Thyroid FNA cytology: Impact of the COVID-19 pandemic and vaccination in a Brazilian series.

BACKGROUND: The coronavirus disease 2019 pandemic prompted changes in medical practice, with a reduction in cytopathology volumes and a relative increase in the malignancy rate during lockdown and the initial postlockdown period. To date, no study has evaluated the impact of these changes on the volume of rapid on-site evaluation (ROSE) or on the frequency of cases according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories after vaccination. METHODS: Ultrasound-guided thyroid fine-needle aspiration (FNA) and ROSE assessments performed from January 2019 to May 2022 were evaluated retrospectively according to TBSRTC categories for three periods: prepandemic (period 1), from transmission to expansion (period 2), and after vaccination (period 3). RESULTS: There were 7531 nodules from 5815 patients. FNA cases increased throughout the pandemic despite a drop during lockdown. The frequency of TBSRTC categories changed. Nondiagnostic cases had an increase of 18.1% in period 2 and 76.2% after vaccination compared with prepandemic levels. Malignant cases increased from 2.3% to 4.2% in period 2 and to 5.1% in period 3, representing increases of 83.1% and 121.2%, respectively, compared with period 1. Data corrected by time showed increases in categories IV, V, and VI and a decrease in benign nodules during the two pandemic periods. ROSE was performed in 787 cases during the prepandemic period, and there were decreases of 29.4% and 22.8% in periods 2 and 3, respectively. The ROSE-to-category I ratio was reduced significantly after vaccination. CONCLUSIONS: Increased volume with sustained lower benign rates and higher malignant rates before and after vaccination indicate better selection of patients for FNA. A worse adequacy rate was correlated with a decrease in the number of ROSE assessments.

Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides.

Background: Thyroid nodules can be identified in up to 68% of the population. Fine-needle aspiration (FNA) cytopathology classifies 20%-30% of nodules as indeterminate, and these are often referred for surgery due to the risk of malignancy. However, histological postsurgical reports indicate that up to 84% of cases are benign, highlighting a high rate of unnecessary surgeries. We sought to develop and validate a microRNA (miRNA)-based thyroid molecular classifier for precision endocrinology (mir-THYpe) with both high sensitivity and high specificity, to be performed on the FNA cytology smear slide with no additional FNA. Methods: The expression of 96 miRNA candidates from 39 benign/39 malignant thyroid samples, (indeterminate on FNA) was analyzed to develop and train the mir-THYpe algorithm. For validation, an independent set of 58 benign/37 malignant FNA smear slides (also classified as indeterminate) was used. Results: In the training set, with a 10-fold cross-validation using only 11 miRNAs, the mir-THYpe test reached 89.7% sensitivity, 92.3% specificity, 90.0% negative predictive value and 92.1% positive predictive value. In the FNA smear slide validation set, the mir-THYpe test reached 94.6% sensitivity, 81.0% specificity, 95.9% negative predictive value, and 76.1% positive predictive value. Bayes' theorem shows that the mir-THYpe test performs satisfactorily in a wide range of cancer prevalences. Conclusions: The presented data and comparison with other commercially available tests suggest that the mir-THYpe test can be considered for use in clinical practice to support a more informed clinical decision for patients with indeterminate thyroid nodules and potentially reduce the rates of unnecessary thyroid surgeries.

Genetic alterations detected by comparative genomic hybridization in BRCAX breast and ovarian cancers of Brazilian population.

BACKGROUND: About 5-10% of breast/ovarian cancers are hereditary. However, for a large proportion of cases (around 50%), the genetic cause remains unknown. These cases are grouped in a separated BRCAX category. The aim of this study was to identify genomic alterations in BRCA1/BRCA2 wild-type tumor samples from women with family history strongly suggestive of hereditary breast/ovarian cancer. RESULTS: A cohort of 31 Brazilian women was included in the study. Using the GISTIC algorithm, we identified 20 regions with genomic gains and 31 with losses. The most frequent altered regions were 1q21.2, 6p22.1 and 8p23.3 in breast tumors and Xq26 and Xp22.32-22.31 among the ovarian cancer cases. An interesting association identified was the loss of 22q13.31-13.32 and the presence of ovarian cancer cases. Among the genes present in the frequently altered regions, we found FGFR1, NSMCE2, CTTN, CRLF2, ERBB2, STARD3, MIR3201 and several genes of RAET and ULBP family. CONCLUSIONS: In conclusion, our results suggest that alterations on chromosomes 1, 6, 8 and X are common on BRCAX tumors and that the loss on 22q can be associated with the presence of ovarian cancer. METHODS: DNA copy number alterations were analyzed by 60K array comparative genomic hybridization in breast and ovarian FFPE tumors.

Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL).

Objective To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology. Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13-16 years and 17-24 years). Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13-16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse. Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.

Early Age at First Sexual Intercourse is Associated with Higher Prevalence of High-grade Squamous Intraepithelial Lesions (HSIL) / Idade precoce de início da atividade sexual está associada a elevada prevalência de Lesão Intraepitelial Escamosa de Alto Grau

Abstract Objective To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology. Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13-16 years and 17-24 years). Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13-16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse. Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL.

Resumo Objetivo Avaliar a associação entre idade de início da atividade sexual e os resultados de citologia cervico-vaginal. Métodos Estudo observacional sobre a prevalência dos resultados de citologia cervico-vaginal alterados em mulheres com idade entre 18 e 34 anos na região de Resultados Do total de 2.505.154 exames, 898.921 preencheram os critérios de inclusão. Considerando mulheres com tempo desde a primeira relação sexualmenor ou igual a 4 anos como grupo de referência, mulheres com intervalos de 5 a 9 anos e 10 anos ou mais entre a data do exame e a primeira relação sexual mostraram maior prevalência de lesão intraepitelial escamosa de alto grau (LIEAG). Mulheres cominício da atividade sexual mais precoce (13-16 anos) mostraram altas prevalências de atipia de células escamosas, lesão intraepitelial escamosa de baixo grau e LIEAG. A razão de prevalência de LIEAG ajustada pela idade na data do exame e pela idade do início da atividade sexual foi maior somente para mulheres que apresentaram iníciomais precoce da atividade sexual. Conclusão A idade de início da atividade sexual pode ser uma possível variável de seleção das mulheres com maior risco de LIEAG.

Abhyanga no manejo do estresse: revisão de literatura / Aabhyanga on stress management: integrative literature review

Abhyanga ajuda a reduzir estresse? Foram consultados artigos, teses e dissertações publicados durante o período de janeiro de 2009 a junho de 2014, em onze bancos de dados: Bon, RCAAP, ERIC, Google Acadêmico, Pubmed, Scielo, Bireme, LILACS, Capes, Free Medical Jour-nals e Bvsalud. As palavras-chave utilizadas foram: 1. Ayurvedic Abhyanga Massage; 2. Ayurvedic Massage and stress; 3. Ayurveda and stress e 4. Abhyanga and stress. Três publicações trataram do efeito do abhyanga em indivíduos saudáveis e trouxeram indícios da importância do abhyanga sobre o sistema imunológico, redução da experimentação subjetiva de estresse, redução da taxa de batimentos cardíacos e diminuição de pressão arterial em sujeitos hipertensos. Quatro publicações trataram do efeito do abhyanga para aliviar problemas orgânicos. Avaliaram a efetividade do abhyanga para tratamento da espondilose cervical, osteoartrite de joelhos e dermatite seborréica. Nesses estudos, o procedimento terapêutico abhyanga mostrou-se efetivo tanto para prevenção de algumas doenças, como para tratamento de doenças já instaladas. Nos estudos revisados neste artigo foram observa¬das alterações bioquímicas que favoreceram o fortalecimento do sistema imunológico e que podem estar relacionados à ativação do sistema nervoso parassimpático e da resposta de relaxamento.(AU)

Does abhyanga help to reduce stress? Articles and discussions published during the period of January of 2009 to June of 2014 had been consulted in eleven ddata bases: B-on, RCAAP, ERIC, Google Acadêmico, Pubmed, Scielo, Bireme, LILACS, Capes, Free Medical Journals and Bvsalud. Keywords used: 1.Ayurvedic Abhyanga Massage; 2.Ayurvedic Massage and stress; 3.Ayurbeda and stress and 4.Abhyanga and stress. Three publications had dealt with the effect of abhyanga in healthful individuals and had brought indications of the importance of abhyanga on the immunologic system, reduction of the subjective experimentation of stress, heart tax reduction and blood pressure reduction for hypersensitive citizens. Four publications had dealt with the effect of abhyanga to alleviate organic problems and had evaluated the efectiveness of abhyanga for cervical spondylolysis, osteoarthritis of knees and dandruff, In the selected publications, abhyanga procedure showed to be effective for illness prevention as well as for already installed ilnesses treatment. It was observed in these studies biochemical alterations that help immunologic system empowerment that can be related to parasympathetic nervous system activation and relaxation response.(AU)

[Frequency of atypical squamous cells of undetermined significance (ASCUS) for pregnant and non-pregnant women]. / Frequência de células escamosas atípicas de significado indeterminado (ASCUS) em mulheres grávidas e não grávidas.

PURPOSE: To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20-24, 25-29 and 30-34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75-0.97) and 25-29 years (OR=0.78; 95%CI 0.63-0.96). There was no difference in the group between 30-34 years (OR=0.76; 95%CI 0.57-1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routine.

Frequência de células escamosas atípicas de significado indeterminado (ASCUS) em mulheres grávidas e não grávidas / Frequency of atypical squamous cells of undetermined significance (ASCUS) for pregnant and non-pregnant women

OBJETIVO: Comparar a frequência do resultado citopatológico de ASCUS em mulheres gestantes e não gestantes, estratificadas em grupos etários. MÉTODOS: Foram analisados 1.336.180 resultados de exames citopatológicos realizados de forma oportunística, no período entre 2000 e 2009 (10 anos) com a finalidade de rastreamento do carcinoma do colo do útero. Foram feitas comparações entre gestantes e não gestantes, com estratificação das amostras em três grupos etários (20-24, 25-29 e 30-34 anos). Foi utilizado o teste do χ2 e a medida da magnitude da associação foi analisada por valores estimados de Odds Ratio (OR) com intervalo de confiança de 95% (IC95%). RESULTADOS: Ao total, 447.489 amostras foram excluídas com base nos critérios adotados, totalizando uma amostra final de 37.137 mulheres gestantes e 851.554 não gestantes. O resultado citopatológico de ASCUS foi detectado em 1,2% dos casos, havendo diferença significante entre gestantes e não gestantes nas faixas etárias entre 20-24 anos (OR=0,85; IC95% 0,75-0,97) e 25-29 anos (OR=0,78; IC95% 0,63-0,96). Não houve diferença no grupo entre 30-34 anos (OR=0,76; IC95% 0,57-1,03). CONCLUSÕES: Este estudo sugeriu que mulheres não gestantes apresentam maior prevalência de ASCUS, mais evidente no grupo etário de 20 a 29 anos. A coleta do exame citopatológico não deve ser um exame compulsório na rotina do pré-natal. .

PURPOSE: To compare the frequency of an ASCUS Pap Smear result in pregnant and non-pregnant women, stratified by age group. METHODS: We analyzed the results of 1,336,180 cytopathologyc exams of Pap smears performed between 2000 and 2009 (ten years) with the purpose of screening for cervical carcinoma. Comparisons were made between pregnant and non-pregnant women, and the sample was stratified into three age groups (20-24, 25-29 and 30-34 years). The χ2 test was used and the magnitude of association was determined by the by Odds Ratio (OR) with the 95% confidence interval (95%CI). RESULTS: A Total of 447,489 samples were excluded on the basis of the criteria adopted, for a total final sample of 37,137 pregnant women and 851,554 non-pregnant women. An ASCUS result was detected in 1.2% of cases, with a significant difference between pregnant and non-pregnant women in the age groups of 20-24 years (OR=0.85; 95%CI 0.75-0.97) and 25-29 years (OR=0.78; 95%CI 0.63-0.96). There was no difference in the group between 30-34 years (OR=0.76; 95%CI 0.57-1.03). CONCLUSIONS: This study suggested that non-pregnant women have a higher frequency of ASCUS, most evident in the age group of 20 to 29 years. The collection of cervical cancer screening should not be a compulsory part of the prenatal routine. .

Usefulness of vaginal cytology tests in women with previous hysterectomy for benign diseases: assessment of 53,891 tests.

OBJECTIVE: To assess the value of vaginal screening cytology after hysterectomy for benign disease. METHODS: This cross-sectional study used cytology audit data from 2,512,039 screening tests in the metropolitan region of Campinas from 2000 to 2012; the object was to compare the prevalence of abnormal tests in women who had undergone a hysterectomy for benign diseases (n=53,891) to that of women who had had no hysterectomy. Prevalence ratios (95% confidence intervals, 95% CI) were determined, and chi-square analysis, modified by the Cochrane-Armitage test for trend, was used to investigate the effects of age. RESULTS: The prevalence of atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion or squamous-cell carcinoma (HSIL/SCC) was 0.13%, 0.04% and 0.03%, respectively, in women who had undergone hysterectomy, and 0.93%, 0.51% and 0.26% in women who had not undergone hysterectomy. The prevalence ratios for ASC, LSIL and HSIL/SCC were 0.14 (0.11-0.17), 0.08 (0.06-0.13) and 0.13 (0.08-0.20), respectively, in women with a hysterectomy versus those without. For HSIL/SCC, the prevalence ratios were 0.09 and 0.29, respectively, for women <50 or ≥50 years. The prevalence rates in women with a previous hysterectomy showed no significant variation with age. CONCLUSION: The prevalence rates of ASC, LSIL and HSIL/SCC were significantly lower in women with a previous hysterectomy for benign disease compared with those observed in women with an intact uterine cervix. This study reinforces the view that there is no evidence that cytological screening is beneficial for women who have had a hysterectomy for benign disease.

Absence of Wharton's jelly: case report / Ausência da geleia de Wharton: relato de caso

There are few reports in the literature of the absence of Wharton's Jelly. Here we report the seventh case in a primigravida, 22 years old, admitted after vaginal delivery of stillborn. The umbilical cord have a long segment with disruption of cord structures and the three blood vessels were completely separated from each other, with a minimum amount of Wharton's jelly remaining around each vessel. The absence of Wharton' jelly is associated with fetal distress, intrauterine growth restriction, and fetal death. Quantitative/qualitative studies of Wharton's jelly represent an open field of research for possible correlations with obstetric conditions and fetal deaths.

Na literatura, há poucos relatos sobre a ausência de geleia de Wharton. Relatamos o sétimo caso em uma primigesta de 22 anos, admitida após parto vaginal de feto natimorto. O cordão umbilical apresentava longo segmento com esfacelo da geleia e três vasos sanguíneos completamente separados uns dos outros, com mínima quantidade de geleia de Wharton remanescente ao redor de cada vaso. Ausência de geleia de Wharton associa-se a estresse, restrição de crescimento e óbitos fetais. Estudos quantitativos/ qualitativos sobre a geleia de Wharton representam campo de pesquisa aberto para possíveis correlações com condições e doenças obstétricas e óbitos fetais.

[Planned home births assisted by nurse midwives: maternal and neonatal transfers]. / Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais.

The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais / Planned home births assisted by nurse midwives: maternal and neonatal transfers / Partos domiciliarios planificados atendidos por enfermeras obstétricas: traslados maternales y neonatales

O presente trabalho trata-se de estudo exploratório-descritivo que teve como objetivo descrever a taxa e as causas de transferência intraparto para o hospital de mulheres assistidas no domicílio por enfermeiras obstétricas e os desfechos desses nascimentos. A amostra foi composta por onze mulheres e seus recém-nascidos, de janeiro de 2005 a dezembro de 2009. Os dados foram coleta-dos em prontuários e cadernetas de saúde e analisados por estatística descritiva. A taxa de transferência foi de 11%, a maioria de nulíparas (63,6%), e todas foram transferidas durante o primeiro período clínico do parto. Os motivos mais frequentes de transferência foram parada de dilatação cervical e progressão da apresentação fetal, e desproporção cefalopélvica. Os escores de Apgar no 1º e 5º minutos foram >7 em 81,8% dos casos e não houve internação em unidade de terapia intensiva neonatal. Neste estudo constatou-se que o parto domiciliar planejado assistido por enfermeiras obstétricas, com protocolo assistencial, apresentou bons resultados maternos e neonatais, mesmo quando a transferência para o hospital foi necessária.

The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

Estudio exploratorio descriptivo que objetivó describir la tasa y causas de traslados hospitalarios intraparto a mujeres atendidas en domicilio por enfermeras obstétricas y los desenlaces de tales nacimientos. Muestra compuesta por once mujeres y sus recién nacidos, de enero 2005 a diciembre 2009; datos recolectados a partir de historia clínicas y carpetas de salud, analizadas por estadística descriptiva. La tasa de traslado fue 11,0%, mayoritariamente de nulíparas (63,3%), todas ellas trasladadas durante el primer período clínico del parto. Los motivos más frecuentes obedecieron a interrupción de dilatación cervical, progresión de presentación fetal y desproporción cefalopélvica. Los puntajes de Apgar en minutos 1 y 5 fueron >7 en 81,8% de los casos, no produciéndose internación en unidad de terapia intensiva neonatal. Según el estudio, el parto domiciliario planificado atendido por enfermeras obstétricas según protocolo de atención, exhibió buenos resultados maternales y neonatales, inclusive cuando fue necesario efectuar traslados hospitalarios.

Resultado de partos domiciliares atendidos por enfermeiras de 2005 a 2009 em Florianópolis, SC / Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil

Estudo transversal sobre resultados obstétricos e neonatais dos partos domiciliares planejados assistidos por enfermeiras obstétricas em Florianópolis, SC. Dados coletados nos prontuários de 100 parturientes assistidas de 2005 a 2009 apontam 11 transferências hospitalares, sendo nove submetidas a cesariana. A maioria das que pariram no domicílio apresentou batimentos cardíacos fetais (94,0%) e evolução no partograma normais (61,0%), adotou posição vertical na água, no período expulsivo (71,9%), e os recém-nascidos receberam Apgar do 5° minuto > 7 (98,9%). A frequência de episiotomia foi 1,0%, 49,4% não necessitaram sutura perineal. Os resultados indicam que o parto domiciliar é seguro.

A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0%) and progress on the partogram (61.0%), vertical water delivery was the position most frequently chosen (71.9%), newborns had an Apgar score > 7 at five minutes (98.9%), episiotomy was performed in 1.0%, and 49.4% did not need perineal suturing. Outcomes indicated that planned home birth is safe.

[Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil]. / Resultado de partos domiciliares atendidos por enfermeiras de 2005 a 2009 em Florianópolis, SC.

A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0%) and progress on the partogram (61.0%), vertical water delivery was the position most frequently chosen (71.9%), newborns had an Apgar score ≥ 7 at five minutes (98.9%), episiotomy was performed in 1.0%, and 49.4% did not need perineal suturing. Outcomes indicated that planned home birth is safe.

Cytopathic effects of human papillomavirus infection and the severity of cervical intraepithelial neoplasia : A frequency study.

Cytopathic effects related to the human papillomavirus (HPV) infection are more frequently found in cervical intraepithelial neoplasia (CIN) 1; however, there are indications that at least half the histological diagnoses of CIN2 and CIN3 include koilocytosis areas. The objective of this study was to evaluate the frequency of the cytological criteria suggestive of HPV infection in the cervical smears of women with a histological diagnosis of CIN. One hundred and sixty-two women with abnormal cervical smears and a diagnosis of CIN confirmed by histopathology were selected, including 46 cases of CIN 1, 42 of CIN 2 and 74 cases of CIN 3. Koilocytosis was found in 63% of the smears from women with a histopathological diagnosis of CIN 1. This sign was observed in 26.2% and 25.7% of smears of women with a diagnosis of CIN 2 and CIN 3, respectively. Cytomegaly also was frequent in cervical smears of women with histopathological diagnosis of CIN 1 (71.8%). On the other hand, spindle cells and atypical metaplasia were more frequent in women with CIN 2 and CIN 3. Atypical parakeratosis showed similar frequency in all grades of CIN diagnosis. Koilocytois and cytomegaly were inversely correlated with the diagnosis of CIN2 or CIN 3, with OR values respectively of 0.30 (95%CI 0.13-0.68) and 0.26 (95%CI 0.11-0.58). The others signs analyzed did not show any significant association. Koilocitosis and cytomegaly can provides good reassurance that a patient with atypical cervical smear have CIN 1.

Immunohistochemical detection of factors related to cellular proliferation and apoptosis in radicular and dentigerous cysts.

INTRODUCTION: This study proposed to investigate aspects of cell proliferation and death in the epithelium of radicular (RCs) and dentigerous (DCs) cysts. METHODS: Serial sections of 17 RCs and 9 DCs were prepared for immunohistochemical detection of caspase-3, Bcl-2, and Ki-67 antigens. RESULTS: Caspase-3 was detected mainly in the suprabasal and superficial epithelial cells of RCs and DCs, whereas Ki-67 was detected predominantly in the basal layer. Both markers had significant expression in hyperplastic epithelium related to an intense inflammation in the capsule. Immunoreactivity for Bcl-2 was restricted to the basal layer and was significantly higher in atrophic epithelium of DCs than that of RCs. CONCLUSIONS: These results suggest that epithelial proliferation is balanced by apoptosis and that the presence of inflammation inhibits the Bcl-2 expression. DCs and RCs have different formation mechanisms but have similar biological behavior in the presence of intense inflammatory infiltrate.

Cytological criteria to predict basal phenotype of breast carcinomas.

Breast carcinoma is a heterogeneous disease. It can be classified into phenotypes based on the expression of certain proteins, with distinct differences in prognosis. The basal phenotype is associated with worse prognosis and it still remains without specific treatment. However, there is currently no international consensus on the cytological criteria that could predict this phenotype. The purpose of the study was to evaluate the cytological criteria in fine-needle aspiration biopsy and to identify their association with the basal phenotype of breast carcinoma. Fine-needle aspiration biopsy specimens and tissue sections (mastectomy specimen) from 74 cases of high-grade invasive ductal breast carcinomas were consecutively retrieved from the files of three institutions. Breast carcinomas were studied using the tissue microarray technique, being classified into phenotypes: luminal A, luminal B, HER2 overexpression, and basal. The cytological criteria for all cases were reviewed blindly by two pathologists according to five cytological criteria: cellularity, cell pattern, presence of necrosis, nucleoli, and nuclear atypia. Exact Fisher test was used to test the association between cytological criteria and the phenotypes of breast carcinoma. Necrosis was present in 64.7% of basal breast carcinomas, and 31.1% of nonbasal breast carcinomas, and that result was statistically significant, showing an odds ratio (OR) of 3.80. The basal phenotype, compared with the luminal A, showed more necrosis (OR = 6.97), present/prominent nucleoli (OR = 8.18), and cellularity more frequently (OR = 18.03). Necrosis, as well as present/prominent nucleoli and abundant cellularity are criteria more frequently associated to the basal phenotype of breast carcinoma.

Possible Relationship between Basal-Like Breast Carcinoma and Age.

SUMMARY: INTRODUCTION: Estrogen receptor expression is lower in breast carcinoma of women ≤45 years compared to women ≥65 years of age, which may imply a higher frequency of basal-like breast carcinomas in younger women. This study evaluated whether there is any difference in the frequency of basal-like phenotype and estrogen receptor (ER)-/HER2- invasive breast carcinomas between women of these 2 different age groups. PATIENTS AND METHODS: A total of 151 women aged ≤45 years or ≥65 years with invasive breast carcinomas were evaluated using tissue microarray, and classified into the following phenotypes: luminal A (ER+/HER2-), luminal B (ER+/HER2+), HER2 overexpression (ER-/HER2+), and basal-like (ER-/HER2- and expressing at least 1 of the basal markers p63, CK5 and/or P-cadherin). RESULTS: ER-/HER2- carcinomas were twice as frequent in women aged ≤45 years (p = 0.0247). However, when the basal-like phenotype was compared with all the other phenotypes grouped together, no statistically significant difference was found (p = 0.0854). CONCLUSIONS: ER-/HER2- carcinomas were more frequent in younger women compared to all the other phenotypes grouped together. An international consensus will be necessary to establish which markers should be used to define basal-like phenotype.

Carcinoma de mama: novos conceitos na classificação: [revisão] / Breast cancer: new concepts in classification: [review]

O carcinoma de mama é a neoplasia maligna mais comum em mulheres. Estudos moleculares do carcinoma de mama, baseados na identificação do perfil de expressão gênica por meio do cDNA microarray, permitiram definir pelo menos cinco sub-grupos distintos: luminal A, luminal B, superexpressão do HER2, basal e normal breast-like. A técnica de tissue microarray (TMA), descrita pela primeira vez em 1998, permitiu estudar, em várias amostras de carcinoma, os perfis de expressão protéica de diferentes neoplasias. No carcinoma de mama, os TMAs têm sido utilizados para validar os achados dos estudos preliminares, identificando, desta forma, os novos subtipos fenotípicos do carcinoma de mama. Dentre os subtipos classicamente descritos, o grupo basal constitui um dos mais intrigantes subtipos tumorais e é freqüentemente associado com pior prognóstico e ausência de alvos terapêuticos definidos. A classificação histopatológica do carcinoma de mama tem pobre valor preditivo. Portanto, a associação entre o diagnóstico histológico com técnicas moleculares nos laboratórios de anatomia patológica, por meio do estudo imunoistoquímico, pode determinar o perfil molecular do carcinoma de mama, buscando melhorar a resposta terapêutica. Este estudo visou resumir os mais recentes conhecimentos em que se baseiam os novos conceitos da classificação do carcinoma de mama.

Breast cancer is the principal cause of death from cancer in women. Molecular studies of breast cancer, based in the identification of the molecular profiling techniques through cDNA microarray, had allowed defining at least five distinct sub-group: luminal A, luminal B, HER-2-overexpression, basal and " normal" type breast-like. The technique of tissue microarrays (TMA), described for the first time in 1998, allows to study, in some samples of breast cancer, distinguished by differences in their gene expression patterns, which provide a distinctive molecular portrait for each tumor and the basis for and improved breast cancer molecular taxonomy. Another important implication is that genetic profiling may lead to the identification of new target for therapy and better predictive markers are needed to guide difficult treatment decisions. Additionally, the current pathology classification system is suboptimal, since patients with identical tumor types and stage of disease present different responses to therapy and different overall outcomes. Basal breast tumor represents one of the most intriguing subtypes and is frequently associated with poor prognosis and absence of putative therapeutic targets. Then, the purpose of this review was to resume the most recent knowledge about the breast carcinoma classification and characterization.

[Breast cancer: new concepts in classification]. / Carcinoma de mama: novos conceitos na classificação.

Breast cancer is the principal cause of death from cancer in women. Molecular studies of breast cancer, based in the identification of the molecular profiling techniques through cDNA microarray, had allowed defining at least five distinct sub-group: luminal A, luminal B, HER-2-overexpression, basal and 'normal' type breast-like. The technique of tissue microarrays (TMA), described for the first time in 1998, allows to study, in some samples of breast cancer, distinguished by differences in their gene expression patterns, which provide a distinctive molecular portrait for each tumor and the basis for and improved breast cancer molecular taxonomy. Another important implication is that genetic profiling may lead to the identification of new target for therapy and better predictive markers are needed to guide difficult treatment decisions. Additionally, the current pathology classification system is suboptimal, since patients with identical tumor types and stage of disease present different responses to therapy and different overall outcomes. Basal breast tumor represents one of the most intriguing subtypes and is frequently associated with poor prognosis and absence of putative therapeutic targets. Then, the purpose of this review was to resume the most recent knowledge about the breast carcinoma classification and characterization.