (24 SUPPL 1), pp. S1-S15Massad, L.S., Einstein, M., Myers, E., Wheeler, C.M., Wentzensen, N., Solomon, D., The impact of human papillomavirus vaccination on cervical cancer prevention efforts (2009) Gynecol Oncol., 114 (2), pp. 360-364Insinga, R.P., Liaw, K.L., Johnson, L.G., Madeleine, M.M., A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States (2008) Cancer Epidemiol Biomarkers Prev., 17 (7), pp. 1611-1622Trottier, H., Mahmud, S., Prado, J.C., Sobrinho, J.S., Costa, M.C., Rohan, T.E., Type-specific duration of human papillomavirus infection: Implications for human papillomavirus screening and vaccination (2008) J Infect Dis., 197 (10), pp. 1436-144

Clinically Undetectable Lymph Node Invasion In Vulvar Cancer [invasão Linfática Clinicamente Não Detectável Do Câncer Vulvar]

OBJECTIVE. To assess the neoplastic invasion of superficial and deep inguinal lymph nodes of women with invasive vulvar squamous carcinoma smaller than 5 centimeters with a clinically normal inguinal region. Methods: the medical records of 59 women cared at the State University of Campinas with invasive vulvar squamous carcinoma T1 and T2 and who presented clinically normal inguinal regions (N0) were reviewed. Clinical characteristics of both tumor and patients were evaluated as well as the follow-up data. Odds ratios and Fisher's Exact Test were used to assess the correlations between the invasion of inguinal lymph nodes and tumor size, grade, relapses and clinical complications. Confidence limits of 95% were used. RESULTS. Age of the patients ranged from 34 to 91 years (mean 67 years), and follow-up time ranged from 3 days (peri-operatory death) to 252 months (mean 27 months). Clinically, 22 (37%) women had lesions T1 lesions and 37 (63%) T2. Histological analysis showed unilateral lymphatic invasion in six (10%) women and bilateral in three (5%). There was no significant association between tumor size and lymph node invasion. Also, pathologic tumor size and grade were not associated with lymph node neoplastic involvement. Relapses and late complications were not correlated with lymph node neoplastic invasion. CONCLUSIONS. Superficial and deep inguinal dissection disclosed clinically undetectable lymph node neoplastic invasion, although tumor size and histological grade, relapses and late complications were not associated with node involvement.514228232Coleman, R.L., Santoso, J.T., Vulvar carcinoma (2000) Curr Treat Opion Oncol, 1, pp. 177-190Verdiani, L.A., Juliato, C.R., Derchain, S.F.M., Carcinoma da vulva: Epidemiologia e aspectos clínicos (1997) Rev Centro de Referência, 2, pp. 86-90Canavan, T.P., Cohen, D., Vulvar cancer (2002) Am Fam Physician, 66, pp. 1269-1274Disaia, P.J., Creasman, W.T., Invasive cancer of the vulva (1989) Clinical Gynecologic Oncology. 3 rd Ed., pp. 241-272. , Disaia PJ, Creasman WT. St Louis: MosbyDe Hullu, J.A., Hollema, H., Lolkema, S., Boezen, M., Boonstra, H., Burger, M.O., Vulvarcarcinoma: The price of less radical surgery (2002) Cancer, 95, pp. 2331-2338Micheletti, L., Levi, A.C., Bogliatto, F., Preti, M., Massobrio, M., Rationale and definition of the lateral extension of the inguinal lymphadenectomy for vulvar cancer derived from an embriological and anatomical study (2002) J Surg Oncol, 81, pp. 19-24Kim, R.Y., Alvarez, R.D., Omura, G.A., Advances in the treatment of gynecologic malignancies. Part 1: Cancers of the cervix and vulva (2002) Oncology, 16, pp. 1510-1517Rouzier, R., Haddad, B., Plantier, F., Dubois, P., Pelisse, M., Paniel, B.J., Local relapse in patients treated for squamous cell vulvar carcinoma: Incidence and prognostic value (2002) Obstet Gynecol, 100, pp. 1159-1167Edwards, S., Handfield-Jones, S., Gull, S., National guidelines on the management of vulval conditions (2002) Int J STD AIDS, 13, pp. 411-415Ulitin, H.C., Pak, Y., Dede, M., Can radiotherapy be a treatment option for elderly women with invasive vulvar carcinoma without radical surgery? (2002) Eur J Gynaecol Oncol, 23, pp. 426-428Puig-Tintore, L.M., Ordi, J., Vidal-Sicart, S., Lejarcegui, J.Á., Torn, A., Pahisa, J., Further data on the usefulness of sentinel lymph node identification and ultrastaging in vulvar squamous cell carcinoma (2003) Gynecol Oncol, 88, pp. 29-34Scheiströen, M., Nesland, J.M., Trope, C., Have patients with early squamous carcinoma of the vulva been overtreated in the past? The norvegian experience 1977-1991 (2002) Eur J Gynaecol Oncol, 23, pp. 93-103Hullu, J.A., Van Der Zee, A.G., Sentinel node techniques in cancer of the vulva (2003) Curr Womens Health Rep, 3, pp. 19-26Shepherd, J.H., Cervical and vulvar cancer: Changes in FIGO definitions of staging (1996) Br J Obstet Gynecol, 103, pp. 405-406Scully, R.E., Bonfligio, T.A., Kurman, R.J., Silverberg, S.G., Wilkins, E.J., Histological typing of female genital tract tumors (1994) Histological Classification of Tumors. 2th Ed., , World Health Organization. International. Berlin: Springer-VerlagBosquet, J.G., Kinney, W.K., Russel, A.H., Gaffey, T.A., Magrina, J.F., Podratz, K.C., Risk of occult inguinofemoral lymph node metastasis from squamous carcinoma of the vulva (2003) Int J Radiat Oncol Biol Phys, 2, pp. 419-424Gomes-Rueda, N., Vighi, S., Garcia, A., Cardinal, L., Belardi, M.G., Di Paola, G., Histologic predictive factors: Therapeutic impact in vulvar cancer (1994) J Reprod Med, 39, pp. 71-76Crum, C.P., Carcinoma of the vulva: Epidemiology and pathogenesis (1992) Obstet Gynecol, 79, pp. 448-454Kurman, R.J., Trimble, C.L., Shah, K.V., Human papilloma virus and the pathogenesis of vulvar carcinoma (1992) Curr Opin Obstet Gynecol, 4, pp. 582-585Trimble, C.L., Hildenshein, A., Brinton, L.A., Shah, K.V., Kurman, R.J., Heterogenous etiology of squamous carcinoma of the vulva (1996) Obstet Gynecol, 87, pp. 59-64AlGhamdi, A., Freedman, D., Miller, D., Poh, C., Rosin, M., Zhang, L., Vulvar squamous cell carcinoma in young women: A clinicopathologic study of 21 cases (2002) Gynecol Oncol, 84, pp. 94-101Morris, J.M., A formula for selective lymphadenectomy: Its application to cancer of the vulva (1977) Obstet Gynecol, 50, pp. 152-158Hacker, N.F., Management of regional lymph nodes and their prognostic influence in vulvar cancer (1983) Obstet Gynecol, 61, pp. 408-412DiSaia, P.J., Creasman, W.T., Rich, W.M., An alternate approach to early cancer of the vulva (1979) Am J Obstet Gynecol, 133, pp. 825-832Gordinier, M.E., Malpica, A., Burke, T.W., Bodurka, D.C., Wolf, J.K., Jhingran, A., Groin recurrence in patients with vulvar cancer with negative nodes on superficial inguinal lymphadenectomy (2003) Gynecol Oncol, 90, pp. 625-628Tilmans, A.S., Sutton, G.P., Look, K.Y., Sethman, F.B., Ehrilich, C.E., Hornback, N.B., Recurrent squamous carcinoma of the vulva (1992) Am J Obstet Gynecol, 167, pp. 1383-1389Levenback, C., Burke, T.W., Gershenson, D.M., Morris, M., Malpica, A., Ross, M.I., Intraoperative lymphatic mapping for vulvar cancer (1994) Obstet Gynecol, 84, pp. 163-167Terada, K.Y., Shimizu, D.M., Wong, J.H., Sentinel node dissection and ultrastaginc in squamous cell cancer of the vulva (2000) Gynecol Oncol, 76, pp. 40-4

Erbb-2 Expression And Hormone Receptor Status In Areas Of Transition From In Situ To Invasive Ductal Breast Carcinoma [expressão Da Proteína Erbb-2 E Dos Receptores De Hormônios Na Transição Das Regiões In Situ Para Invasora De Tumores Da Mama]

PURPOSE: to evaluate the expression of erbB-2 and of the estrogen and progesterone (ER/P) hormonal receptors in the transition regions between the in situ and the invasive fractions of ductal breast neoplasia (ISDC and IDC, respectively). METHODS: Eighty-five cases of breast neoplasia, containing contiguous ISDC and IDC areas, were selected. Histological specimens from the ISDC and the IDC areas were obtained through the tissue microarray (TMA) technique. The erbB-2 and the ER/PR expressions were evaluated through conventional immunohistochemistry. The McNemar's test was used for the comparative analysis of the expressions of erbB-2 protein and the ER/PR in the in situ and invasive regions of the tumors. The confidence intervals were set to 5% (p=0.05). Intraclass correlation coefficients (ICC) were calculated to assess the cross-tabulation agreement of the erbB-2 and the ER/PR expression in the ISDC and the IDC areas. RESULTS: the erbB-2 expression has not differed between the ISDC and the IDC areas (p=0.38). Comparing the two areas in each case, there was agreement in the expression of erbB-2 (ICC=0.64), PR (ICC=0.71) and ER (ICC=0.64). Restricting the analysis to tumors with the in situ component harboring necrosis (comedo), the ICC for erbB-2 was 0.4, compared to 0.6 for the whole sample. In this select group, the ICC for PR/ER did not differ substantially from those obtained with the complete dataset: as for the ER, ICC=0.7 (versus 0.7 for the entire sample) and for PR, ICC=0.7 (versus 0.6 for the entire sample). CONCLUSIONS: our findings suggest that the erbB-2 and the ER/PR expressions do not differ in the contiguous in situ and invasive components of breast ductal tumors.319461467Schnitt, S.J., The transition from ductal carcinoma in situ to invasive breast cancer: The other side of the coin (2009) Breast Cancer Res., 11 (1), p. 101Wiechmann, L., Kuerer, H.M., The molecular journey from ductal carcinoma in situ to invasive breast cancer (2008) Cancer, 112 (10), pp. 2130-42Skinner, K.A., Silverstein, M.J., The management of ductal carcinoma in situ of the breast (2001) Endocr Relat Cancer, 8 (1), pp. 33-45(2008) Drogas de alvo molecular na oncologia e hematologia [Internet], , http://www.nibsemabs.com.br/bases.asp?id=1, Nibs & Mabs, citado 2008 Set 6, Disponível emLatta, E.K., Tjan, S., Parkes, R.K., O'Malley, F.P., The role of HER2/neu overexpression/amplification in the progression of ductal carcinoma in situ to invasive carcinoma of the breast (2002) Mod Pathol., 15 (12), pp. 1318-25Hussein, M.R., Abd-Elwahed, S.R., Abdulwahed, A.R., Alterations of estrogen receptors, progesterone receptors and c-erbB2 oncogene protein expression in ductal carcinomas of the breast (2008) Cell Biol Int., 32 (6), pp. 698-707Heldring, N., Pike, A., Andersson, S., Matthews, J., Cheng, G., Hartman, J., Estrogen receptors: How do they signal and what are their targets (2007) Physiol Rev., 87 (3), pp. 905-31Provenzano, E., Hopper, J.L., Giles, G.G., Marr, G., Venter, D.J., Armes, J.E., Biological markers that predict clinical recurrence in ductal carcinoma in situ of the breast (2003) Eur J Cancer, 39 (5), pp. 622-30Wärnberg, F., Nordgren, H., Bergkvist, L., Holmberg, L., Tumour markers in breast carcinoma correlate with grade rather than with invasiveness (2001) Br J Cancer, 85 (6), pp. 869-74Gusterson, B.A., Machin, L.G., Gullick, W.J., Gibbs, N.M., Powles, T.J., Price, P., Immunohistochemical distribution of c-erbB-2 in infiltrating and in situ breast cancer (1988) Int J Cancer, 42 (6), pp. 842-5Park, K., Han, S., Kim, H.J., Kim, J., Shin, E., HER2 status in pure ductal carcinoma in situ and in the intraductal and invasive components of invasive ductal carcinoma determined by fluorescence in situ hybridization and immunohistochemistry (2006) Histopathology, 48 (6), pp. 702-7Sauter, G., Lee, J., Bartlett, J.M., Slamon, D.J., Press, M.F., Guidelines for human epidermal growth factor receptor 2 testing: Biologic and methodologic considerations (2009) J Clin Oncol., 27 (8), pp. 1323-33http://cran.r-project.org/doc/manuals/refman.pdf, The R Development Core Team. 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