Participación de mujeres de 13 y más años en la prevención del cáncer cervical: área de influencia de un hospital público, Paraguay / Participation of 13 years old women and over in cervical cancer prevention: area of influence of a public hospital, Paraguay

RESUMEN Introducción: el cáncer cervical representa un grave problema de salud pública a pesar de ser altamente prevenible. Objetivo: determinar las características clínicas y epidemiológicas de la participación de las mujeres del área de influencia de un Hospital Público en la prevención del cáncer de cuello uterino entre los meses de enero a diciembre de los años 2020 al 2021. Metodología: diseño no experimental de corte transversal tipo descriptivo, con enfoque cuantitativo. Se incluyó el total de mujeres participantes de la prevención de cáncer cervical en el área de influencia del Hospital Público. Se utilizaron datos secundarios que fueron cargados en una planilla elaborada previamente. Resultados: el 61 % de las mujeres estaban en edad de riesgo, 83 % no estaban embarazadas y 17 % si, 53 % tiene antecedente de PAP y 47 %, no, 86 % tuvo resultado negativo para lesión, 9 % inflamatorio y 4 % positivo. Entre los resultados positivos el preponderante fue el de ASCUS con un 47 %. Se concluye que la mayoría de las mujeres tuvieron un resultado de PAP negativo. Entre las mujeres con resultados positivos se tuvo preponderancia de diagnósticos de ASCUS y en segundo lugar CIN I LSIL. Conclusión: las características que se encontraron significativamente asociadas al resultado de PAP fueron: formar parte del grupo de edad de riesgo y presencia de embarazo. Se sugiere seguir haciendo hincapié en la prevención y seguimiento, indagar en las edades de riesgo e incluir otras variables de interés en futuros estudios.

ABSTRACT Introduction: cervical cancer represents a serious public health problem despite being highly preventable. Objective: to determine the clinical and epidemiological characteristics of the participation of women in the area of influence of a Public Hospital in the prevention of cervical cancer between the months of January to December of the years 2020 to 2021. Methodology: non-experimental cross-sectional descriptive design, with a quantitative approach. The total number of women participating in the prevention of cervical cancer in the area of influence of the Public Hospital was included. Secondary data were used that were loaded into a previously prepared form. Results: 61 % of the women were of 13 years old at risk, 83 % were not pregnant and 17 % were pregnant, 53 % had a history of PAP and 47 % did not, 86 % had a negative result for lesion, 9 % inflammatory and 4 % positive. Among the positive results, the predominant one was ASCUS with 47 %. The majority women had a negative PAP result. As a conclusion among women with positive results, there was a predominance of ASCUS diagnoses and in second place CIN I LSIL. Conclusion: the features that were found to be significantly associated with the PAP result were: being part of the age group at risk and presence of pregnancy. It is suggested to continue emphasizing prevention and follow-up, to investigate the ages at risk and to include other variables of interest in future studies.

A study to evaluate the knowledge of women about the prevention of carcinoma cervix by vaccination

Background: Cervical cancer, characterized by malignant growth in the cervix uteri, often manifests with vaginal bleeding and can progress silently until reaching an advanced stage. It ranks as the most common cancer among women in numerous developing nations. The study aimed to evaluate the knowledge of the women about the prevention of carcinoma cervix by vaccination.Methods: This cross-sectional observational study was conducted at the outpatient department of obstetrics and gynecology, Dhaka medical college and hospital, Bangladesh from Jan 2020 to Dec 2021. In this study, 100 women attending the mentioned department, were interviewed with a view in mind to find out their knowledge level regarding the vaccination of cervical cancers. Data were analyzed by using MS office tools.Results: The study revealed a direct correlation between education level and awareness of HPV, underscoring a significant lack of knowledge about cervical cancer vaccination. It emphasizes the urgent need to educate individuals about the vaccine's role in preventing cervical cancer. Education campaigns utilizing local media could effectively disseminate information.Conclusions: The unavailability and cost of the vaccine pose barriers to its accessibility. Integrating the vaccine program into existing expanded program on immunization (EPI) initiatives could be transformative for community health.

Exploring Morphometric Features of the Female Reproductive Tract in Brazilian Pantanal Cattle / Un Análisis de las Características Morfométricas del Tracto Reproductivo Femenino en el Ganado del Pantanal Brasileño

SUMMARY: The cattle in the Pantanal region show a notable influence from Bos indicus breeds and their crossbreeds. However, a comprehensive biometric assessment of the reproductive system in these animals is currently lacking. This study evaluated the effects of breed, age, carcass weight, and estrous cycle phase on female reproductive system morphometry. A total of 124 healthy, non-pregnant reproductive tracts (83 Nelore and 41 Crossbred) were collected at a slaughterhouse. Neither the volume and weight of the ovaries nor the majority of uterine dimensions were affected by breed. Compared to heifers, cows showed longer uterine horns, a larger external caudal diameter of the uterine horns and body, and a greater external cranial diameter and internal caudal diameter of the cervix. The carcass weight (below vs. within commercial weight) affected the length of the uterine horns, uterine body, and cervix. Ovaries with a corpus luteum presented higher volume and weight than those with only follicles. Although the uterine measurements in the luteal phase were increased, the cycle stage did not affect the uterine morphometry. The average number of cervical rings was 5.0, independent of weight or breed. Crossbred animals presented a higher first cervical ring. Age didn´t influence the number, height, or distance between cervical rings. Deviation from the normal alignment of the cervix was recorded in 14.29 % of the animals, with a higher occurrence among Nelore cattle; deviation from the median axis was the most common (30%). This study emphasizes various parameters influencing the morphometry of the female reproductive system in Nelore cattle and their crosses, which could be crucial for implementing reproductive biotechnology techniques better suited to the morphological characteristics of zebu breeds.

El ganado de la región del Pantanal muestra una notable influencia de las razas Bos indicus y sus cruces. Sin embargo, actualmente falta una evaluación biométrica exhaustiva del sistema reproductivo de estos animales. Este estudio evaluó los efectos de la raza, la edad, el peso de la canal y la fase del ciclo estral sobre la morfometría del sistema reproductivo de la hembra. En un matadero se recogieron un total de 124 tractos reproductivos sanos y no preñados (83 Nelore y 41 cruzados). Ni el volumen ni el peso de los ovarios ni la mayoría de las dimensiones del útero se vieron afectados por la raza. En comparación con las novillas, las vacas mostraron cuernos uterinos más largos, un diámetro caudal externo más grande de los cuernos y del cuerpo uterino, y un diámetro craneal externo y un diámetro caudal interno más grandes del cuello uterino. El peso de la canal (por debajo versus dentro del peso comercial) afectó la longitud de los cuernos uterinos, el cuerpo uterino y el cuello uterino. Los ovarios con cuerpo lúteo presentaron mayor volumen y peso que aquellos con solo folículos. Aunque las medidas uterinas en la fase lútea aumentaron, la etapa del ciclo no afectó la morfometría uterina. El número promedio de anillos cervicales fue de 5,0, independientemente del peso o la raza. Los animales mestizos presentaron un primer anillo cervical más alto. La edad no influyó en el número, altura o distancia entre anillos cervicales. La desviación de la alineación normal del cuello uterino se registró en el 14,29 % de los animales, con mayor ocurrencia en el ganado Nelore; la desviación del eje de la mediana fue la más común (30%). Este estudio enfatiza varios parámetros que influyen en la morfometría del sistema reproductor de las hembras en el ganado Nelore y sus cruces, lo que podría ser crucial para implementar técnicas de biotecnología reproductiva más adecuadas a las características morfológicas de las razas cebú.

Exploring neuroendocrine carcinoma of the cervix: a case report and literature review

Neuroendocrine neoplasms (NENs) are rare, comprising less than 1% of cervical malignancies. Diagnosis and management of cervical neuroendocrine carcinoma (NEC) pose challenges due to its rarity and aggressive nature. Aim of the study was to highlight the importance of considering NEC in the differential diagnosis of cervical malignancies and underscore the potential benefits of comprehensive treatment approaches. We report a case of a 35-year-old woman presenting with post-coital bleeding, subsequently evaluated and diagnosed with NEC T1b1N0Mx following radical hysterectomy. Adjuvant chemoradiotherapy and chemotherapy led to one year of remission. Cervical NEC poses diagnostic and therapeutic challenges due to its rarity and aggressive nature. Despite multimodal treatment, prognosis remains poor, warranting further research and targeted therapies. The rarity of cervical NEC emphasizes the need for increased awareness among clinicians to facilitate early detection and appropriate management. Further studies are warranted to explore novel treatment modalities and improve outcomes for patients with this challenging malignancy.

Unveiling the uncommon: invasive adenocarcinoma cervix presenting during pregnancy: a rare case report

Adenocarcinoma of the cervix presenting during pregnancy is an exceedingly rare occurrence, and the optimal management approach remains uncertain due to limited reported cases. Here we are presenting a case of a multiparous lady who presented with complaints of amenorrhoea for 3 months, pain abdomen, spotting per vaginum, mass felt per vaginum. Ultrasonography showed single live intrauterine pregnancy at 11 weeks 4 days of gestational age with an ill-defined hyperechoic lesion measuring 4.36×4.92×4.16 cm in cervix. HPE of cervical biopsy confirmed cervical adenocarcinoma-endocervical type, grade 2. On MRI, a heterogeneous exophytic irregular mass involving the external os, protruding into the upper vaginal cavity was identified with infiltration into the anterior upper vaginal wall, pelvic lymphadenopathy, and sub-centimetric inguinal lymph nodes were observed. The patient underwent radical hysterectomy with bilateral pelvic lymph node dissection. The surgical specimen exhibited stromal invasion exceeding 5mm in depth and width greater than 7mm, involving entire cervical wall with lympho-vascular space invasion. The tumor was ER/PR negative, strongly positive for P16, and HPV studies were also positive. Adjuvant external beam radiotherapy (EBRT) was administered to the pelvis, and the patient is currently in remission.

Principales indicadores del Programa de Diagnóstico Precoz del Cáncer Cervicouterino en un hospital de Santiago de Cuba

Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

Reflexiones sobre el cáncer de cérvix y la salud pública / Reflections on Cervical Cancer and Public Health

En este artículo tratamos de mostrar la actual realidad y problemática del cáncer de cuello uterino en la salud pública. Su repercusión en la población femenina desde temprana edad y el plan de acción para su control como política a largo plazo para disminuir su mortalidad

In this article we try to show the current reality and problems of cervical cancer in public health. Its impact on the female population from an early age and the action plan for its control as a long-term policy to reduce mortality

Prevalencia y factores de riesgo de la neoplasia intraepitelial anal en pacientes con lesión intraepitelial cervical de alto grado / Prevalence and risk factors for anal intraepithelial neoplasia in patients with high- grade cervical intraepithelial lesion

Resumen OBJETIVO: Determinar la prevalencia de alteraciones en la citología anal, infección anal por virus del papiloma humano y en la neoplasia intraepitelial anal; además, explorar los factores de riesgo y los serotipos asociados en pacientes con lesión intraepitelial cervical de alto grado, a partir de la hipótesis de que esta población tiene mayor riesgo de lesiones precursoras o cáncer anal. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal, con componente analítico, efectuado en pacientes con diagnóstico de lesión intraepitelial cervical de alto grado (LIEAG) en dos instituciones de salud: una privada y otra pública de Bogotá, atendidas entre enero de 2017 y febrero de 2018. Se efectuó un muestreo no probabilístico, por conveniencia. RESULTADOS: Se incluyeron 119 participantes, en 4 de ellas se evidenció, en la citología anal, el hallazgo de células anormales en el tejido que reviste la parte exterior del cuello uterino. Se encontraron 14 anoscopias anormales que dieron una prevalencia de neoplasia intraepitelial anal del 6.7%. Siete eran neoplasia intraepitelial anal de bajo grado y una de alto grado. Se encontró infección por VPH anal en 45 participantes (37.8%) y se detectaron genotipos de VPH-AR en 29 participantes (24.4%). Más de 3 compañeros sexuales, más de 3 hijos y tener menos de 21 años antes del primer embarazo tuvieron un valor de p < 0.05 que confiere mayor riesgo de infección por VPH anal. CONCLUSIÓN: Es importante establecer en Colombia protocolos para la detección de la neoplasia intraepitelial anal en grupos de alto riesgo, como las pacientes con neoplasia intraepitelial cervical o cáncer de cuello uterino, e incentivar el adiestramiento en la anoscopia de alta resolución en especialistas relacionados con el diagnóstico de patología anogenital.

Abstract OBJECTIVE: To determine the prevalence of alterations in anal cytology, anal human papillomavirus infection, and anal intraepithelial neoplasia, and to explore the risk factors and associated serotypes in patients with high-grade cervical intraepithelial lesion, based on the hypothesis that this population is at higher risk for precancerous lesions or anal cancer. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study, with analytical component, performed in patients diagnosed with high-grade cervical intraepithelial lesion (HG-CIL) in two health institutions: one private and one public in Bogota, visited between January 2017 and February 2018. A non-probabilistic sampling was performed, by convenience, with a sample calculated in 124 patients. RESULTS: 119 participants were included, in 4 of them it was evidenced in the anal cytology, the finding of abnormal cells in the tissue lining the outside of the cervix. Fourteen abnormal anoscopies were found, giving a prevalence of anal intraepithelial neoplasia of 6.7%. Seven were low-grade anal intraepithelial neoplasia and one was high-grade. Anal HPV infection was detected in 45 participants (37.8%) and HR-HPV genotypes were detected in 29 participants (24.4%). More than 3 sexual partners, more than 3 children and being younger than 21 years before first pregnancy had a p-value < 0.05 conferring an increased risk of anal HPV infection. CONCLUSION: It is important to establish protocols in Colombia for the detection of anal intraepithelial neoplasia in high-risk groups, such as patients with cervical intraepithelial neoplasia or cervical cancer, and to promote training in high-resolution anoscopy in specialties related to the diagnosis of anogenital pathology.

Factores de riesgo del cáncer de cérvix en pacientes atendidas en un consultorio médico

Introducción: El cáncer de cérvix es un grave problema de salud que puede prevenirse con diagnósticos tempranos y la participación activa de las mujeres y profesionales de la salud. Objetivo: Determinar la asociación entre factores de riesgo y la aparición del cáncer de cérvix en mujeres procedentes del Consultorio Médico no. 7 del área del Policlínico Docente Julio Castillo Álvarez, en Chambas, Ciego de Ávila. Materiales y métodos: Se realizó un estudio analítico retrospectivo con 18 mujeres entre 25 y 60 años con diagnóstico previo de cáncer de cérvix, pertenecientes al Consultorio Médico no. 7, que fueron atendidas en el Hospital Provincial General Docente Roberto Rodríguez, de Morón. Resultados: Solo el 13 % de las participantes mencionaron gestaciones prematuras, y el 37,0 % reportó infección vaginal. El embarazo en la adolescencia fue el factor más común, con un 55,6 % de las mujeres afectadas. La mayoría de las mujeres (92,6 %) habían tomado anticonceptivos orales. Conclusiones: Los factores de riesgo identificados incluyen el primer coito antes de los 15 años y el hábito tabáquico, presentes en una franca minoría. El embarazo en la adolescencia y la ingestión de anticonceptivos orales fueron los más referidos.

Introduction: Cervical cancer is a serious health problem that can be prevented with early diagnoses and the active participation of women and health professionals. Objective: To determine the association of risk factors and the onset of cervical cancer in women from Doctor's office #7 of the Teaching Polyclinic Julio Castillo Alvarez area, in Chambas, Ciego de Avila. Materials and methods: A retrospective, analytical study was carried out with 18 women aged between 25 and 60 years, with previous diagnosis of cervical cancer, and belonging to the Doctor's Office # 7, who were treated at the Provincial General Teaching Hospital Roberto Rodríguez, in Morón. Results: Only 13% of the participants mentioned premature gestations and 37.0 reported vaginal infection. Teenage pregnancy was the most common factor, with 55.6% of women affected. Most of women (92.6%) had taken contraceptives. Conclusions: The risk factors identified include the first intercourse before the age of 15 and smoking, present in a clear minority. Pregnancy in adolescence and ingestion of oral contraceptives were the most mentioned.

Clinical and uterine cervix characteristics of women with Mycoplasma and Ureaplasma in genital discharge

SUMMARY OBJECTIVE: The objective of this study was to assess the clinical and uterine cervix characteristics of patients displaying vaginal discharge with positive results for Mycoplasma sp. and/or Ureaplasma spp. METHODS: An analytical cross-sectional study involving women aged 18-45 years was conducted. Microbiological assessments included Ureaplasma and Mycoplasma cultures, as well as human papillomavirus hybrid capture using ecto and endocervix swabs. All tests were two-tailed, and significance was set at p<0.05. RESULTS: Among 324 women, Ureaplasma prevalence was 17.9%, and Mycoplasma prevalence was 3.1%. The Ureaplasma-positive group exhibited a higher frequency of urinary tract infections (39.1 vs. 19%, p=0.002) and human papillomavirus (39.7 vs. 12.8%, p≤0.001) compared with controls. The Mycoplasma-positive group showed a higher frequency of non-contraceptive use compared with controls (66.2 vs. 30.0%, p=0.036). Abnormal colposcopic findings were more prevalent in the Mycoplasma/Ureaplasma-positive group than in controls (positive: 65% vs. control: 35%, p=0.001). Pap smear findings did not differ between the groups. CONCLUSION: Ureaplasma spp. was associated with urinary tract infections and human papillomavirus, while the presence of Mycoplasma sp. was linked to reduced contraceptive use. When analyzing both pathogens together, a higher frequency of abnormal colposcopic findings was observed, with no difference in cytological findings in the positive group.

A new screening of preterm birth in gestation with short cervix after pessary plus progesterone

Abstract Objective This study aims to create a new screening for preterm birth < 34 weeks after gestation with a cervical length (CL) ≤ 30 mm, based on clinical, demographic, and sonographic characteristics. Methods This is a post hoc analysis of a randomized clinical trial (RCT), which included pregnancies, in middle-gestation, screened with transvaginal ultrasound. After observing inclusion criteria, the patient was invited to compare pessary plus progesterone (PP) versus progesterone only (P) (1:1). The objective was to determine which variables were associated with severe preterm birth using logistic regression (LR). The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) were calculated for both groups after applying LR, with a false positive rate (FPR) set at 10%. Results The RCT included 936 patients, 475 in PP and 461 in P. The LR selected: ethnics white, absence of previous curettage, previous preterm birth, singleton gestation, precocious identification of short cervix, CL < 14.7 mm, CL in curve > 21.0 mm. The AUC (CI95%), sensitivity, specificity, PPV, and PNV, with 10% of FPR, were respectively 0.978 (0.961-0.995), 83.4%, 98.1%, 83.4% and 98.1% for PP < 34 weeks; and 0.765 (0.665-0.864), 38.7%, 92.1%, 26.1% and 95.4%, for P < 28 weeks. Conclusion Logistic regression can be effective to screen preterm birth < 34 weeks in patients in the PP Group and all pregnancies with CL ≤ 30 mm.

The top hat procedure does not impact the management of women treated by LEEP in cervical cancer screening

Abstract Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. Conclusion: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.

Is the colposcopic lesion size a predictor of high-grade lesions in young patients?

ABSTRACT Objective: This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age. Methods: This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05. Results: The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings. Conclusion: The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.

Validación de la técnica de ganglio centinela en cáncer de cuello uterino en el Hospital de la Mujer / Validation of the sentinel lymph node technique in cervical cancer at the Women's Hospital / Validação da técnica do linfonodo sentinela em câncer de colo do útero no Hospital da Mulher

Introducción: el cáncer de cuello (CC) uterino representa un problema de salud pública. En Uruguay ocupa el tercer lugar en incidencia en mujeres, provocando 133 fallecimientos anuales. La afectación ganglionar es uno de sus principales factores pronósticos y condiciona el tratamiento. El ganglio centinela (GC) en estadios precoces de cáncer cervicouterino es una técnica segura que permite una adecuada estadificación y reduce la morbilidad asociada a la linfadenectomía convencional. Objetivo: validar la utilización de la técnica de la biopsia GC en estadios precoces de CC como estándar de tratamiento para la detección de metástasis ganglionares en el Hospital de la Mujer. Material y método: se realizó un estudio prospectivo, longitudinal, de casos. Se incluyó a 30 usuarias con CC en estadios iniciales, en el período comprendido entre enero de 2018 y noviembre de 2022. La marcación se realizó con tecnecio 99m (99mTc). En el mismo acto quirúrgico se realizó la linfadenectomía pélvica sistemática. Resultados: se detectó GC de forma bilateral en 29 de 30 pacientes. Con una tasa de detección por región de 98,3%. En cinco pacientes se detectaron GC metastásicos, no encontrando ganglios no centinela positivos. Una de ellas correspondió a una micrometástasis detectada por ultraestadificación. La sensibilidad fue de 100%: IC95% (56,55 -100) con VPN 100% IC95% (86,68 - 100). Conclusiones: de acuerdo con los resultados arrojados por el estudio, el equipo interdisciplinario del Hospital de la Mujer está en condiciones de utilizar la biopsia de GC de cérvix como estándar de tratamiento en el CC uterino en estadio precoz.

Introduction: Cervical cancer (CC) is a public health problem. In Uruguay, it ranks third in incidence in women, causing 133 deaths annually. Lymph node involvement is one of its main prognostic factors and determines treatment. The sentinel lymph node (SLN) in early stages of cervical cancer is a safe technique that allows for adequate staging and reduces morbidity associated with conventional lymphadenectomy. Objective: To validate the use of the SLN biopsy technique in early stages of CC as the standard treatment for detecting lymph node metastases at the Women's Hospital. Method: A prospective, longitudinal case study was conducted. Thirty patients with early-stage cervical cancer between January 2018 and November 2022 were included in the study. The marking was done with Tc99. Systematic pelvic lymphadenectomy was performed in the same surgical procedure. Results: Sentinel lymph nodes were detected bilaterally in 29 out of 30 patients. With a detection rate per region of 98.3%, metastatic SLNs were detected in 5 patients, with no positive non-sentinel nodes found. One of them corresponded to a micrometastasis detected by ultra-staging. Sensitivity was 100% (95% CI 56.55,100) with a negative predictive value of 100% (95% CI 86.68, 100). Conclusions: According to the results of the study, the interdisciplinary team at the Women's Hospital is in a position to use cervical SLN biopsy as the standard treatment for early-stage cervical cancer.

Introdução: O câncer do colo do útero (CCU) representa um problema de saúde pública. No Uruguai, ocupa o terceiro lugar em incidência em mulheres, causando 133 mortes por ano. O acometimento dos linfonodos é um dos principais fatores prognósticos e condiciona o tratamento. O linfonodo sentinela (LS) em estágios iniciais do câncer do colo do útero é uma técnica segura que permite o estadiamento adequado e reduz a morbidade associada à linfadenectomia convencional. Objetivo: Validar o uso da técnica de biópsia por LS em estágios iniciais do CCU como tratamento padrão para a detecção de metástases linfonodais no Hospital da Mulher. Materiais e métodos: Foi realizado um estudo de caso prospectivo e longitudinal. Trinta usuárias com LS em estágio inicial foram incluídas no período de janeiro de 2018 a novembro de 2022. A marcação foi realizada com Tc99. A linfadenectomia pélvica sistemática foi realizada no mesmo ato cirúrgico. Resultados: O LS foi detectado bilateralmente em 29 das 30 usuárias, com uma taxa de detecção por região de 98,3%. Em 5 pacientes foram detectados LS metastáticos e não foram encontrados nódulos não-sentinela positivos. 1 deles correspondia a uma micrometástase detectada por ultrassonografia. A sensibilidade foi de 100% CI 95% (56,55,100) com NPV 100% CI 95% (86,68, 100). Conclusões: Com base nos resultados do estudo, a equipe interdisciplinar do Hospital da Mulher está em condições de usar a biópsia de LS cervical como padrão de tratamento no câncer cervical em estágio inicial.

Study and analysis of cervical pap smears in our hospital

Background: Cervical cancer is one of the major causes of mortality among women worldwide. It has taken fourth place among malignancies that affect women, the first leading is breast cancer. In developing countries including India, it is the leading cause of morbidity and mortality. It is readily preventable and can be diagnosed at the pre invasive stage with adequate and repetitive cytological screening and Papanicolaou smears.Methods: This observational study was aimed to screen the patients attending gynae OPD of ESIMCH, Bihta. The main purpose was to study the incidence of premalignant and malignant lesions in population in and around ESICMCH, Bihta. A total of 100 patients attending gynaecology OPD of ESIC, Bihta were screened during a period of one year from October 2022 to September 2023.燩ap smears are taken from women visiting gynaecological OPD between ages of 25 to 70 with different gynaecological complaints using Ayer抯 spatula. Smears were reported according to Bethesda system 2001.Results: A total of 200 pap smears were examined. There were 68 patients with NILM, and 67 patients with inflammatory smear. ASCUS was found in 12 patients, LSIL in 10 patients, HSIL in 7 and squamous cell carcinoma in 1 patient. This study concluded that a simple pap smear test could be offered to vast populations for diagnosing premalignant conditions of the survey this has and will in future continue to aid us with the early diagnosis of survival cancer.Conclusions: PAP smear is useful in diagnosing malignant and premalignant lesions of the cervix. In developing countries such as India this screening method is cheap and can be widely used. It can be used by trainers and para medical staffs.

Evaluación de la dilatación cervical en simuladores comparada con una herramienta visual: estudio aleatorizado / Cervical dilation assessment in simulators compared to a visual tool: A randomized study / Avaliação da dilatação cervical em simuladores comparada a uma ferramenta visual: estudo randomizado

Objetivo: comprobar la tasa de evaluación correcta mediante la comparación visual directa de las medidas de dilatación cervical en modelos de cuello uterino de consistencia dura. Método: estudio aleatorizado abierto con 63 estudiantes de obstetricia a los que se les asignó usar o no la comparación visual directa con una guía de dilatación. Los estudiantes estimaron de forma ciega la dilatación cervical en simuladores con diferentes dilataciones. El resultado primario fue la tasa de evaluación correcta. Resultados: los estudiantes realizaron 441 pruebas. Se observó una mayor tasa de evaluación correcta en el grupo experimental que en el grupo control (47,3% versus 27,2%; p < 0,001; Odds Ratio = 2,41; intervalo de confianza del 95% = 1,62-3, 58). Conclusión: la comparación visual directa aumentó la precisión de la evaluación de la dilatación cervical en modelos de simulación de cuello, lo que podría ser beneficioso en el entrenamiento de laboratorio. Registro Brasileño de Ensayos Clínicos n.º U1111-1210-2389.

Objective: to verify the correct assessment rate when using direct visual comparison in the cervical dilation measures in hard-consistency cervix simulation models. Method: an open-label and randomized study conducted with 63 Obstetrics students that were designated either to use direct visual comparison in a dilation guide or not. The students estimated cervical dilation blindly in simulators with different dilations. The primary outcome was the correct assessment rate. Results: the students performed 141 tests. A higher correct assessment rate was found in the Experimental Group than in the Control Group (47.3% versus 27.2%; p<0.001; Odds Ratio = 2.41; 95% Confidence Interval = 1.62-3.58). Conclusion: the direct visual comparison increased precision of the cervical dilation assessment in cervix simulation models, with the possibility of being beneficial in laboratory training. Brazilian Registry of Clinical Trials No. U1111-1210-2389.

Objetivo: verificar a taxa de avaliação correta com o uso da comparação visual direta nas medidas de dilatação cervical em modelos de simulação de colo com consistência dura. Método: estudo randomizado aberto com 63 estudantes de obstetrícia que foram designados para usar comparação visual direta em um guia de dilatação ou não. Os estudantes estimaram cegamente a dilatação cervical em simuladores com diferentes dilatações. O desfecho primário foi a taxa de avaliação correta. Resultados: os estudantes realizaram 441 testes. Foi encontrada maior taxa de avaliação correta no grupo experimental do que no grupo controle (47,3% versus 27,2%; p <0,001; Odds Ratio = 2,41; intervalo de confiança de 95% = 1,62-3,58). Conclusão: a comparação visual direta aumentou a precisão da avaliação da dilatação cervical em modelos de simulação de colo, podendo ser benéfica no treinamento em laboratório. Registro Brasileiro de Ensaios Clínicos nº U1111-1210-2389.

Efficacy and safety of oral mifepristone on preinduction cervical ripening at term pregnancy prospective randomized control study

Background: Cervical ripening is important prerequisite for induction of labour, induction is indicated when it is advantageous to mother and fetus. Successful induction of labour decreases caesarean rate. Beyond term pregnancy there will be placental insufficiency, it leads to complications such as oligohydramnios thereby cord compression, birth asphyxia, increased incidence of operative delivery. Induction at term pregnancy has the potential to improve the neonatal outcomes. Aim was to study the efficacy and safety of oral mifepristone on cervical ripening prior to induction of labor at term pregnancy and to compare the feto maternal outcome with control group.Methods: Total 112 pregnant women at term pregnancy, where pregnancy can be continued for another 48 hours with bishop score 4 or less were selected. Sample was equally divided into study group (56 women) to receive 200mg mifepristone and control Group group (56 women) to receive placebo orally. Bishop score was assessed at 24hours and 48hours. In women who did not enter labor spontaneously other modes of induction was done.Results: There is significant improvement in bishop score at 24 hr and 48hr in study group p value 0.001, 80.35% women in study group and 50 % women in control group delivered vaginally. 33.9% women of study group and 10.7% women of control group delivered spontaneously. Requirement of PGE2 gel and oxytocin was significantly lesser in study group, there was no significant adverse effect seen on mother and newborn compared to control group.Conclusions: Cervical ripening with mifepristone prior to induction of labour at term improves bishop score and decreases rate of failed induction and cesarean section rate, with good neonatal outcome.

Association of colposcopy with pap smear in evaluation of unhealthy cervix- a prospective study

Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.

A study of the age profile, diagnosis, type of sample, adequacy of sample and the results of patients undergoing cervical cytology at a tertiary care center

Background: Carcinoma of cervix is the most common genital malignancy in India. It is an indolent cancer which can be picked up at an early stage using screening methods such as Papanicoloau smear and liquid based cytology. The present study was undertaken to analyze the age distribution, diagnosis, type of sample, adequacy of sample and results of patients undergoing cervical cytology screening.Methods: The study was conducted using 300 random cytology reports from the pathology department of a tertiary care center in the period of 5 months from January 2019 to May 2019. Patient’s data was collected and analyzed.Results: The percentage of patients in each age group undergoing cervical cytology was: 21-30 years (7.4%), 31-40 years (14.6%), 41-50 years (36%), 51-60 years (30.7%), 61-70 years (10.7%) and 71-80 years (0.6%). The most common diagnosis/indication for doing cervical cytology is screening (41.6%), followed by abnormal uterine bleeding (24%). 95% of samples sent for cytology were liquid based cytology. Among the 300 samples sent to the pathology department for cervical cytology, 290 were adequate for opinion (97%) and 10 were inadequate for opinion (3%). The results are as follows: negative for intraepithelial lesion or malignancy (68%), inflammatory smear (8%), ASCUS (6%), ASC-H (3%), LSIL (9%), HSIL (6%).Conclusions: Most samples belonged to the age group of 41-50 years. Common indication being screening. Most samples were adequate for opinion. Most commonly, they were reported as negative for intraepithelial lesion or malignancy.

Association of colposcopy with pap smear in evaluation of unhealthy cervix- a prospective study

Background: Unhealthy cervix is a very common finding in our country due to poor genital hygiene, malnutrition and multiparity. The cervix is the commonest site for female genital cancer. Gynaecologists who work in tertiary care institutes in the developing countries to get referrals from practitioners and peripheral health centres for patients with a clinical diagnosis of an “unhealthy cervix. An “unhealthy cervix” or grossly abnormal cervix can harbour premalignant cervical lesions or invasive carcinoma. That’s why present study was planned to evaluate colposcopy role in relation to PAP smear in symptomatic patients.Methods: The present study was a prospective, analytical study. After institutional committee approval this study was conducted from January 2021 to January 2022 in department of obstetrics and gynecology at RNT Medical college, Udaipur. Total 140 women were assessed for this study.Results: Our study results based on combined cytology and colposcopy with histopathology- sensitivity =100%, specificity =87.03%, PPV=84.09%, NPV=100%, accuracy =92.30%. The result of current study supports that, PAP smear demonstrates premalignant and malignant lesions, whereas colposcopy shows the exact site for biopsy for histopathological diagnosis and for further management.Conclusions: Colposcopy and cytology are complementary to each other. Best result in early detection of pre-invasive carcinomas could be obtained by combined use of cytology, colposcopy and colposcopy guided biopsy. So, use of ‘single visit approach’ in which cytology, colposcopy and guided biopsy all are done in one setting and treated accordingly in resource poor countries will enable maximum utilization of scarce medical resources.