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1.
Zhonghua Fu Chan Ke Za Zhi ; 56(9): 622-629, 2021 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-34547863

RESUMO

Objective: To investigate the hierarchical management scheme of cervical adenocarcinoma in situ (AIS) based on cervical conization margin state. Methods: All medical records of 249 patients diagnosed as AIS by loop electrosurgical excision procedure (LEEP) conization from Jan. 2010 to Dec. 2015 in Obstetrics and Gynecology Hospital of Fudan University were retrospectively reviewed, to explore the relationship between the status of the resection margin and the residual lesion after LEEP, and the multivariate logistic regression method was used to analyze the related factors that affect the residual lesion after LEEP in cervical AIS patients. Results: (1) The age of 249 cervical AIS patients was (40±8) years old (range: 23-71 years old). Of the 249 patients, 19 (7.6%, 19/249) had residual lesions; 69 cases were pathologically diagnosed as AIS after LEEP, and the residual lesion rate was 13.0% (9/69), which was significantly higher than that of AIS + high-grade squamous intraepithelial lesion [5.6% (10/180); χ2=3.968,P=0.046]; 33 cases were multifocal lesions, the residual rate of lesions was 21.2% (7/33), which was significantly higher than that of single focal lesions patients [5.6% (12/216); χ2=7.858, P=0.005]; 181 patients underwent endocervical curettage (ECC) before surgery, the residual rate of lesions in ECC-positive patients was 14.0% (14/100) , significantly higher than that of ECC-negative patients [4.9% (4/81); χ2=4.103, P=0.043]. (2) Among 249 cases of AIS patients, the positive rate of resection margins after LEEP was 35.3% (88/249); the residual rate of lesions in patients with positive resection margins (14.8%, 13/88) was significantly higher than those with negative margins [3.8%(6/156); χ2=9.355, P=0.002]. The age of patients underwent total hysterectomy after LEEP was (43±7) years old, which was significantly higher than that of patients who did not undergo total hysterectomy [(37±8) years old; t=6.518, P<0.01].Among the patients underwent total hysterectomy after LEEP, 3 cases (2.0%, 3/152) had fertility requirements, while 38 cases (39.2%, 38/97) did not underwent total hysterectomy, the difference between the two groups was statistically significant (χ2=59.579, P<0.01). Among the 152 patients who underwent total hysterectomy after LEEP, the residual rate of lesions was 11.8% (18/152); the residual rate of lesions in patients with positive resection margins was significantly higher than that of patients with negative resection margins [18.8% (12/64) vs 7.0% (6/86); χ2=4.861, P=0.028]. The median follow-up time of 97 patients who did not undergo total hysterectomy after LEEP was 32 months (range: 4-70 months). During the follow-up period, 3 cases of cervical AIS recurrence (3.1%, 3/97) and were followed by hysterectomy,no invasive adenocarcinoma were seen. (3) Multivariate logistic regression analysis showed that the positive resection margin (OR=4.098, 95%CI: 1.235-13.595, P=0.021), multifocal lesions (OR=5.464, 95%CI: 1.494-19.981, P=0.010) were independent risk factors that affected the residual lesions in patients with cervical AIS after LEEP. Conclusions: The cervical AIS patients after LEEP conization suggested be stratified by cone margin state as the first-line stratified index, age and fertility needs as the second-line stratified management index. The individualized management plan should be developed based on comprehensive assessment of high-risk factors of residual lesions.


Assuntos
Adenocarcinoma in Situ , Neoplasias do Colo do Útero , Adenocarcinoma in Situ/epidemiologia , Adenocarcinoma in Situ/cirurgia , Adulto , Idoso , Conização , Eletrocirurgia , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasia Residual/cirurgia , Gravidez , Estudos Retrospectivos , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
2.
Femina ; 49(7): 425-432, 20210731. ilus
Artigo em Português | LILACS | ID: biblio-1290592

RESUMO

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)


Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)


Assuntos
Humanos , Feminino , Neoplasias do Colo do Útero/patologia , Colo do Útero/cirurgia , Carcinoma Endometrioide/patologia , Conização , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma in Situ/patologia , Colposcopia , Citodiagnóstico/métodos
3.
PLoS Med ; 18(6): e1003665, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34086680

RESUMO

BACKGROUND: Excisional procedures of cervical intraepithelial neoplasia (CIN) may increase the risk of preterm birth. It is unknown whether this increased risk is due to the excision procedure itself, to the underlying CIN, or to secondary risk factors that are associated with both preterm birth and CIN. The aim of this study is to assess the risk of spontaneous preterm birth in women with treated and untreated CIN and examine possible associations by making a distinction between the excised volume of cervical tissue and having cervical disease. METHODS AND FINDINGS: This Dutch population-based observational cohort study identified women aged 29 to 41 years with CIN between 2005 and 2015 from the Dutch pathology registry (PALGA) and frequency matched them with a control group without any cervical abnormality based on age at and year of pathology outcome (i.e., CIN or normal cytology) and urbanization (<100,000 inhabitants or ≥100,000 inhabitants). All their 45,259 subsequent singleton pregnancies with a gestational age ≥16 weeks between 2010 and 2017 were identified from the Dutch perinatal database (Perined). Nineteen potential confounders for preterm birth were identified. Adjusted odds ratios (ORs) were calculated for preterm birth comparing the 3 different groups of women: (1) women without CIN diagnosis; (2) women with untreated CIN; and (3) women with treated CIN prior to each childbirth. In total, 29,907, 5,940, and 9,412 pregnancies were included in the control, untreated CIN, and treated CIN group, respectively. The control group showed a 4.8% (1,002/20,969) proportion of spontaneous preterm birth, which increased to 6.9% (271/3,940) in the untreated CIN group, 9.5% (600/6,315) in the treated CIN group, and 15.6% (50/321) in the group with multiple treatments. Women with untreated CIN had a 1.38 times greater odds of preterm birth compared to women without CIN (95% confidence interval (CI) 1.19 to 1.60; P < 0.001). For women with treated CIN, these odds 2.07 times increased compared to the control group (95% CI 1.85 to 2.33; P < 0.001). Treated women had a 1.51 times increased odds of preterm birth compared to women with untreated CIN (95% CI 1.29 to 1.76; P < 0.001). Independent from cervical disease, a volume excised from the cervix of 0.5 to 0.9 cc increased the odds of preterm birth 2.20 times (37/379 versus 1,002/20,969; 95% CI 1.52 to 3.20; P < 0.001). These odds further increased 3.13 times and 5.93 times for women with an excised volume of 4 to 8.9 cc (90/724 versus 1,002/20,969; 95% CI 2.44 to 4.01; P < 0.001) and ≥9 cc (30/139 versus 1,002/20,969; 95% CI 3.86 to 9.13; P < 0.001), respectively. Limitations of the study include the retrospective nature, lack of sufficient information to calculate odds of preterm birth <24 weeks, and that the excised volume could only be calculated for a select group of women. CONCLUSIONS: In this study, we observed a strong correlation between preterm birth and a volume of ≥0.5 cc excised cervical tissue, regardless of the severity of CIN. Caution should be taken when performing excisional treatment in women of reproductive age as well as prudence in case of multiple biopsies. Fertile women with a history of performing multiple biopsies or excisional treatment for CIN may benefit from close surveillance during pregnancy.


Assuntos
Adenocarcinoma in Situ/epidemiologia , Neoplasia Intraepitelial Cervical/epidemiologia , Nascimento Prematuro/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adulto , Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/cirurgia , Bases de Dados Factuais , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Humanos , Países Baixos/epidemiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/diagnóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
4.
Medicine (Baltimore) ; 100(21): e25861, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032698

RESUMO

RATIONALE: Gastric adenocarcinoma of fundic gland (chief cell predominant type) (GA-FG-CCP) is a new, rare variant of gastric adenocarcinoma, which is characterized by mild nuclear atypia and specific immunohistochemical markers. PATIENT CONCERNS: An 84-year-old Chinese man was referred to our hospital for endoscopic resection of a gastric lesion. INTERVENTIONS: We performed endoscopic submucosal dissection, and successfully removed the lesion. DIAGNOSIS: Esophago gastroduodenoscopy showed a slightly elevated lesion with a diameter of 22 mm in the posterior wall of cardia. Magnifying endoscopy with narrow band imaging revealed an abnormal microsurface and microvessels on the tumor surface. Endoscopic ultrasonography revealed a hypoechoic mass located in the first layer. The pathological diagnosis of the biopsy specimens indicated that the tumor was high grade intraepithelial neoplasia. The pathological diagnosis differed between the superficial and deeper part of the lesion. The superficial part was composed of a tubular structure with prominent atypia and was diagnosed as well differentiated intestinal adenocarcinoma. The deeper part was composed of a well-differentiated tubular adenocarcinoma mimicking the fundic gland cells, mainly the chief cells. The tumor cells showed mild nuclear atypia and was positive for pepsinogen-I (PG-I) and mucin-6 (MUC6). This deeper part was diagnosed as GA-FG-CCP. OUTCOMES: The tumor was successfully removed. This patient had no discomfort during the follow-up period (10 months). LESSONS: We present a rare case of GA-FG-CCP coexisted with well-differentiated tubular adenocarcinoma. GA-FG-CCP exists in the deep mucosal layer and the muscularis mucosa, which could not be found under endoscopy, but could be discerned in pathology with mild nuclear atypia and special biomarkers.


Assuntos
Adenocarcinoma in Situ/diagnóstico , Adenocarcinoma/diagnóstico , Fundo Gástrico/patologia , Neoplasias Complexas Mistas/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Biópsia , Celulas Principais Gástricas/patologia , Endoscopia do Sistema Digestório , Endossonografia , Gastrectomia , Fundo Gástrico/citologia , Fundo Gástrico/diagnóstico por imagem , Fundo Gástrico/cirurgia , Humanos , Mucosa Intestinal/patologia , Masculino , Mucina-6/análise , Neoplasias Complexas Mistas/patologia , Neoplasias Complexas Mistas/cirurgia , Pepsinogênio A/análise , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
5.
J Thorac Oncol ; 16(8): 1312-1320, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33915249

RESUMO

INTRODUCTION: The WHO classification of lung tumors defines adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) as cancers with no or limited histologic invasive components. The probability of patients with AIS or MIA being recurrence free for 5 years postoperatively has been found to be 100%. This study aimed to analyze the prognosis of patients with AIS or MIA after more than 5 postoperative years. METHODS: We reviewed the pathologic findings of 4768 patients who underwent resection for lung cancer between 1998 and 2010. Of these, 524 patients with curative resection for AIS (207 cases, 39.5%) and MIA (317 cases, 60.5%) were included. Postoperative recurrence, survival, and development of secondary primary lung cancer (SPLC) were analyzed. RESULTS: Of the included patients, 342 (65.3%) were of female sex, 333 (63.5%) were nonsmokers, and 229 (43.7%) underwent sublobar resection. Average pathologic total tumor diameter was 15.2 plus or minus 5.5 mm. Median postoperative follow-up period was 100 months (range: 1-237). No recurrence of lung cancer was observed for either AIS or MIA cases. Estimated 10-year postoperative disease-specific survival rates were 100% and 100% (p = 0.72), and overall survival rates were 95.3% and 97.8% (p = 0.94) for AIS and MIA cases, respectively. Estimated incidence rates of metachronous SPLC at 10 years after surgery were 5.6% and 7.7% for AIS and MIA, respectively (p = 0.45), and these were not correlated with the EGFR mutation status. CONCLUSIONS: Although the development of metachronous SPLC should be noted, the risk of recurrence is quite low at more than 5 years after resection of AIS and MIA. This finding strengthens the clinical value of distinguishing AIS and MIA from other adenocarcinomas of the lung.


Assuntos
Adenocarcinoma in Situ , Adenocarcinoma de Pulmão , Adenocarcinoma , Neoplasias Pulmonares , Adenocarcinoma/cirurgia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/cirurgia , Feminino , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos
6.
Am J Surg Pathol ; 45(4): 567-576, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33177339

RESUMO

Lung cancer screening has improved mortality among high-risk smokers but has coincidentally detected a fraction of nonprogressive adenocarcinoma historically classified as bronchoalveolar carcinoma (BAC). In the National Lung Screening Trial (NLST) the majority of BAC-comprising 29% of computed tomography-detected stage I lung adenocarcinoma-were considered overdiagnosis after extended follow-up comparison with the control arm. In the current classification, adenocarcinoma in situ and minimally invasive adenocarcinoma have replaced BAC but together comprise only ∼5% of stage I lung adenocarcinoma. Lepidic and subsets of papillary and acinar adenocarcinoma also infrequently recur. We, therefore, propose criteria for low malignant potential (LMP) adenocarcinoma among nonmucinous adenocarcinoma measuring ≤3 cm in total, exhibiting ≥15% lepidic growth, and lacking nonpredominant high-grade patterns (≥10% cribriform, ≥5% micropapillary, ≥5% solid), >1 mitosis per 2 mm2, angiolymphatic or visceral pleural invasion, spread through air spaces or necrosis. We tested these criteria in a multi-institutional cohort of 328 invasive stage I (eighth edition) and in situ adenocarcinomas and observed 16% LMP and 7% adenocarcinoma in situ/minimally invasive adenocarcinoma which together (23%) approximated the frequency of overdiagnosed stage I BAC in the NLST. The LMP group had 100% disease-specific survival. The proposed LMP criteria, incorporating multiple histologic parameters, may be a clinically useful "low-grade" prognostic group. Validation of these criteria in additional retrospective cohorts and prospective screen-detected cohorts should be considered.


Assuntos
Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma in Situ/mortalidade , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/cirurgia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Mitose , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Carga Tumoral , Estados Unidos
7.
Acta Cytol ; 65(2): 150-157, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33176300

RESUMO

INTRODUCTION: Gastric-type mucinous carcinoma (GAS) of the uterine cervix is an adenocarcinoma subtype with a gastric phenotype that poses diagnostic pitfalls in cervical screening cytology because of its blunt morphologic atypia and the limited utility of human papillomavirus testing and ancillary immunochemical staining. Despite the recent widespread uptake of liquid-based cytology (LBC) systems, the cytomorphological features of GAS in LBC samples and the differential features between GAS and usual-type endocervical adenocarcinoma (UEA) remain unclear. METHODS: Eight GAS cases, all of which were surgically treated following histological confirmation, were examined. Direct Papanicolaou-stained smears and LBC samples were reviewed and compared with 10 UEA cases as controls. Featured cytomorphological findings were as follows: background (mucinous, inflammatory, or necrotic), cell crowding (size of neoplastic cell clusters), cytoplasm (golden mucin and cell border), and nuclei (nuclear chromatin and nucleoli). RESULTS: Of 18 adenocarcinomas, 16 were detected against a non-mucinous background in LBC samples, most of which were accompanied by mild to moderate inflammation. Clusters comprising >300 neoplastic cells were identified in both GAS and UEA in conventional smears (CSs), while no LBC samples harboured clusters as large as these. Cell borders of GAS were more distinct than those of UEA in CSs (p < 0.001), although fewer populations of neoplastic clusters revealed distinct cell borders in both GAS and UEA in LBC samples. Three of 8 and 2 of 8 GAS cases had golden mucin in CSs and in LBC samples, respectively, which was not detected in UEA at all. Nucleoli against fine nuclear chromatin were more pronounced in GAS than in UEA on CS (p = 0.03), although the difference between GAS and UEA was not apparent in LBC samples. DISCUSSION/CONCLUSION: This study demonstrated that the diagnostic clues to detect GAS using the conventional approach, namely distinct cell borders and prominent nucleoli, are not useful for excluding UEA in LBC samples. Conventional cervical smears may indicate a diagnosis of GAS; however, specific high-risk HPV detection approaches, such as HPV test or immunocytochemical p16/Ki-67 dual staining, are desirable to differentiate GAS from UEA in the setting of LBC with ambiguous cytomorphological features.


Assuntos
Adenocarcinoma in Situ/patologia , Adenocarcinoma Mucinoso/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma Mucinoso/cirurgia , Adulto , Idoso , Feminino , Humanos , Biópsia Líquida , Pessoa de Meia-Idade , Teste de Papanicolaou , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/cirurgia , Esfregaço Vaginal , Adulto Jovem
8.
Sci Rep ; 10(1): 19920, 2020 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-33199765

RESUMO

This study aims to reveal the risk factors associated with recurrence or new-onset high-grade squamous intraepithelial lesions (HSILs) or more severe lesions (HSILs +) and analyze obstetrical outcomes in patients with adenocarcinoma in situ (AIS) or stage IA1 cervical cancer patients after conization. A retrospective cohort study was developed from January 1, 2002, and July 1, 2018, in a single center, where all patients with AIS or stage IA1 cervical cancer who accepted conization for primary surgery were reviewed and followed up until July 1, 2019, for the pathological findings of HSILs + and obstetric outcomes. Two hundred and seventeen patients were identified, including 114 cases of AIS, 76 cases of stage IA1 squamous cell carcinoma (SCC) and 27 cases of stage IA1 adenocarcinoma (ADC). A total of 88 (40.6%) patients had an intact uterus without radiotherapy. Five patients experienced HSIL+ recurrence. The cumulative 3-, 5- and 10-year incidence rates of HSILs + were 1.0%, 1.5% and 2.0%, respectively. No significant risk factors, including primary disease, margin status and hysterectomy, were associated with recurrence. Twenty (66.7%) of 30 patients who attempted pregnancy had 23 successful pregnancies, which result in 7 miscarriages, 16 live births and 5 preterm births. Age at conization was the only independent risk factor associated with pregnancy, live births and preterm births. In conclusion, conization is safe for young women with AIS, stage IA1 SCC and ADC who desire future fertility, and the associated HSIL recurrence rate is low. Increased age significantly lowered the conception or live birth rate.


Assuntos
Adenocarcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Conização/métodos , Histerectomia/métodos , Recidiva Local de Neoplasia/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma in Situ/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Fatores de Risco , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
9.
Gynecol Oncol ; 159(3): 623-629, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33032824

RESUMO

OBJECTIVE: Adenocarcinoma in situ (AIS) of the cervix is a precursor to cervical adenocarcinoma. When AIS is detected by cervical screening an excision biopsy is mandatory to exclude invasion. We aimed to compare margins status, specimen size and fragmentation after loop electrosurgical excision procedure (LEEP) and 'cold knife cone biopsy' (CKC). METHODS: The EXCISE Trial was an investigator-initiated, multicenter, open-label, parallel-group, phase 2, randomized study. Patients were enrolled at seven hospitals in Australia and New Zealand. We randomly assigned women aged ≥18 to ≤45 years with screen detected AIS to LEEP or CKC. Co-primary endpoints were margin status, specimen size and fragmentation. Analysis was by intention-to-treat. RESULTS: Between August 2, 2017 and September 6, 2019, 40 patients were randomly assigned 2:1 to LEEP or CKC. Margin status was evaluable in 36 cases. The proportion of patients with involved margins did not differ between groups. 25 of 26 LEEP and all 14 CKC biopsies were excised as single specimens (p = 1·00). There were no differences in specimen dimensions. Patients in the CKC group had more post-operative complications (64.3% compared to 15.4% for LEEP p = ·00). There were no differences in grade three complications (p = ·65). CONCLUSIONS: LEEP was not associated with a greater likelihood of positive margins, specimen fragmentation or smaller excision compared to CKC when performed according to a standardized protocol. However, the study was not powered to establish non-inferiority of LEEP and a definitive phase 3 trial to compare margin status and rates of treatment failure after LEEP and CKC is warranted.


Assuntos
Adenocarcinoma in Situ/cirurgia , Eletrocirurgia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Adulto , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Colo do Útero/patologia , Colo do Útero/cirurgia , Eletrocirurgia/instrumentação , Eletrocirurgia/métodos , Feminino , Humanos , Margens de Excisão , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Índice de Gravidade de Doença , Neoplasias do Colo do Útero/patologia
10.
Surg Oncol ; 33: 164-169, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32561083

RESUMO

BACKGROUND: Accurate and fast localization of small pulmonary nodules is required for local pulmonary resection. In this study, we introduced and assessed a novel technique for the preoperative localization of small pulmonary nodules by using ZT medical glue (2-octyl cyanoacrylate). METHODS: 101 patients who had a combined total of 106 small pulmonary nodules located by ZT glue and 53patients with 53 small pulmonary nodules located by hookwire were selected. Guided by computed tomography (CT), the surgeon injected certain volume ZT glue into an area adjacent to the small pulmonary nodule, then, the adjacent lung tissue infiltrated by ZT glue formed into a depressed hard nodule which can be used for preoperative localization with an obvious mark on lung surface or different hand touch. After localization, Wedge resection was performed via video-assisted thoracoscopic surgery and the specimen obtained from the procedure was immediately sent for pathological examination, followed by a standard surgical procedure. A contrast has been made between the ZT glue method and the hookwire. RESULTS: 101 operations were successfully performed by using this novel technique, and 106 small pulmonary nodules were successfully located. Compared with the hookwire location, ZT glue method obviouslyextended the Time interval between localization and operation (P = 0.00) and a same complication rate (P = 0.07). CONCLUSIONS: The use of ZT glue is a safe and effective method for the localization of small pulmonary nodules. TRIAL REGISTRATION: This study was approved by the ethics committee of Shaoxing People's Hospital (Number:2016-004, Date:2016,2,24), and informed consent was obtained from all enrolled patients.


Assuntos
Cianoacrilatos , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Pneumonectomia/métodos , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adesivos Teciduais , Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Idoso , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/patologia , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Cirurgia Assistida por Computador , Carga Tumoral
11.
Am J Obstet Gynecol ; 223(6): 888.e1-888.e9, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32585223

RESUMO

BACKGROUND: Loop electrosurgical excision procedure may be performed under local anesthesia or general anesthesia, and practice patterns differ worldwide. No randomized head-to-head comparison has been published to confirm or refute either practice. OBJECTIVE: This study aimed to compare loop electrosurgical excision procedure under local anesthesia vs general anesthesia regarding patient satisfaction and procedure-related outcomes such as rates of involved margins, complications, pain, and blood loss. STUDY DESIGN: Consecutive women referred to our colposcopy unit were recruited. Loop electrosurgical excision procedure was performed under local anesthesia with 4 intracervical injections of bupivacaine hydrochloride 0.5% or under general anesthesia with fentanyl, propofol, and a laryngeal mask with sevoflurane maintenance. The primary endpoint was patient satisfaction assessed on the day of surgery and 14 days thereafter using a Likert scale (score 0-100) and a questionnaire. Secondary endpoints included rates of involved margins, procedure-related complications, pain, blood loss, and surgeon preference. Results were compared using nonparametric and chi-square tests. RESULTS: Between July 2018 and February 2020, we randomized 208 women, 108 in the local anesthesia arm and 100 in the general anesthesia arm. In the intention-to-treat analysis, patient satisfaction did not differ between the study groups directly after surgery (Likert scale 100 [90-100] vs 100 [90-100]; P=.077) and 14 days thereafter (Likert scale 100 [80-100] vs 100 [90-100]; P=.079). In the per-protocol analysis, women in the local anesthesia arm had significantly smaller cone volumes (1.11 cm3 [0.70-1.83] vs 1.58 cm3 [1.08-2.69], respectively; P<.001), less intraoperative blood loss (Δhemoglobin, 0.2 g/dL [-0.1 to 0.4] vs 0.5 g/dL [0.2-0.9]; P<.001), and higher satisfaction after 14 days (100 [90-100] vs 100 [80-100]; P=.026), whereas surgeon preference favored general anesthesia (90 [79-100] vs 100 [90-100], respectively; P=.001). All other secondary outcomes did not differ between groups (resection margin status R1, 6.6% vs 2.1% [P=.26]; cone fragmentation, 12.1% vs 6.3% [P=.27]; procedure duration, 151.5 seconds [120-219.5] vs 180 seconds [117-241.5] [P=.34]; time to complete hemostasis, 60 seconds [34-97] vs 70 seconds [48.25-122.25] [P=.08]; complication rate, 3.3% vs 1.1% [P=.59]). In a multivariate analysis, parity (P=.03), type of transformation zone (P=.03), and cone volume (P=.02) and not study group assignment, age, body mass index, and degree of dysplasia independently influenced the primary endpoint. CONCLUSION: Loop electrosurgical excision procedure under local anesthesia is equally well tolerated and offers patient-reported and procedure-related benefits over general anesthesia, supporting the preferred practice in some institutions and refuting the preferred practice in others.


Assuntos
Anestesia Geral/métodos , Anestesia Local/métodos , Colposcopia/métodos , Eletrocirurgia/métodos , Satisfação do Paciente , Displasia do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adulto , Anestésicos Inalatórios/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Anestésicos Locais/uso terapêutico , Ansiedade , Atitude do Pessoal de Saúde , Perda Sanguínea Cirúrgica , Bupivacaína/uso terapêutico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Conização/métodos , Feminino , Fentanila/uso terapêutico , Ginecologia , Humanos , Máscaras Laríngeas , Margens de Excisão , Dor Pós-Operatória/fisiopatologia , Dor Processual , Complicações Pós-Operatórias , Hemorragia Pós-Operatória , Propofol/uso terapêutico , Sevoflurano/uso terapêutico , Lesões Intraepiteliais Escamosas Cervicais/patologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Cirurgiões , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia
12.
Thorac Cancer ; 11(6): 1728-1733, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32286013

RESUMO

Here, we describe a novel method using microwave ablation (MWA) guided by electromagnetic navigation bronchoscopy (ENB) and video-assisted thoracoscopic surgery (VATS) for simultaneous treatment of multiple high-risk pulmonary nodules in a 47-year-old woman. After the ENB registration process, the operator delivered the locatable electromagnetic probe to the target in the right upper lobe following the navigational route. MWA was performed after an antenna was passed into the lesion through the working channel. The wedge resection of the left upper lobe and lower lobe and the lingual segment resection were performed by VATS. The pathological diagnoses was adenocarcinoma in situ (AIS) of the right upper lobe lesion, AIS of the left upper lobe, minimally invasive adenocarcinoma of the left lower lobe lesion and chronic inflammation of the lingular segment. MWA guided by ENB combined with VATS is an alternative treatment strategy to deal with multiple pulmonary nodules at the same stage of the operation.


Assuntos
Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/cirurgia , Broncoscopia/métodos , Neoplasias Pulmonares/cirurgia , Micro-Ondas/uso terapêutico , Nódulos Pulmonares Múltiplos/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Prognóstico , Ablação por Radiofrequência
13.
Eur Radiol ; 30(5): 2680-2691, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32006165

RESUMO

OBJECTIVES: Develop a CT-based radiomics model and combine it with frozen section (FS) and clinical data to distinguish invasive adenocarcinomas (IA) from preinvasive lesions/minimally invasive adenocarcinomas (PM). METHODS: This multicenter study cohort of 623 lung adenocarcinomas was split into training (n = 331), testing (n = 143), and external validation dataset (n = 149). Random forest models were built using selected radiomics features, results from FS, lesion volume, clinical and semantic features, and combinations thereof. The area under the receiver operator characteristic curves (AUC) was used to evaluate model performances. The diagnosis accuracy, calibration, and decision curves of models were tested. RESULTS: The radiomics-based model shows good predictive performance and diagnostic accuracy for distinguishing IA from PM, with AUCs of 0.89, 0.89, and 0.88, in the training, testing, and validation datasets, respectively, and with corresponding accuracies of 0.82, 0.79, and 0.85. Adding lesion volume and FS significantly increases the performance of the model with AUCs of 0.96, 0.97, and 0.96, and with accuracies of 0.91, 0.94, and 0.93 in the three datasets. There is no significant difference in AUC between the FS model enriched with radiomics and volume against an FS model enriched with volume alone, while the former has higher accuracy. The model combining all available information shows minor non-significant improvements in AUC and accuracy compared with an FS model enriched with radiomics and volume. CONCLUSIONS: Radiomics signatures are potential biomarkers for the risk of IA, especially in combination with FS, and could help guide surgical strategy for pulmonary nodules patients. KEY POINTS: • A CT-based radiomics model may be a valuable tool for preoperative prediction of invasive adenocarcinoma for patients with pulmonary nodules. • Radiomics combined with frozen sections could help in guiding surgery strategy for patients with pulmonary nodules.


Assuntos
Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulo Pulmonar Solitário/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Área Sob a Curva , Feminino , Secções Congeladas , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Cuidados Pré-Operatórios , Curva ROC , Estudos Retrospectivos , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X/métodos
14.
Ann Surg Oncol ; 27(8): 3052-3063, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32048092

RESUMO

BACKGROUND: Adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) are both small tumors with good prognosis after surgical resection, and most of them present as ground glass opacities (GGOs) on computed tomography (CT) screening. However, the differences in clinicopathologic features and genetic alterations between AIS and MIA are poorly elaborated, and few studies have evaluated the prognosis of MIA with different invasive components. Meanwhile, the histological features of lung lesions presenting as unchanged pure GGOs are barely understood. METHODS: Clinicopathologic features and genetic alterations of AIS (n = 59) and MIA (n = 62) presenting as GGOs were analyzed. Long-term preoperative observation (ranging from 2 to 1967 days) and postoperative follow-up (ranging from 0 to 92 months) was conducted. RESULTS: The tumor size and consolidation/tumor ratio were significantly larger in the MIA cohort than those in the AIS cohort both on CT and microscopy images. Immunohistochemically, the expression of p53, Ki67, and cyclin D1 was higher in MIA than in AIS. The EGFR mutation rate was significantly higher in MIA, while other genetic alterations showed no differences. Six MIA cases showed recurrence or metachronous adenocarcinoma and all the cases with a predominant micropapillary invasive pattern demonstrated this feature. CONCLUSIONS: The current CT measurements may be helpful in distinguishing AIS from MIA, but show limited utility in predicting the histology of unchanged pure GGOs. The invasive pattern may have an influence on the postoperative process of MIA; therefore, further studies are needed to evaluate the current diagnostic criteria and treatment strategy for MIA.


Assuntos
Adenocarcinoma in Situ , Adenocarcinoma de Pulmão , Neoplasias Pulmonares , Adenocarcinoma in Situ/genética , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/genética , Seguimentos , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/genética , Invasividade Neoplásica , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
15.
Eur Radiol ; 30(5): 2984-2994, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31965255

RESUMO

OBJECTIVES: Lung adenocarcinomas which manifest as ground-glass nodules (GGNs) have different degrees of pathological invasion and differentiating among them is critical for treatment. Our goal was to evaluate the addition of marginal features to a baseline radiomics model on computed tomography (CT) images to predict the degree of pathologic invasiveness. METHODS: We identified 236 patients from two cohorts (training, n = 189; validation, n = 47) who underwent surgery for GGNs. All GGNs were pathologically confirmed as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), or invasive adenocarcinoma (IA). The regions of interest were semi-automatically annotated and 40 radiomics features were computed. We selected features using L1-norm regularization to build the baseline radiomics model. Additional marginal features were developed using the cumulative distribution function (CDF) of intratumoral intensities. An improved model was built combining the baseline model with CDF features. Three classifiers were tested for both models. RESULTS: The baseline radiomics model included five features and resulted in an average area under the curve (AUC) of 0.8419 (training) and 0.9142 (validation) for the three classifiers. The second model, with the additional marginal features, resulted in AUCs of 0.8560 (training) and 0.9581 (validation). All three classifiers performed better with the added features. The support vector machine showed the most performance improvement (AUC improvement = 0.0790) and the best performance was achieved by the logistic classifier (validation AUC = 0.9825). CONCLUSION: Our novel marginal features, when combined with a baseline radiomics model, can help differentiate IA from AIS and MIA on preoperative CT scans. KEY POINTS: • Our novel marginal features could improve the existing radiomics model to predict the degree of pathologic invasiveness in lung adenocarcinoma.


Assuntos
Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma de Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Margens de Excisão , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Invasividade Neoplásica/patologia , Estudos Retrospectivos , Máquina de Vetores de Suporte
16.
Aust N Z J Obstet Gynaecol ; 60(1): 123-129, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578727

RESUMO

BACKGROUND: Adenocarcinoma in situ of cervix is increasingly managed by local excision rather than hysterectomy and this study will ascertain if conservative management by excision alone is adequate. AIMS: To evaluate the long-term outcomes of conservative management of adenocarcinoma in situ of cervix, particularly in relation to excisional margin status. MATERIALS AND METHODS: Retrospective analysis of women diagnosed with adenocarcinoma in situ and their management between 1992 and 2010 retrieved from the Victorian Cervical Cytology Registry, Australia. Failure of conservative treatment is defined by histologically proven adenocarcinoma in situ or adenocarcinoma at follow-up after negative excisional margins. RESULTS: adenocarcinoma in situ of the cervix was managed primarily with cold knife cone biopsy or loop electrosurgical excision of the cervix. Most excisions were in one piece (83.4%) with average depth of 16.1 mm and 21.9% had involved excisional margins. Women with adenocarcinoma in situ on any excisional margin were more likely to have residual or recurrent disease (28.7%) compared with negative excisional margins (4.3%). Residual adenocarcinoma in situ was twice as common if adenocarcinoma in situ was present at endocervical (29.6%) and stromal (23.1%) margins compared with an ectocervical margin (13.6%). Cancer incidence at follow-up was 2.3% for women with positive excisional margins compared to 1.3% with negative margins. CONCLUSIONS: Women with adenocarcinoma in situ of cervix can be managed with local excisional procedures, best in single pieces to provide the important information on excisional margins. Adenocarcinoma in situ at endocervical and stromal excisional margins needs re-excision or where appropriate, hysterectomy, while negative excisional margins have a low rate of recurrence and can be followed up with test of cure.


Assuntos
Adenocarcinoma in Situ/cirurgia , Colo do Útero/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Adulto , Austrália , Colo do Útero/patologia , Conização , Eletrocirurgia , Feminino , Humanos , Incidência , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
17.
J Cancer Res Ther ; 16(7): 1569-1574, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33565501

RESUMO

Background: Detection of early-stage lung cancers has increased due to computed tomography (CT). The pathological stages and subtypes of early lung cancer determine the treatment strategy. We aimed to investigate the correlation between CT characteristics and pathological status in early lung adenocarcinoma (ADC). Subjects and Methods: Between June 2018 and December 2019, 415 consecutive patients who underwent surgery for lung ADC with pathological atypical adenomatous hyperplasia (AAH) and ADC in situ (AIS), T1a (mi) N0M0, and T1a-cN0M0 were analyzed. The relationship between CT imaging and pathological status was investigated using Chi-squared or Kruskal-Wallis test and binary logistic regression. Results: When cases of AAH, AIS, and T1a (mi) N0M0 were used as the control group, the lesion size, solid component ratio (SCR), and spiculation were significantly and independently associated with T1a-cN0M0 (P < 0.01). SCR >50% (P < 0.01) and spiculation (P < 0.05) were significantly and independently associated with T1aN0M0. In cases of pathological T1a-cN0M0, SCR >50% was significantly different between adherent wall growth ADC and mucinous ADC (P < 0.01). Conclusions: Some CT characteristics are related to the pathological stage and subtypes of early lung ADC. Larger diameter, spiculation, and SCR >50% are associated with invasive ADC. SCR >50% is positively correlated with mucinous ADC and negatively with adherent growth ADC.


Assuntos
Adenocarcinoma in Situ/diagnóstico , Adenocarcinoma de Pulmão/diagnóstico , Neoplasias Pulmonares/diagnóstico , Pneumonectomia/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adenocarcinoma in Situ/patologia , Adenocarcinoma in Situ/cirurgia , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/cirurgia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/estatística & dados numéricos
18.
Eur J Obstet Gynecol Reprod Biol ; 240: 273-277, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352128

RESUMO

OBJECTIVE: to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice. METHODS: the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I-VI) and letters (A-E). RESULTS: Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1-1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20-25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B). CONCLUSION: the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.


Assuntos
Adenocarcinoma in Situ/cirurgia , Colo do Útero/cirurgia , Colposcopia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma in Situ/patologia , Colo do Útero/patologia , Feminino , Humanos , Neoplasias do Colo do Útero/patologia
20.
J Cancer Res Ther ; 15(1): 164-168, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880774

RESUMO

Background: Radiofrequency ablation (RF) is already a viable alternative to surgical resection for focal liver tumors treatment. The use of RF ablation in combination with surgery or chemotherapy and the large panel of RF tools need new experimental models to develop new opportunities for this kind of therapy. Purpose: The purpose of this study was to identify the optimal RF parameters that will allow in situ colic cancer liver metastases destruction with minimal secondary effects. Materials and Methods: The CC531s colic cancer tumor cells were used to induce liver metastases in 30 synergic Wag/Rij rats. When metastases reached at least 1 cm in diameter, RF generator RITA 1500X, and expandable tip RF probe Starburst SDE (Angiodynamics, USA) was used for the RF ablation. The animal survival rate and the RF-induced lesions have been studied, while only the generator delivered power has been modified (90W, 20W, and 10W, respectively). Results: Survival was significantly low in the group with 90W-delivered power RF. Moreover, statistically significant differences were revealed between groups with high and low RF power, regarding the morphological changes of the liver parenchyma and the adjacent organs, without significant difference on the RF therapeutically effect. Conclusions: In an experimental setting, an increased RF generator power induces important lesions of the abdominal organs with subsequently important mortality rate, without improving the RF therapeutic efficiency.


Assuntos
Adenocarcinoma in Situ/cirurgia , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/cirurgia , Ablação por Radiofrequência/métodos , Adenocarcinoma in Situ/mortalidade , Animais , Linhagem Celular Tumoral/transplante , Modelos Animais de Doenças , Humanos , Fígado/patologia , Fígado/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Masculino , Ablação por Radiofrequência/efeitos adversos , Ratos , Taxa de Sobrevida , Resultado do Tratamento
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