Controversia en el tratamiento de la lesión intraepitelial escamosa de alto grado (NIC II) / Controversy in the treatment of high-grade squamous intraepithelial lesion (CIN II)

Contexto: el cono LLETZ actualmente es el tratamiento de las NIC de alto grado. La resistencia al procedimiento es argumentada por los efectos del sobretratamiento (estenosis e insuficiencia cervical), sobre todo cuando se utilizan métodos ablativos destructivos en lugar de la resección quirúrgica ambulatoria (LLETZ). Objetivo: analizar el diagnóstico y tratamiento del NIC II mediante cono y legrado en pacientes que acuden al servicio de Patología del tracto genital inferior del Hospital Oncológico SOLCA-Quito Ecuador. Sujetos y métodos: en este estudio epidemiológico descriptivo observacional de corte transversal se analizaron expediente clínicos de 820 pacientes con diagnóstico histopatológico por biopsia de NIC II; mujeres entre 17 a 82 años que acudieron al servicio de patología del tracto genital inferior sujetas a control, en estas pacientes se realizó 530 legrados. El estudio fue realizado en el Hospital Oncológico SOLCA de Quito Ecuador, de los años 2004 a 2013. Resultados: la histopatología de los conos libres de neoplasia representa el 98,66% (n=809); existen 11 casos de neoplasias residuales (1,34%). El 53,7% de casos presenta una lesión igual o mayor que en biopsia, lo que justifica el cono. Conclusión: el procedimiento de cono LLETZ tiene gran utilidad diagnóstica, terapéutica y pronóstica en mujeres que presentan NIC II y otras patologías similares. (AU)

Background: the LLETZ cone is currently the treatment of high grade NICs. The resistance to the procedure is argued by the effects of overtreatment (stenosis and cervical insufficiency), especially when destructive ablative methods are used instead of ambulatory surgical resection (LLETZ). Objective: to analyze the diagnosis and treatment of CIN II by means of cone and curettage in patients attending the pathology department of the lower genital tract of the SOLCA-Quito Ecuador Oncology Hospital. Subjects and methods: in this cross-sectional descriptive epidemiological observational study, we analyzed clinical records of 820 patients with histopathological diagnosis by CIN II biopsy; women between 17 and 82 years old who visited the pathology service of the lower genital tract subject to control, in these patients 530 catheters were performed. The study was conducted at the SOLCA Oncology Hospital of Quito, Ecuador, from 2004 to 2013. Results: the histopathology of neoplasm-free cones represents 98.66% (n = 809); there are 11 cases of residual neoplasms (1.34%). 53.7% of cases present a lesion equal to or greater than in biopsy, which justifies the cone.(AU)

Diagnostic Value of the CareTM HPV Test in Screening for Cervical Intraepithelial Neoplasia Grade 2 or Worse

Background: Cervical cancer is the fourth leading cause of cancer death in women worldwide. Persistent infection with a high risk human papillomavirus (HR-HPV) is the main etiological factor, so that early early detection of HR-HPV is very important. The aim of this study was to investigate the efficacy of CareTM HPV, a new method, as compared with Pap smear, PCR, and biopsy for screening purposes. Material and Method: In this cross-sectional study, 200 sexually active women aging from 25-50 years referred to the oncology clinic of Shahid Sodoughi Yazd Hospital in 2015 with a variety of cervix epithelial lesions or a need for colposcopy were enrolled. Results for CareTM HPV test (cervical), Pap smear, PCR, and biopsy were analyzed using SPSS 15 software and chi-square test, McNemar, and ROC curve analysis. Qualitative variables were compared using a Chi-square test. Results: CareTM HPV test sensitivity in detecting cervical intraepithelial neoplasia grade II (CIN-II) and also positive and negative predictive values were higher as compared to with other tests (p<0.05). The Pap smear test specificity was highest. There was no significant differences between CareTM HPV and PCR tests regarding detection of HPV-DNA in cases of CIN-II and worse (p>0.05). Conclusion: The CareTM HPV test has high sensitivity and predictive values for detecting HPV infection, with higher efficacy than the Pap smear test for tracking CIN-II. Therefore it may be recommended for use as a screening test in low-income areas.

Double-blind randomized placebo-controlled multicenter clinical trial (phase IIa) on diindolylmethane's efficacy and safety in the treatment of CIN: implications for cervical cancer prevention.

BACKGROUND: The article presents the results of a clinical trial on the efficacy and safety of a novel pharmaceutical composition in the form of vaginal suppositories containing diindolylmethane in the course of cervical intraepithelial neoplasia (CIN) I-II conservative treatment. It offers an attractive drug therapy for more personalized prevention of cervical cancer. METHODS: A total of 78 women of reproductive age were included. This was a multicenter, randomized, placebo-controlled, double-blind, parallel-group trial with efficacy determined by histological evaluation of cervical biopsies. The efficacy of active drug treatment (100 and 200 mg/day) in both treatment groups was significantly higher in comparison with the placebo group, according to the primary efficacy end point (proportion of patients with complete CIN regression after 90-180 days of the study drug treatment). RESULTS: The efficacies were 100.0 % (confidence interval (CI) 95 %: 82.35-100.00 %), 90.5 % (CI 95 %: 69.62-98.83 %), and 61.1 % (CI 95 %: 35.75-82.70 %), for the high dose, low does, and placebo, respectively. Adverse events in the placebo group were reported in 22 % of patients (CI 95 %: 7.5-43.7 %); in the first treatment group (100 mg/day), adverse events were reported in 40.0 % of patients (CI 95 %: 21.1-61.3 %); in the second treatment group (200 mg/day), adverse events were reported in 42.0 % of patients (CI 95 %: 22.1-63.4 %). The differences in side effects between treatment groups treated with the active drug and placebo were statistically significant. No serious adverse events were reported in any of the groups. CONCLUSIONS: Thus, the use of diindolylmethane in the form of intravaginal suppositories can be effective in patients with CIN I-II and is not accompanied by clinically significant side effects. This approach could be a better option for young women with CIN I-II as it takes in attention their reproductive plans. TRIAL REGISTRATION: ID: ChiCTR-INR-15007497 (2 December 2015).

Neoplasia intraepitelial cervical de alto grado en mujeres menores de 25 años y mayores de 45 años / Cervical intraepithelial neoplasia of high degree in women younger than 25 and older than 45 years old

Evaluar las características de pacientes menores de 25 y mayores de 45 años con diagnóstico de neoplasia intraepitelial cervical II-III. Estudio retrospectivo, descriptivo y comparativo de 334 historias de neoplasia intraepitelial cervical II-III consultantes a la Maternidad "Concepción Palacios" entre 2005 y 2009, distribuidas en: 20,7 por ciento menores de 25 años (Grupo A), 64,8 por ciento entre 25-45 (Grupo B) y 14,4 por ciento mayores de 45 (Grupo C). En 23,1 por ciento la lesión era grado II y en 76,9 por ciento grado III. El inicio de la actividad sexual fue 15,5 ± 2, 16,9 ± 2,6 y 17,8 ± 3 años, respectivamente (P=0,001), el primer embarazo ocurrió a los 15, 19 y 20 años para cada grupo (P=0,001). El número de gestaciones fue 1, 2 y 4 respectivamente (P=0,01). Hubo 43,9 por ciento de fumadoras en el Grupo C (P=0,001) y 29,6 por ciento de pacientes inmunosuprimidas en el Grupo A (P< 0,05). Predominaron las alteraciones de las células epiteliales en la citología de los 3 grupos. No hubo diferencias en la colposcopia, la terapéutica utilizada ni en las tasas de curación, persistencia o recidiva. En el grupo A, 85,7 por ciento de las lesiones persistentes fueron lesiones de bajo grado (P< 0,05). Los factores de riesgo importantes en el grupo A fueron: inicio precoz de relaciones sexuales, primer embarazo temprano, número de gestaciones e inmunosupresión. En el grupo C fueron mayor paridad, tabaquismo, y mayor índice de masa corporal. La clínica, tratamiento y evolución fueron similares con 20 por ciento de persistencia y menos de 10 por ciento de recidivas

To assess the characteristics of patients under the age of 25 and over 45 years with diagnosis of cervical intraepithelial neoplasia II-III. Retrospective, descriptive and comparative study of 334 patients with cervical intraepithelial neoplasia II-III diagnostic consulting to Maternidad Concepcion Palacios, in 2005-2009, distributed in:20.7 percent under the age of 25 (Group A) 64.8 percent between 25-45 (Group B) and 14.4 percent over the age of 45 (Group C). El 23.1 percent had cervical intraepithelial neoplasia II and 76.9 percent cervical intraepithelial neoplasia III. The onset of sexual activity was 15.5 ± 2, 16.9 ± 2.6 and 17.8 ± 3 years, respectively (P=0.001), the first pregnancy occurred 15, 19 and 20 years for each group (P=0.001). The number of pregnancies was 1, 2 and 4 respectively (P=0.01). There was 43.9 percent of smokers in Group C (P=0,001) and 29.6 percent of patients who are immunosuppressed in Group A (P< 0,05). The disturbances of epithelial cells on cytologyof 3 groups were predominated. There were no differences in the colposcopy, therapeutic or in rates of healing, persistence or recurrence. In Group A, 85.7 percent of persistent injuries were low grade (P< 0.05). The more important risk factors in Group A were: early onset of sexual relations, early first pregnancy, number of pregnancies and immunosuppression. In Group C were: greater parity, smoking, and higher body mass index. The clinic, treatment and evolution were similar with 20 percent of persistence and less than 10 percent of relapses