94 research outputs found
Complications and relapse rate in patients with vulvar squamous cell carcinoma undergoing radical vulvectomy with one or three incisions: study of 132 cases
The purpose of the present study was to compare postoperative complications and recurrence rates in 132 women with invasive vulvar carcinoma treated by radical vulvectomy and bilateral groin lymphadenectomy performed with one or three incisions. It was a nonrandomized retrospective clinical study, including 65 women operated using a single incision and 67 with three incisions, between 1986 and 1996. Fischer's, chi-square, Student's t tests followed by logistic regression were used for statistical analysis as well as survival curves by the Kaplan-Meyer method, compared using Wilcoxon test, followed by Cox regression, with the statistical significance limit of 5%. The groups were similar regarding age, smoking, presence of other diseases, histologic type and grade. Pathologic stage III was significantly more frequent in the single incision group, while free lymph nodes were more frequent in the three-incision group. The patients treated with triple incision showed statistically less frequent immediate complications (76% vs 92%, p<0.05), less dehiscence (72% vs 92%, p<0.01), and shorter mean hospital stay (19.4 days vs 38.7 days, p<0.001) and secondary procedures were less necessary (76% vs 94%, p<0.01). Seven postoperative deaths were observed: five with single incision and two with triple incision. Recurrence rate was statistically lower in patients treated with triple incision (19% vs 35%, p<0.01) and with negative lymph nodes (6% vs 15%, p<0.01). After Cox regression, only positive lymph nodes had negative influence on disease-free survival. We concluded that vulvectomy using three incisions shows less complications than single incision, without compromising therapeutic efficacy, independently of the stage of the disease.O objetivo deste estudo foi comparar as taxas de complicações pós-operatórias e a taxa de recidiva em 132 mulheres com carcinoma da vulva tratadas com vulvectomia radical e linfadenectomia inguinal bilateral com uma ou três incisões. Foi um ensaio clínico retrospectivo não randomizado, incluindo 65 mulheres operadas por incisão única e 67 por três incisões, entre 1986 e 1996. Para análise estatística foram realizados os testes Exato de Fischer, Qui-Quadrado, t de Student e regressão logística e curvas de sobrevida pelo método de Kaplan-Meyer, comparadas pelo teste de Wilcoxon, seguidas de regressão de Cox, com limite de 5% de significância estatística. Os grupos foram semelhantes com relação à idade, tabagismo, presença de síndromes clínicas, tipo e grau histológico. Pacientes com neoplasia no estadio III foram mais freqüentes no grupo de incisão única e mais linfonodos livres no grupo de três incisões. As pacientes tratadas com três incisões apresentaram significativamente menos complicações pós-operatórias imediatas (76% vs 92%, p<0,05), menos deiscências (72% vs 92%, p<0,01), menor necessidade de procedimentos secundários (76% vs 94%, p<0,01) e menor tempo de internação (média de 19,4 dias vs 38,7 dias, p<0,001). Ocorreram sete óbitos pós-operatórios: cinco no grupo tratado com incisão única e dois com três incisões. A taxa de recidiva foi significativamente menor nas operadas com três incisões (19% vs 35%, p<0,01) e com linfonodos livres de doença (6% vs 15%, p<0,01). Após a regressão de Cox, apenas os linfonodos comprometidos influenciaram negativamente o tempo livre de doença. Concluímos que a vulvectomia por três incisões apresenta menos complicações que a incisão única, sem comprometer a eficácia terapêutica, independente do estádio da neoplasia.9710
Complicações e taxa de recidiva em pacientes com carcinoma epidermóide da vulva tratadas com vulvectomia radical com uma ou três incisões: estudo de 132 casos
The Impact Of A Community Intervention To Improve Cervical Cancer Screening Uptake In The Amazon Region Of Brazil.
In the northern region of Brazil, cervical cancer is the most important cause of cancer-related deaths among women. There is considerable likelihood, however, that official incidence and mortality figures are greatly underestimated. The aim of this study was to estimate the repercussions from improvement in cervical cancer screening programs on the incidence of pre-invasive and invasive cervical lesions in a municipality in this region. This was a quasi-experimental study that assessed process dimensions relevant to the program objectives. The study comprised a sample of 2,226 women seen at primary healthcare units in Cruzeiro do Sul, a small city in the Brazilian Amazon region, from April 2003 to July 2004. Women were recruited through local radio advertisements and by oral communication from the investigators. The women answered a structured questionnaire and underwent pelvic examination, which included Papanicolaou (Pap) smears and naked-eye inspection of the cervix after applying diluted acetic acid. Women with positive Pap smears or abnormal gynecological examination were referred for colposcopy and possible biopsy, diathermic large loop excision of the transformation zone or conization. The results obtained were compared with historical official data retrieved from the Brazilian Ministry of Health's database. Intervention resulted in a 40% increase in positive Pap smears and detection of cancer was nine times higher than had been observed in routine screening. Detection of pre-invasive and invasive cervical lesions in the intervention group was remarkably higher than among women seen during routine screening.12542-
Prevalence of HPV 16, 18, 45 and 31 in women with cervical lesions
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.OBJETIVO: avaliar a prevalência dos HPV 16, 18, 31 e 45 em amostras de raspado cervical de mulheres com alterações celulares e/ou colposcopia sugestiva de lesão de alto grau ou lesão de baixo grau persistente submetidas à conização. MÉTODOS: Foram incluídas 120 mulheres. A análise histológica dos cones cervicais revelou 7 casos de cervicite, 22 de NIC1, 31 de NIC2, 54 de NIC3 e 6 carcinomas invasores. Foram analisadas as amostras de raspado cervical coletadas antes da conização para a presença do DNA-HPV por PCR com os primers de consenso, PGMY09/11. As amostras positivas para DNA de HPV foram testadas para presença do HPV16, 18, 31 e 45 utilizando-se primers tipo específico para esses HPV. RESULTADOS: O DNA-HPV foi detectado em 67,5% das mulheres. O HPV 16 (40%) foi o tipo mais prevalente na maioria das lesões, seguido dos HPV 31 (13,3%), 45 (13,3%) e 18 (4,1%). Infecções múltiplas ocorreram em 15% dos casos e as infecções por outros tipos de HPV foram detectadas em 14% da amostra. CONCLUSÕES: as infecções pelos HPV 16 e 18 nem sempre ocorrem de maneira solitária (infecção única), estando associadas a outros tipos de HPV em diversas ocasiões.31532
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 specificities 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
[prevalence Of Hpv 16, 18, 45 And 31 In Women With Cervical Lesions].
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. 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. 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. HPV 16 and 18 infections do not always occur as a single infection, and may be associated with other HPV types on different occasions.32315-2
ErbB-2 expression and hormone receptor status in areas of transition from in situ to invasive ductal breast carcinoma
OBJETIVOS: avaliar a expressão de erbB-2 e dos receptores hormonais para estrógeno e progesterona (RE/RP) nas regiões de transição entre as frações in situ e invasoras de neoplasias ductais da mama (CDIS e CDI, respectivamente). MÉTODOS: oitenta e cinco casos de neoplasias mamárias, contendo regiões contíguas de CDIS e CDI, foram selecionados. Espécimes histológicos das áreas de CDIS e de CDI foram obtidos através da técnica de tissue microarray (TMA). As expressões da erbB-2 e dos RE/RP foram avaliadas por meio de imunoistoquímica convencional. A comparação da expressão da erbB-2 e dos RE/RP nas frações in situ e invasoras da mama foi realizada com emprego do teste de McNemar. Os intervalos de confiança foram determinados em 5% (p=0,05). Foram calculados coeficientes de correlação intraclasse (ICC) para avaliar a concordância na tabulação cruzada da expressão de erbB-2 e RE/RP nas frações de CDIS e CDI. RESULTADOS: a expressão da erbB-2 não diferiu entre as áreas de CDIS e CDI (p=0,38). Comparando caso a caso suas áreas de CDIS e CDI, houve boa concordância na expressão da erbB-2 (coeficiente de correlação intraclasse, ICC=0,64), dos RP (ICC = 0,71) e dos RE (ICC = 0,64). Considerando apenas tumores cujo componente in situ apresentasse áreas de necrose (comedo), o ICC para erbB-2 foi de 0,4, comparado a 0,6 no conjunto completo de casos. Os ICC não diferiram substancialmente daqueles obtidos com o conjunto completo de espécimes em relação aos RE/RP: para RE, ICC=0,7 (versus 0,7 no conjunto completo), e para RP, ICC=0,7 (versus 0,6 no conjunto completo). CONCLUSÕES: nossos achados sugerem que as expressões de erbB-2 e RE/RP não diferem nos componentes contíguos in situ e invasivo em tumores ductais 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.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq
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