ABSTRACT
Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies such as lung cancer. Cutaneous reactions to checkpoint inhibitors are frequent, appearing in approximately 40% of patients. Although most of the reactions are well tolerated, these drugs can lead to severe cutaneous adverse reactions, but a quick recognition of the symptoms can significantly decrease their mortality. In this case report, we describe a patient with metastatic squamous lung cell carcinoma suffering from nivolumab-induced Stevens-Johnson syndrome with severe skin denudation and mucosal involvement.
Subject(s)
Antineoplastic Agents, Immunological/adverse effects , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Squamous Cell/drug therapy , Immune Checkpoint Inhibitors/adverse effects , Lung Neoplasms/drug therapy , Nivolumab/adverse effects , Stevens-Johnson Syndrome/etiology , Aged , Drug Therapy, Combination , Humans , Male , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/drug therapy , Stevens-Johnson Syndrome/pathologyABSTRACT
Introducción. Las recomendaciones del cribado de cáncer de cérvix en España incluyen la participación en programas de control de calidad externos a los laboratorios de citología. La Sociedad Española de Citología (SEC) ha iniciado un programa de control de calidad de la citología ginecológica (CG). Objetivo. Presentar y analizar los resultados de la segunda ronda del control de calidad de la SEC. Material y métodos. Se incluyeron casos procesados mediante citología en medio líquido. Se escanearon las laminillas mediante la plataforma Aperio. Se seleccionaron 23 muestras procedentes de un banco de casos con al menos un 75% de acuerdo entre 4 expertos citopatólogos. Los diagnósticos de los casos para estudio incluyeron: uno negativo, 15 lesiones de bajo grado (4 ASCUS y 11 LSIL) y 7 lesiones de alto grado (uno ASCH y 6 HSIL). La CML correspondía a ThinPrep® en 16 casos y a SurePath® en 7. Se realizó el estudio de la correlación diagnóstica interobservador. Resultados. Participaron 16 hospitales. Las concordancias medias fueron: global 70,6% y por tipo de lesión 63,1%. En negativo 71,9%, en ASCUS 56,2%, en LSIL 69,5% y en HSIL 82,8%. Los casos discordantes correspondían con mayor frecuencia a negativos y a ASCUS. Se observó discordancia severa (HSIL/ASCH frente a negativo) en un 4,4% de los casos. Conclusiones. Nuestros resultados son similares a los descritos en la literatura, encontrando muy escasas discordancias severas (AU)
Introduction. In Spain, the guidelines for cervical cancer screening include a recommendation to enroll in external quality control programs. The Spanish Society of Cytology (SEC) has initiated its own quality control program of gynecological cytology (QCPGC). Aim. To describe and discuss the results of the second round of SEC¿s QCPGC. Material and method. The cases are selected by a group of expert cytologists. The cases with an agreement of 75% of four cytopathologists were used. The cases were scanned with Aperio. The scanned cases not available were excluded. We included a total of 23 cases, 1 negative, 15 low grade lesions (4 ASCUS and 11 LSIL) and 7 high grade lesions (1 ASCH and 6 HSIL). Sixteen cases were studied with ThinPrep™ platform and in 7 cases the SurePath™ platform was used. Results. Sixteen hospitals participated. The global mean concordance was 70.6%. The mean concordance in the type of lesion was 63.1%. The concordance was 71.9% in negative diagnoses, 56.2% in ASCUS, 69.5% in LSIL and 82.8% in HSIL The discordant cases were diagnosed more frequently as negative and ASCUS. 4.4% of cases had major discordances (HSIL or ASCH versus negatives). Conclusions: Our results are similar to those reported in the literature, with very little severe discordance. The method of exchanging slides does not allows continuous training, since the review of discordant cases can not be made. Therefore, methodological corrections are contemplated for future rounds (AU)
Subject(s)
Humans , Genital Neoplasms, Female/pathology , Histological Techniques/trends , Histocytochemistry/standards , Early Detection of Cancer/methods , Mass Screening/methods , Quality Control , Quality of Health CareABSTRACT
INTRODUCTION: In Spain, the guidelines for cervical cancer screening include a recommendation to enroll in external quality control programs. The Spanish Society of Cytology (SEC) has initiated its own quality control program of gynecological cytology (QCPGC). AIM: To describe and discuss the results of the second round of SECs QCPGC. MATERIAL AND METHOD: The cases are selected by a group of expert cytologists. The cases with an agreement of 75% of four cytopathologists were used. The cases were scanned with Aperio. The scanned cases not available were excluded. We included a total of 23 cases, 1 negative, 15 low grade lesions (4 ASCUS and 11 LSIL) and 7 high grade lesions (1 ASCH and 6 HSIL). Sixteen cases were studied with ThinPrep™ platform and in 7 cases the SurePath™ platform was used. RESULTS: Sixteen hospitals participated. The global mean concordance was 70.6%. The mean concordance in the type of lesion was 63.1%. The concordance was 71.9% in negative diagnoses, 56.2% in ASCUS, 69.5% in LSIL and 82.8% in HSIL The discordant cases were diagnosed more frequently as negative and ASCUS. 4.4% of cases had major discordances (HSIL or ASCH versus negatives). CONCLUSIONS: Our results are similar to those reported in the literature, with very few severe discordances.
Subject(s)
Cytodiagnosis/standards , Genital Diseases, Female/pathology , Quality Control , Female , Humans , Program Evaluation , Societies, Medical , SpainABSTRACT
Introducción. Las recomendaciones del cribado de cáncer de cérvix en España incluyen la participación en programas de control de calidad externos a los laboratorios de citología. La Sociedad Española de Citología ha iniciado un programa de control de calidad de la citología ginecológica. Objetivo. Presentar y discutir los resultados de la primera ronda del control de calidad de la Sociedad Española de Citología. Material y método. Organización de los hospitales participantes según el tipo de citología. Intercambio de preparaciones de 50 casos entre los participantes: 10 negativos, 20 ASCUS-ASCH, 10 LSIL y 10 HSIL. Estudio de la correlación diagnóstica interobservador. Resultados. Trece hospitales participantes: 6 en ThinPrep, 5 en triple toma y 2 en SurePath. La concordancia global media fue del 69,7%. La concordancia media por tipo de lesión fue del 41,7%. La concordancia en negativos fue del 78,1%, en ASCUS del 41,3%, en LSIL de 58,9% y en HSIL del 64,2%. Los casos discordantes se diagnosticaban con mayor frecuencia como negativos, ASCUS y LSIL. Las discordancias severas (HSIL/ASCH versus negativo), alcanzaron un 3,8% de casos. Conclusiones. Nuestros resultados son similares a los descritos en la literatura con muy escasas discordancias severas. El método de intercambio de laminillas utilizado no permite una formación continuada posterior, ya que no incluye la revisión de los casos con discordancias diagnósticas. Por ello, se contemplan correcciones metodológicas en sucesivas rondas (AU)
Introduction. The Spanish guidelines for cervical cancer screening recommend participating in external quality control programs. The Spanish Society of Cytology has started its own program of quality control for gynecological cytology. Aim. To describe and discuss the results of the first round of The Spanish Society of Cytology quality control for gynecological cytology. Material and method. Organization of participating hospitals on the basis of cytology type. Exchange of diagnostic slides from 50 cases among participants, as follows: 10 negative; 20 ASCUS-ASCH, 10 LSIL and 10 HSIL. Analysis of inter-observer correlation. Results. 13 hospitals took part: 6 with ThinPrep liquid-based cytology, 5 with conventional cytology, and 2 with SurePath liquid-based cytology. The global mean concordance was 69.7%. The mean concordance in the type of lesion was 41.7%. The concordance was 78.1% in negative diagnoses, 41.3%, in ASCUS, 58.9% in LSIL and 64.2% in HSIL The discordant cases were diagnosed more frequently as negative, ASCUS and LSIL. 3.8% of cases showed major discordances (HSIL or ASCH versus negatives). onclusions. Our results are similar to those reported in the literature, with very little severe discordance. The method of exchanging slides does not allows continuous training, since the review of discordant cases can not be made. Therefore, methodological corrections are contemplated for future rounds (AU)
Subject(s)
Humans , Female , Quality Control , Quality Indicators, Health Care/organization & administration , Societies, Medical/standards , Uterine Cervical Neoplasms/diagnosis , Cervix Uteri/cytology , Uterine Cervical Neoplasms/pathology , Cervix Uteri/pathology , Mass Screening/methods , Diagnostic Errors/prevention & controlABSTRACT
Study of cervical cancer screening using HPV and PAP co-testing. Target population (30-64 years of age) was 27,409 women using Cobas 4800 HPV testing.810 patients with positive HPV between 2012 and 2014. HPV prevalence, 8.3%.23% positive to HPV16, 8% to HPV18 and 69% to other genotypes.56.5% had benign cytology, 14.2% ASC-US and 14.9% LSIL.16/18 genotypes more frequent in the 30-45 age group. Women <30 years, infection by multiple genotypes was more frequent than infection by a single genotype.138 (17%) biopsies were CIN2+, 73 (52.9%) positive for HPV16/18 and 65 (47.1%) positive for other genotypes (p < 0.001).24.2% of the women with positive results for more than one genotype group had a CIN2+, 15.8% positive for a single genotype group (p = 0.024)
Estudio del cribado de cáncer cervical utilizando cotest (test de VPH y citología). La población diana (30-64 años) fue de 24.578 mujeres. El test de VPH se realizó con Cobas 4800. Ochocientas diez pacientes con VPH positivo entre 2012 y 2014. Prevalencia de VPH, 8,3%. Un 23% positivas a VPH16, 8% a VPH18 y 69% a otros genotipos. El 56,5% VPH positivos tenían una citología benigna, 14,2% ASC-US y 14,9% LSIL. VPH16/18 más frecuentes en el grupo de 30-45 años. Pacientes <30, la infección por múltiples genotipos fue más frecuente que la infección por un solo genotipo. Ciento treinta y ocho (17%) biopsias fueron CIN2+, 73(52,9%) positivas a VPH16/18 y 65(47,1%) a otros genotipos (p < 0,001). El 24,2% de las mujeres positivas a más de un genotipo tuvo CIN2+ y 15,8% de las positivas a un solo genotipo (p = 0,024)