Uso de fitoterápicos no controle das alterações bucais pós-tratamento oncológico: novas alternativas na odontologia / Use of herbal medicines to control oral changes post-oncological treatment: new alternatives in dentistry

O tratamento oncológico pode ocasionar diversas alterações orais durante e após o processo que podem acarretar déficit de mastigação, fonação, deglutição, além de dor e nutrição deficiente. Nesse contexto, ainda existe uma busca na comprovação do uso de fitoterápicos na oncologia com presença de lesões na cavidade oral ocasionadas pela oncoterapia, para tratamento destas. Assim, o trabalho em questão se trata de uma revisão de literatura, com objetivo de relatar, a partir da análise de periódicos, a observação de efeitos favoráveis para o tratamento das lesões orais por consequência da quimioterapia e radioterapia, através do uso dos fitoterápicos: Camomila (Matricaria chamomilla), Romã (Punica granatum) e extrato de Própolis (Apis mellifera L.). Realizou-se busca eletrônica de dados através do Scholar Google e PubMed, utilizando os Descritores em Ciências da Saúde (Medicamentos Fitoterápicos, Neoplasias, Protocolos Antineoplásicos). Os estudos apresentados neste trabalho evidenciam que o uso destes fitoterápicos pode auxiliar no tratamento das lesões decorrentes da quimioterapia e radioterapia, por possuírem diversas ações anti-inflamatórias, antimicrobianos, antitumorais, entre outras. Por fim, os fitoterápicos apresentados podem ser considerados como uma nova alternativa sendo assim uma escolha favorável de tratamento em relação aos medicamentos convencionais (alopatia), tanto pelo fato de serem naturais e não reduzirem mais ainda a imunidade do paciente, como também pelo seu baixo custo.

The cancer treatment can cause several oral changes during and after the process that can lead to deficits in chewing, phonation, swallowing, in addition to pain and poor nutrition. In this context, there is still a search to prove the use of herbal medicines in oncology with lesions in the oral cavity caused by oncotherapy. Thus, the work in question is a literature review, with the objective of reporting, from the analysis of journals, the observation of favorable effects for the treatment of oral lesions as a result of chemotherapy and radiotherapy, through the use of herbal medicines: Chamomile (Matricaria chamomilla), Pomegranate (Punica granatum) and Propolis extract (Apis mellifera L.). Electronic data search was carried out through Scholar Google and PubMed, using the Health Sciences Descriptors (Phytotherapic Drugs, Neoplasms, Antineoplastic Protocols). The studies presented in this work show that the use of these herbal medicines can help in the treatment of injuries resulting from chemotherapy and radiotherapy, as they have several anti-inflammatory, antimicrobial and anti-tumor actions, among others. Finally, the herbal medicines presented can be considered as a new alternative, thus being a favorable treatment choice in relation to conventional medicines (allopathy), both because they are natural and do not further reduce the patient's immunity, but also because of their low cost.

Retinoblastoma in Ceara: An epidemiological study in a Brazilian pediatric oncology referral center

ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas.

Rare case of mantle cell lymphoma of the lacrimal sac

ABSTRACT Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.

Anterior lamellar corneoscleral keratoplasty for the management of corneal thinning following treatment with mitomycin-C and interferon to treat highly suspected ocular surface squamous neoplasia: a case report

ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

Robot-assisted, laparoscopic and open radical cystectomy for bladder cancer: A systematic review and network meta-analysis

ABSTRACT Objectives: To evaluate the safety and effectiveness of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC), and open radical cystectomy (ORC) in bladder cancer. Methods: A literature search for network meta-analysis was conducted using international databases up to February 29, 2024. Outcomes of interest included baseline characteristics, perioperative outcomes and oncological outcomes. Results: Forty articles were finally selected for inclusion in the network meta-analysis. Both LRC and RARC were associated with longer operative time, smaller amount of estimated blood loss, lower transfusion rate, shorter time to regular diet, fewer incidences of complications, and fewer positive surgical margin compared to ORC. LRC had a shorter time to flatus than ORC, while no difference between RARC and ORC was observed. Considering lymph node yield, there were no differences among LRC, RARC and ORC. In addition, there were statistically significant lower transfusion rates (OR=-0.15, 95% CI=-0.47 to 0.17), fewer overall complication rates (OR=-0.39, 95% CI=-0.79 to 0.00), fewer minor complication rates (OR=-0.23, 95% CI=-0.48 to 0.02), fewer major complication rates (OR=-0.23, 95% CI=-0.68 to 0.21), fewer positive surgical margin rates (OR=0.22, 95% CI=-0.27 to 0.68) in RARC group compared with LRC group. Conclusion: LRC and RARC could be considered as a feasible and safe alternative to ORC for bladder cancer. Notably, compared with LRC, RARC may benefit from significantly lower transfusion rates, fewer complications and lower positive surgical margin rates. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

Opalski syndrome: a case study (Case Report) / Síndrome de Opalski: um relato de caso (Relato de Caso)

Opalski Syndrome (OS) is an unusual presentation of Lateral Medullary Syndrome (LMS) with ipsilateral hemiparesis. We report the case of a 65-year-old woman with a background of unprovoked deep venous thrombosis and unintentional weight loss that presented after a one-week-long episode of sudden onset vertigo, frontotemporal headache, blurry vision, and weakness. A head magnetic resonance imaging (MRI) revealed subacute ischemic event, with flow-void loss in the right vertebral artery and absence of blood flow, suggesting OS secondary to likely right posterior inferior cerebellar artery (PICA) occlusion. An abdominal and thoracic computed tomography (CT) scan showed suggestive findings of stage IV pancreatic tail cancer. Because of its non-classical presentation, OS might be a diagnostic challenge to most physicians. As in this patient, the existence of concomitant cancer probably led to a hypercoagulable state, which could explain the ischemic stroke while on anticoagulation therapy.

A Síndrome de Opalski (OS) é uma apresentação incomum da Síndrome Medular Lateral (LMS) com hemiparesia ipsilateral. Relatamos o caso de uma mulher de 65 anos com história de trombose venosa profunda não provocada e perda de peso não intencional que se apresentou após um episódio de uma semana de vertigem de início súbito, cefaleia frontotemporal, visão turva e fraqueza. Uma ressonância magnética (RM) de crânio revelou evento isquêmico subagudo, com perda de fluxo vazio na artéria vertebral direita e ausência de fluxo sanguíneo, sugerindo OS secundária à provável oclusão da artéria cerebelar inferior posterior direita (PICA). Uma tomografia computadorizada (TC) de abdome e tórax evidenciou achados sugestivos de câncer de cauda pancreática em estágio IV. Devido à sua apresentação não clássica, a OS pode ser um desafio diagnóstico para a maioria dos médicos. No caso dessa paciente, a existência de neoplasia concomitante provavelmente induziu um estado de hipercoagulabilidade, o que poderia explicar o acidente vascular cerebral isquêmico em regime de anticoagulação.

Aspectos éticos en la cirugía esofágica / Ethical aspects in esophageal surgery

Introducción. Los aspectos y desafíos éticos en la atención del paciente portador de patología esofágica incluyen diversas situaciones que deben ser anticipadas y conocidas por los expertos para poder solucionarlas de la manera más adecuada, favorable y justa para los enfermos y sus familiares. Métodos. Se realizó una revisión y análisis de la información disponible en las bases de datos con el fin de establecer los aspectos éticos relevantes para la cirugía esofágica en la actualidad. Discusión. Todos los cirujanos enfrentamos situaciones que conllevan a conflictos éticos en la práctica asistencial diaria. Un cirujano capaz e idóneo debe ser no sólo competente para llevar a cabo el arte y la ciencia de la cirugía, como se lo interpreta tradicionalmente, sino también para ser confiable desde el punto de vista ético y moral. Conclusión. Los principios éticos son de fundamental importancia y sirven de guía para el desempeño del cirujano ético, humanista y competente, y para afianzar la relación diádica entre enfermo y cirujano. El diálogo permanente, la resolución de eventuales conflictos, el reconocimiento de la vulnerabilidad del enfermo y la adhesión a los principios éticos deberán guiar el accionar de los profesionales a lo largo del proceso de atención quirúrgica, poniendo el bienestar y el interés del enfermo en primer lugar.

Introduction. The ethical aspects and challenges in the care of patients with esophageal pathology include different situations that must be anticipated and known by experts to be resolve in the most appropriate, favorable, and fair manner for the patients and their families. Methods. A review and analysis of the information available in the databases was carried out in order to establish the relevant ethical aspects of esophageal surgery today. Discussion. All surgeons face situations that lead to ethical conflicts in their daily care practice. A capable and suitable surgeon must be not only competent to carry out the art and science of surgery, as traditionally interpreted, but also ethically and morally trustworthy. Conclusion. Ethical principles are of fundamental importance and serve as a guide for the performance of the ethical, humanistic, and competent surgeon, and to strength the dyadic relationship between patient and surgeon. Permanent communication, resolution of possible conflicts, recognition of the patient's vulnerability, and adherence to ethical principles should guide the actions of professionals throughout the surgical care process, putting the well-being and interest of the patient first.

Prognostic nutritional index as a predictor of surgical complications in women with gynecological cancer.

OBJECTIVE: To analyze the association between the prognostic nutritional index and surgical morbidity in women with gynecologic cancers. METHODS: This is a retrospective cohort study of women with ovarian, endometrial, or cervical cancer who underwent surgery between January 2013 and December 2020 at a cancer center. Demographic and clinical data were extracted from electronic medical records. The prognostic nutritional index was calculated during the immediate pre-operative period. Binomial logistic regression was conducted to identify the association of the prognostic nutritional index with the outcome of surgical complications after Clavien-Dindo classification, adjusting for confounding variables. RESULTS: A total of 1000 women were included: 114 (11.4%) were diagnosed with cervical cancer, 551 (55.1%) with ovarian cancer, and 335 (33.5%) with endometrial cancer. Patients with a prognostic nutritional index >40 had a decreased possibility of surgical complications (OR=0.39, 95% CI 0.29 to 0.52); basal blood hemoglobin, volume of surgical bleeding, operative time, and length of hospital stay were also explanatory factors. The prognostic nutritional index has a significant effect on patients with endometrial and cervical cancer, but conversely is not significant in patients with ovarian cancer. CONCLUSION: The prognostic nutritional index is associated with surgical morbidity in endometrial and cervical cancers and thus can be a useful tool for predicting morbidity and guide pre-operative interventions in patients with gynecological cancers.

Exploring cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors.

OBJECTIVE: To evaluate the correlation between socioeconomic and healthcare factors and cervical cancer mortality rates, as well as the accessibility to prevention and treatment across Brazilian states and macroregions. The aim is to highlight the multifaceted challenge of addressing cervical cancer mortality, particularly in low- and middle-income countries. METHODS: This cross-sectional study analyzed public data from the Brazilian National Institute of Cancer (INCA), the National Institute of Geography and Statistics (IBGE), and the Brazilian Ministry of Health. Data were collected on indicators such as the Human Development Index (HDI), physician density, average household income, human papillomavirus (HPV) vaccine coverage, Pap smear screening rates, radiotherapy machine density, and non-White population rates by state and macroregion across Brazil. Spearman's rank correlation test and simple linear regression analysis were employed. RESULTS: Cervical cancer mortality rates are statistically lower in women with health insurance, positive self-perception of health, located in states with a higher HDI, per capita household income, density of physicians, and radiotherapy machines per 1000 inhabitants. In contrast, mortality rates proportionally increase according to poverty levels, as expected, and rates of non-White population. Considering public health, HDI scores significantly affected Pap smear test coverage, the number of radiotherapy machines, and HPV vaccine uptake. The North and the Southeast regions have, respectively, the lowest and the highest socioeconomic indicators, proportional to their mortality rates. No significant correlation was found between mortality rates and HPV vaccine or Pap smear coverage. CONCLUSIONS: Cervical cancer mortality in Brazil is significantly influenced by socioeconomic and healthcare disparities. This study provides a data-driven basis for public health strategies that address both medical and social determinants of health.

Auricular Therapy to Control Pain in Women With Breast Cancer: Protocol for Systematic Review and Meta-Analysis.

BACKGROUND: The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. OBJECTIVE: This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. METHODS: This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. RESULTS: The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. CONCLUSIONS: This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. TRIAL REGISTRATION: PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55792.

Abrasive challenge effects on enamel and dentin from irradiated human teeth: an in vitro study.

This study aimed to evaluate the effects of radiotherapy (RT) and chemoradiotherapy (CRT) on the wear and surface roughness of in vitro irradiated human enamel and dentin subjected to abrasive challenge. Enamel and dentin specimens (n = 42) were prepared from teeth donated by healthy patients and those with head and neck cancer who had received radiotherapy (RT) or chemoradiotherapy (CRT). The specimens were categorized into three groups: control, RT, and CRT (n = 14 per group for both enamel and dentin). These samples were subjected to an in vitro abrasive experiment using a brushing machine, followed by wear and surface roughness assessments with a confocal laser scanning microscope conducted before and after the abrasive challenge, considering both exposed and non-exposed areas. Statistical analysis used Shapiro-Wilk tests for normality, Wilcoxon tests for comparing two means, and Kruskal-Wallis tests. A significance level of 5% was adopted. In enamel specimens, wear profile values ​​of CRT and RT groups were not different from the control (p > 0.05). The RT group presents lower step values than the CRT and control groups (p < 0.001). No significant difference in final surface roughness was observed in all groups (p > 0.05). In dentin specimens, no significant difference in wear profile and step was observed in all groups (p > 0.05). However, CRT and RT groups present higher values in final surface roughness (p < 0.001). The exposure to ionizing radiation (associated or not to chemotherapy) influenced the surface roughness of dentin and the wear (step) of enamel after the in vitro abrasive challenge.Trial registration: Ethical procedures were approved by the FORP/USP Research Ethics Committee (CAAE: 61308416.4.0000.5419), and Hospital do Câncer de Barretos/Fundação Pio XII (CAAE: 61308416.4.3001.5437).

Recurrence and resistance risk factors in low-risk gestational trophoblastic neoplasia.

Gestational trophoblastic neoplasia (GTN) is a group of rare but highly curable pregnancy-related tumors, especially in low-risk cases. However, around 25% of patients with GTN develop either resistant or recurrent disease after initial chemotherapy. To enhance the understanding of the mechanisms driving treatment failures and to develop more personalized and effective therapeutic strategies, this review explored diverse factors influencing low-risk GTN prognosis. These factors include FIGO (International Federation of Gynecology and Obstetrics) risk score, histology, patient age, pregnancy type, human chorionic gonadotropin (hCG) levels, disease duration, tumor characteristics, metastasis, Doppler ultrasonography, and consolidation chemotherapy. Additionally, the review examined independent risk determinants for disease recurrence and resistance to single-agent chemotherapy in patients with low-risk GTN. In most previous studies on the risk factors related to low-risk GTN, resistance and recurrence have typically been examined independently, despite their overlapping and interrelated nature. Furthermore, they often involve small sample sizes, suffer from methodological shortcomings, and exhibit limited statistical power.Studies utilizing multivariate analysis have shown that independent risk determinants for resistance to first-line treatment include FIGO score, metastatic disease, pre-treatment hCG level, interval between antecedent pregnancy and GTN diagnosis, tumor size, uterine artery pulsatility index (UAPI), choriocarcinoma, lung metastases, lung nodule size, and clearance hCG quartile. The independent predictive factors associated with recurrence include lung metastases, lung nodule size, interval between antecedent pregnancy and chemotherapy, interval from first chemotherapy to hCG normalization, post-delivery low-risk GTN, number of chemotherapy courses to achieve hCG normalization, and number of consolidation chemotherapy cycles. However, while these identified predictive factors offer valuable guidance, the variability in definitions and populations across studies may have implications for the generalizability of their findings. A comprehensive approach using clear definitions and taking into account multiple predictive factors may be necessary for accurately assessing the risk of resistance and recurrence in patients with low-risk GTN.

Relationship between early age at menarche, older age at menopause and subtypes of breast cancer: a scoping review.

Objective: To determine the relationship between early age at menarche, late age at menopause with specific subtypes of breast cancer (BC). Methods: A literature search was conducted in Embase, Lilacs, PubMed, Scopus, and Scielo databases, following the Joanna Briggs Institute scoping review protocol and answering the question "How early age at menarche or late age at menopause are related to different breast cancer subtypes?". Results: A number of 4,003 studies were identified, of which 17 were selected. Most of the included articles found a clear relationship between early menarche, late menopause and some subtypes of BC, mainly, PR+, ER+, luminal, and HER-2 tumors. However, some studies have found a contradictory relationship and one study didn't find any relationship between them. Conclusion: A relationship between early age at menarche and advanced age at menopause was observed with some subtypes of breast cancer, since other factors must be considered in its understanding.

Immediate prepectoral versus submuscular breast reconstruction in nipple-sparing mastectomy: a retrospective cohort analysis.

Objective: To evaluate early complications in prepectoral breast reconstruction. Methods: A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques. Results: The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63). Conclusion: The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.

Adrenocortical neoplasm in a 2-year-old child: Clinical approach and diagnostic imaging.

Adrenocortical tumors in children and adolescents are rare and aggressive, accounting for only 0.2% of pediatric cancers, with most cases associated with Li-Fraumeni syndrome. The most common manifestation is virilization due to androgen excess. Imaging techniques are crucial in the diagnosis and management of pediatric adrenocortical carcinoma. CT and MRI are essential for differentiating between benign and malignant lesions and assessing tumor characteristics and extent. Correlating imaging findings with clinical and histopathological data is vital for optimal diagnosis and treatment, underscoring the need for a multidisciplinary approach to managing these rare but aggressive neoplasms. This report presents the case of a previously healthy 2-year-old boy who exhibited virilization symptoms and was diagnosed with adrenocortical carcinoma.

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

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.

Validation of the Mirai model for predicting breast cancer risk in Mexican women.

OBJECTIVES: To validate the performance of Mirai, a mammography-based deep learning model, in predicting breast cancer risk over a 1-5-year period in Mexican women. METHODS: This retrospective single-center study included mammograms in Mexican women who underwent screening mammography between January 2014 and December 2016. For women with consecutive mammograms during the study period, only the initial mammogram was included. Pathology and imaging follow-up served as the reference standard. Model performance in the entire dataset was evaluated, including the concordance index (C-Index) and area under the receiver operating characteristic curve (AUC). Mirai's performance in terms of AUC was also evaluated between mammography systems (Hologic versus IMS). Clinical utility was evaluated by determining a cutoff point for Mirai's continuous risk index based on identifying the top 10% of patients in the high-risk category. RESULTS: Of 3110 patients (median age 52.6 years ± 8.9), throughout the 5-year follow-up period, 3034 patients remained cancer-free, while 76 patients developed breast cancer. Mirai achieved a C-index of 0.63 (95% CI: 0.6-0.7) for the entire dataset. Mirai achieved a higher mean C-index in the Hologic subgroup (0.63 [95% CI: 0.5-0.7]) versus the IMS subgroup (0.55 [95% CI: 0.4-0.7]). With a Mirai index score > 0.029 (10% threshold) to identify high-risk individuals, the study revealed that individuals in the high-risk group had nearly three times the risk of developing breast cancer compared to those in the low-risk group. CONCLUSIONS: Mirai has a moderate performance in predicting future breast cancer among Mexican women. CRITICAL RELEVANCE STATEMENT: Prospective efforts should refine and apply the Mirai model, especially to minority populations and women aged between 30 and 40 years who are currently not targeted for routine screening. KEY POINTS: The applicability of AI models to non-White, minority populations remains understudied. The Mirai model is linked to future cancer events in Mexican women. Further research is needed to enhance model performance and establish usage guidelines.

Look-Locker T1 relaxometry and high-resolution T2 in the evaluation of lung lesions: a single-center prospective study.

Objective: To explore the feasibility of two magnetic resonance imaging (MRI) sequences-high-resolution T2-weighted (HR T2) and Look-Locker T1 (LL T1) relaxometry-for the investigation focal lung lesions (FLLs). As a secondary objective, we analyzed the diagnostic accuracy of these sequences. Materials and Methods: This was a prospective observational study involving 39 subjects with FLLs scanned in a 1.5-T MRI system with LL T1 relaxometry and HR T2 sequences focused on the FLL region, in addition to a conventional protocol. All images were evaluated by two radiologists, working independently, who were blinded to other findings. Results: Most of the examinations (31 of the LL T1 relaxometry sequences and 36 of the HR T2 sequences) were of adequate diagnostic quality. Nondiagnostic examinations were considered so mainly because of limited coverage of the sequences. Of the FLLs studied, 19 were malignant, 17 were benign, and three were excluded from the accuracy analysis because there was no definitive diagnosis. Although LL T1 relaxometry could not distinguish between benign and malignant lesions, the signal intensity at its first inversion time (160 ms) differed between the two groups. The HR T2 sequence was considered the best sequence for assessing specific morphological characteristics, especially pseudocavities and pleural tags. We found that MRI showed better accuracy than did computed tomography (86% vs. 74%). Conclusion: Both MRI sequences are feasible for the evaluation of FLLs. Images at 160 ms of the LL T1 relaxometry sequence helped distinguish between benign and malignant lesions, and the HR T2 sequence was considered the best sequence for evaluating specific morphological characteristics.

Objetivo: Explorar a viabilidade de imagens de alta resolução T2 (T2 AR) e relaxometria T1 Look-Locker (T1 LL) para lesões pulmonares focais (LPFs). Como objetivo secundário, analisamos a precisão diagnóstica dessas sequências. Materiais e Métodos: Este é um estudo observacional prospectivo com 39 sujeitos com LPFs examinados em um sistema de ressonância magnética 1.5T com imagens T1 LL e T2 AR focadas na região das LPFs, além de um protocolo convencional. As imagens foram avaliadas por dois radiologistas independentes e cegos para o estudo. Imagens de tomografia computadorizada estavam disponíveis, mas foram avaliadas sem conhecimento dos outros resultados. Resultados: A maioria dos exames apresentou qualidade diagnóstica adequada em ambas as sequências (T1 LL em 31 exames e T2 AR em 36). Exames considerados não diagnósticos estavam principalmente relacionados à cobertura limitada das sequências. Das LPFs estudadas, 19 eram malignas, 17 eram benignas e três casos foram excluídos da análise de precisão de malignidade por falta de um diagnóstico definitivo. A relaxometria T1 LL não conseguiu distinguir entre lesões benignas e malignas, mas a análise da intensidade do sinal do primeiro tempo de inversão (160 ms) diferiu entre os grupos. A T2 AR foi considerada a melhor sequência para avaliar características morfológicas específicas, especialmente pseudocavidades e apêndices pleurais. A ressonância magnética teve melhor precisão em comparação com a tomografia computadorizada (86% e 74%, respectivamente). Conclusão: Ambas as sequências são viáveis na avaliação de LPFs. Imagens a 160 ms da sequência T1 LL ajudaram a distinguir lesões benignas de malignas, e a T2 AR foi considerada a melhor sequência na avaliação de algumas características morfológicas específicas.

Intrathyroidal neurofibroma, a case report. / Neurofibroma intratiroideo, a propósito de un caso.

Neurofibromatosis type 1 (NF1) is the most common neurocutaneous disease. It is characterized by café-au-lait spots, melanocytic hamartomas of the iris, pseudo-freckles, neurofibromas, and tumor predisposition. The presence of neurofibromas in the thyroid gland is extremely rare. Here we present the case of a 6-year-old male patient with NF1 who consulted at the Department of Endocrinology due to a thyroid tumor and whose ultrasound confirmed a heterogeneous mass at the posterior level of the right lobe. A cervical surgery found the tumor was adhered to the larynx and trachea, with the recurrent laryngeal nerve entering the tumor. Due to the impossibility of dissection, a right hemithyroidectomy was performed and the pathological examination confirmed the presence of plexiform neurofibroma and intrathyroidal neurofibroma. This is the second case reported in childhood and the youngest case to date. Neurofibroma with thyroid involvement should be suspected in patients with cervical mass and NF1, since diagnostic guidance allows avoiding unnecessary studies and guide treatment.

La neurofibromatosis tipo 1 (NF1) es la enfermedad neurocutánea más frecuente, caracterizada por manchas café con leche, hamartomas melanocíticos en iris, pseudoefélides, neurofibromas y predisposición a tumores. La presencia de neurofibromas en la glándula tiroides es extremadamente rara. Se presenta un paciente de sexo masculino de 6 años con NF1 que consultó al Servicio de Endocrinología por tumoración tiroidea, con ecografía que confirmó formación heterogénea a nivel posterior del lóbulo derecho. Se realizó cirugía cervical con tumor adherido a laringe y tráquea, con nervio recurrente que ingresaba al tumor. Por imposibilidad de disección, se realizó hemitiroidectomía derecha, con anatomía patológica confirmatoria de neurofibroma plexiforme y neurofibroma intratiroideo. Este caso es el segundo reportado en la infancia y el de menor edad hasta el momento. Se debe sospechar neurofibroma con compromiso tiroideo en pacientes con masa cervical y NF1, ya que la orientación diagnóstica permite evitar estudios innecesarios y orientar el tratamiento.

Breast cancer diagnosis and staging in Chile: A non-randomized survey-based study to assess frequency and delays. / Diagnóstico y etapificación de cáncer de mama en Chile: estudio por encuesta no probabilística de III a IV frecuencia y tiempos.

Introduction: Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods: Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results: A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions: Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.

Introducción: La progresión del cáncer de mama involucra mecanismos fisiológicos como metástasis. Los retrasos en diagnóstico y tratamiento aumentan el riesgo de mortalidad y se asocian a barreras de acceso a la salud. En Chile, el cáncer de mama es altamente prevalente y su diagnóstico temprano ha mejorado, aunque persisten disparidades en el proceso de enfermedad. Este estudio caracterizó exámenes de diagnóstico y etapificación, tiempos de espera y perfiles sociodemográficos para identificar demoras e inequidades en la atención. Métodos: Estudio de encuesta. Utilizando una muestra no probabilística, se aplicó un cuestionario en plataforma encriptada previo consentimiento informado. En el instrumento se recogieron datos de exámenes solicitados, tiempos asociados, etapificación y características sociodemográficas. Estas variables fueron analizadas utilizando estadística descriptiva, test de asociación, intervalos de confianza y test de comparación utilizando . Resultados: Se logró una muestra de 263 personas. Los exámenes más solicitados fueron biopsia (99,62%) y exámenes de sangre (80,23%). La mediana de exámenes solicitados fue de 6 (Q1:4, Q3:8), con media 5,87 (desviación estándar: 2,24). No se observaron diferencias significativas en el porcentaje de personas a quienes se solicitó la totalidad de exámenes según variables estudiadas. Los intervalos día-hora-resultado oscilaron entre 1 y 365 días. La mediana día-hora-resultado de la biopsia fue de 15 días (Q1:10, Q3:30). Las personas entre 40 y 49 años, no residentes de la capital, pertenecientes al quintil I de ingreso, con educación media, del sistema público de salud, con diagnóstico en etapa tardía presentaron mayores medianas de día-hora-resultado en biopsia. No hubo diferencia significativa en la cantidad de exámenes solicitados según etapificación (I a II y III a IV). Conclusiones: La biopsia en Chile es el examen de elección para la confirmación diagnóstica en cáncer de mama. Otros exámenes son solicitados independientemente de la etapa del diagnóstico, existiendo una discordancia con las recomendaciones de la guía clínica. El pronóstico del cáncer es crucial, especialmente en países con mayores inequidades.