Association of p16 and Ki-67 with Risk of Recurrence in Previously Treated Cervical High-Grade Squamous Intraepithelial Lesions.

OBJECTIVE: Our main objective was to assess the association between the markers p16 and Ki-67 and recurrence of disease in patients previously treated for cervical high-grade squamous intraepithelial lesion (HSIL). DESIGN: This is a case-control study at the National Cancer Institute conducted between 2005 and 2015. Of the patients with a pathologically confirmed diagnosis of HSIL, 107 cases were selected. They were divided into 2 groups: 28 cases with recurrence after treatment and a control group of 79 patients without recurrence. We identified clinical, pathological, and treatment variables. METHODS: Two experienced pathologists performed immunohistochemical analysis of biomarkers; they agreed on their interpretation, and we calculated the odds ratios (ORs) associated with recurrence. For group comparisons, we used the Wilcoxon signed-rank, χ2, or Fisher's exact test, depending on the type of variable. We conducted logistic regression models to estimate ORs and determine the factors associated with recurrence. The recurrence-free period was defined as the time frame between conization and either recurrence of disease or the last date the patient was seen. We used Kaplan-Meier plots to visualize survival curves and log-rank tests to compare the curves. We established a p value <0.05 as statistically significant. RESULTS: After pathologists performed immunohistochemical analysis, they achieved an agreement level of 83.7% for p16 and 60% for Ki-67. We did not find an association between recurrence and either p16 expression (p = 0.69) or the percentage of Ki-67 expression (p = 0.71). The recurrence-free period analysis did not reveal a difference in p16 expression (p = 0.57) nor in the percentage of Ki-67 expression in the 3-tiered scale (p = 0.56). LIMITATIONS: Our main limitation was a reduced sample size. CONCLUSION: We found no association between p16 and Ki-67 positivity and the risk of recurrence in previously treated HSIL.

Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer.

BACKGROUND: Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner. METHODS: A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis. RESULTS: In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy. CONCLUSIONS: This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.

[Trends of thyroid pathology in a referral center: steady prevalence of papillary thyroid carcinoma but goiter increase in thyroidectomies]. / Tendencias en patología tiroidea en un centro de referencia: prevalencia estable del carcinoma papilar e incremento de hiperplasia nodular en tiroidectomías.

INTRODUCTION: Changes in the prevalence of papillary thyroid carcinoma (PTC) have been reported in institutions and national cancer registries. OBJECTIVE: To describe time trends in benign and malignant thyroid diseases in a national endocrine referral center. MATERIALS AND METHODS: Systematic review and classification of consecutive specimens with slides/paraffin blocks in surgical pathology archives (January 1990 to December 2009). Institutional registries, size, type of surgery and number of inclusion blocks were recorded. Patients whose registries were granted before January 1990 without nodules, but treated after twelve months for a suspicious thyroid lesion, were included. These patients in a passive follow-up permitted incidence density calculations. Cases were grouped by quinquennium. RESULTS: Institutional registers were conceded to 103,961 persons worthy of attention, and 1,269 were submitted to thyroidectomies (1.2%). One hundred twenty four patients none treated for thyroid diseases before 1990, developed thyroid nodules after 1991. The incidence density for goiter was 0.05 person/year and for PTC 0.04 person/year in that group. In all series woman to man relation was 9:1 with a mean age of 45 years. Total or near total thyroidectomies were performed in 60% patients and benign diseases were diagnosed in 732 (52%) cases. Thyroid surgeries increased since 2005 (p=0.03) with a rise in goiter prevalence (0.25, 0.31, 0.35, 0.38, p for trend 0.0005), without significant increase in PTC prevalence (0.41, 0.43, 0.35, 0.40, p for trend 0.71) in thyroidectomies. CONCLUSIONS: Goiter as the only finding in thyroid specimens increased 52% in the last 20 years. PTC prevalence is steady with a higher number of tumors<3 cm.