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1.
BJOG ; 127(1): 99-105, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31502397

RESUMO

OBJECTIVE: To evaluate if the intraoperative human papillomavirus (IOP-HPV) test has the same prognostic value as the HPV test performed at 6 months after treatment of high-grade squamous intraepithelial lesion (HSIL) to predict treatment failure. DESIGN: Prospective cohort study. SETTING: Barcelona, Spain. POPULATION: A cohort of 216 women diagnosed with HSIL and treated with loop electrosurgical excision procedure (LEEP). METHODS: After LEEP, an HPV test was performed using the Hybrid Capture 2 system. If this was positive, genotyping was performed with the CLART HPV2 technique. The IOP-HPV test was compared with HPV test at 6 months and with surgical margins. MAIN OUTCOME MEASURE: Treatment failure. RESULTS: Recurrence rate of HSIL was 6%. There was a strong association between a positive IOP-HPV test, a positive 6-month HPV test, positive HPV 16 genotype, positive surgical margins and HSIL recurrence. Sensitivity, specificity, and positive and negative predictive values of the IOP-HPV test were 85.7, 80.8,24.0 and 98.8% and of the HPV test at 6 months were 76.9, 75.8, 17.2 and 98.0%. CONCLUSION: Intraoperative HPV test accurately predicts treatment failure in women with cervical intraepithelial neoplasia grade 2/3. This new approach may allow early identification of patients with recurrent disease, which will not delay the treatment. Genotyping could be useful in detecting high-risk patients. TWEETABLE ABSTRACT: IOP-HPV test accurately predicts treatment failure in women with CIN 2/3.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Detecção Precoce de Câncer/métodos , Eletrocirurgia , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/cirurgia , Adulto , Alphapapillomavirus , Biomarcadores Tumorais/metabolismo , Neoplasia Intraepitelial Cervical/virologia , Colposcopia/estatística & dados numéricos , Feminino , Genótipo , Testes de DNA para Papilomavírus Humano/métodos , Humanos , Biópsia Guiada por Imagem , Cuidados Intraoperatórios/métodos , Recidiva Local de Neoplasia/virologia , Estudos Prospectivos , Sensibilidade e Especificidade , Falha de Tratamento , Neoplasias do Colo do Útero/virologia
2.
BJOG ; 127(1): 88-97, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31544327

RESUMO

OBJECTIVE: To assess the short-term incidence of serious complications of surgery for urinary incontinence or pelvic organ prolapse. DESIGN: Prospective longitudinal cohort study using a surgical registry. SETTING: Thirteen public hospitals in France. POPULATION: A cohort of 1873 women undergoing surgery between February 2017 and August 2018. METHODS: Preliminary analysis of serious complications after a mean follow-up of 7 months (0-18 months), according to type of surgery. Surgeons reported procedures and complications, which were verified by the hospitals' information systems. MAIN OUTCOME MEASURES: Serious complication requiring discontinuation of the procedure or subsequent surgical intervention, life-threatening complication requiring resuscitation, or death. RESULTS: Fifty-two women (2.8%, 95% CI 2.1-3.6%) experienced a serious complication either during surgery, requiring the discontinuation of the procedure, or during the first months of follow-up, necessitating a subsequent reoperation. One woman also required resuscitation; no women died. Of 811 midurethral slings (MUSs), 11 were removed in part or totally (1.4%, 0.7-2.3%), as were two of 391 transvaginal meshes (0.5%, 0.1-1.6%), and four of 611 laparoscopically placed mesh implants (0.7%, 0.2-1.5%). The incidence of serious complications 6 months after the surgical procedure was estimated to be around 3.5% (2.0-5.0%) after MUS alone, 7.0% (2.8-11.3%) after MUS with prolapse surgery, 1.7% (0.0-3.8%) after vaginal native tissue repair, 2.8% (0.9-4.6%) after transvaginal mesh, and 1.0% (0.1-1.9%) after laparoscopy with mesh. CONCLUSIONS: Early serious complications are relatively rare. Monitoring must be continued and expanded to assess the long-term risk associated with mesh use and to identify its risk factors. TWEETABLE ABSTRACT: Short-term serious complications are rare after surgery for urinary incontinence or pelvic organ prolapse, even with mesh.


Assuntos
Diafragma da Pelve/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Colposcopia/efeitos adversos , Colposcopia/mortalidade , Colposcopia/estatística & dados numéricos , Feminino , França/epidemiologia , Humanos , Incidência , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/mortalidade , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/mortalidade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Sistema de Registros , Slings Suburetrais/efeitos adversos , Slings Suburetrais/estatística & dados numéricos , Telas Cirúrgicas/estatística & dados numéricos , Centros Cirúrgicos/estatística & dados numéricos , Adulto Jovem
3.
Gynecol Oncol ; 154(2): 360-367, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160073

RESUMO

OBJECTIVES: There is growing interest in using human papillomavirus (HPV) genotyping as a risk-based triage approach for women with atypical squamous cells-undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) cytology. METHODS: This analysis includes 2807 subjects with ASC-US or LSIL cytology, ≥21 years, from the baseline phase of the Onclarity HPV trial. All women were referred to colposcopy/biopsy. Hierarchical-ranked prevalence and risk values, associated with high-grade cervical disease, were calculated based on extended genotyping. RESULTS: HPV 16 carried the highest risk for cervical intraepithelial neoplasia grade 2 or worse (≥CIN2) in both the ASC-US and LSIL populations. Risk of ≥CIN3 and ≥CIN2 associated with the other 13 genotypes varied somewhat for women with ASC-US and LSIL, however, HPV 31, 18, 33/58, 51 and 52 appear to comprise an intermediate risk band. Risk associated with HPV 35/39/68, 45, and 56/59/66, in either cytology population, was relatively low and beneath the benchmark threshold risk for immediate colposcopy. Restricting the analysis to women 21-24 years, ≥25 years, or ≥30 years produced similar results. CONCLUSIONS: HPV genotyping identified multiple risk bands for ≥CIN3 and ≥CIN2 in the ≥21 year-old ASC-US and LSIL populations. These results support a 1-year follow-up period to preclude immediate colposcopy for ASC-US or LSIL women positive for the lowest-risk HPV genotypes.


Assuntos
Células Escamosas Atípicas do Colo do Útero/virologia , Programas de Rastreamento/estatística & dados numéricos , Papillomaviridae/genética , Infecções por Papillomavirus/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colposcopia/estatística & dados numéricos , Estudos Transversais , Feminino , Genótipo , Humanos , Programas de Rastreamento/instrumentação , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/genética , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
4.
J Obstet Gynaecol Res ; 45(7): 1260-1267, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977232

RESUMO

AIM: In Cambodia, the Japan Society of Obstetrics and Gynecology and the Cambodian Society of Gynecology and Obstetrics have an on-going project, started in 2015, for cervical cancer prevention and treatment. The project, currently aimed at factory workers, includes a women's health education program that leads into cervical cancer prevention by establishment of a system for early detection and treatment. It begins by health education, screening for human papillomavirus (HPV), followed by colposcopy and quicker treatment of earlier precursor lesions. METHODS: Rates for participant screening, HPV test positivity, cervical intraepithelial neoplasia (CIN) detection and distribution of HPV types were compared between two screening programs, factory-based and hospital-based. Some HPV test samples were divided into two, one of which was sent to Japan for a quality-control check of the Cambodian testing. RESULTS: The factory-based participant screening rate was 19% (128/681). HPV was detected more frequently in the factory-based program participants (12%) than in the hospital-based program participants (5%). Unfortunately, however, the rate of receiving proper secondary colposcopy screening among the HPV-positive females was significantly higher in the hospital-based program (94%) than the factory-based program (40%) (P < 0.001). The Cambodian laboratory HPV testing accuracy was 92.6%. HPV types demonstrated no significant difference between the two prevention programs. CONCLUSION: We could successfully introduce HPV-based screening, starting from health education. However, low rate of screening, especially secondary screening for HPV positive factory workers was identified. Also, HPV testing could be further improved for accuracy through close monitoring.


Assuntos
Detecção Precoce de Câncer/métodos , Ginecologia/métodos , Educação em Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Camboja , Neoplasia Intraepitelial Cervical/prevenção & controle , Neoplasia Intraepitelial Cervical/virologia , Colposcopia/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde , Humanos , Cooperação Internacional , Japão , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Avaliação de Programas e Projetos de Saúde , Sociedades Médicas , Neoplasias do Colo do Útero/virologia
5.
BMJ ; 364: l240, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728133

RESUMO

OBJECTIVE: To provide the first report on the main outcomes from the prevalence and incidence rounds of a large pilot of routine primary high risk human papillomavirus (hrHPV) testing in England, compared with contemporaneous primary liquid based cytology screening. DESIGN: Observational study. SETTING: The English Cervical Screening Programme. PARTICIPANTS: 578 547 women undergoing cervical screening in primary care between May 2013 and December 2014, with follow-up until May 2017; 183 970 (32%) were screened with hrHPV testing. INTERVENTIONS: Routine cervical screening with hrHPV testing with liquid based cytology triage and two early recalls for women who were hrHPV positive and cytology negative, following the national screening age and interval recommendations. MAIN OUTCOME MEASURES: Frequency of referral for a colposcopy; adherence to early recall; and relative detection of cervical intraepithelial neoplasia grade 2 or worse from hrHPV testing compared with liquid based cytology in two consecutive screening rounds. RESULTS: Baseline hrHPV testing and early recall required approximately 80% more colposcopies, (adjusted odds ratio 1.77, 95% confidence interval 1.73 to 1.82), but detected substantially more cervical intraepithelial neoplasia than liquid based cytology (1.49 for cervical intraepithelial neoplasia grade 2 or worse, 1.43 to 1.55; 1.44 for cervical intraepithelial neoplasia grade 3 or worse, 1.36 to 1.51) and for cervical cancer (1.27, 0.99 to 1.63). Attendance at early recall and colposcopy referral were 80% and 95%, respectively. At the incidence screen, the 33 506 women screened with hrHPV testing had substantially less cervical intraepithelial neoplasia grade 3 or worse than the 77 017 women screened with liquid based cytology (0.14, 0.09 to 0.23). CONCLUSIONS: In England, routine primary hrHPV screening increased the detection of cervical intraepithelial neoplasia grade 3 or worse and cervical cancer by approximately 40% and 30%, respectively, compared with liquid based cytology. The very low incidence of cervical intraepithelial neoplasia grade 3 or worse after three years supports extending the screening interval.


Assuntos
Colo do Útero/patologia , Detecção Precoce de Câncer/métodos , Infecções por Papillomavirus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Adulto , Colo do Útero/virologia , Colposcopia/estatística & dados numéricos , Técnicas Citológicas , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Projetos Piloto , Valor Preditivo dos Testes , Prevalência , Medição de Risco/métodos , Doenças do Colo do Útero/virologia , Neoplasias do Colo do Útero
6.
Acta Obstet Gynecol Scand ; 98(6): 737-746, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30687935

RESUMO

INTRODUCTION: The aim of this study was to describe trends in the diagnosis and treatment of women referred from the national screening program with cervical intraepithelial neoplasia (CIN) in the Netherlands, and to compare these trends with national guidelines and identify potential areas for improvement for the new primary high-risk HPV screening program. MATERIAL AND METHODS: We conducted a population-based cohort study using data from the Dutch pathology archive. Women aged 29-63 years who took part in the Dutch cervical screening program between 1 January 2005 and 31 December 2014 were selected. Three referral groups were identified: direct referrals and those referred after either one (first indirect referrals) or two (second indirect referrals) repeat cytology tests, totaling 85 239 referrals for colposcopy. The most invasive management technique and the most severe diagnosis of each screening episode was identified. Rates of management techniques were calculated separately by referral type, highest CIN diagnosis and age group. RESULTS: In all, 85.1% of CIN 3 lesions were treated with excision (either large excision or hysterectomy) and 26.4% of CIN 1 lesions were treated with large excision. Rates of overtreatment (CIN 1 or less) in see-and-treat management were higher for indirect referrals than for direct referrals and increased with age. Large excision rates increased with CIN diagnosis severity. CONCLUSIONS: Despite guideline recommendations not to treat, CIN 1 lesions were treated in just over 25% of cases and approximately 15% of CIN 3 lesions were possibly undertreated. Given the expected increase in CIN detection in the new primary high-risk HPV screening program, reduction in CIN 1 treatment and CIN 2 treatment in younger women is needed to avoid an increase in potential harm.


Assuntos
Neoplasia Intraepitelial Cervical , Colposcopia , Detecção Precoce de Câncer , Infecções por Papillomavirus , Adulto , Neoplasia Intraepitelial Cervical/diagnóstico , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/terapia , Colposcopia/métodos , Colposcopia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Países Baixos/epidemiologia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Encaminhamento e Consulta/estatística & dados numéricos , Procedimentos Desnecessários/métodos , Procedimentos Desnecessários/estatística & dados numéricos
7.
Int J Gynecol Cancer ; 29(1): 23-27, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640679

RESUMO

OBJECTIVE: To evaluate the use of a portable, rechargeable colposcope combined with human papillomavirus (HPV) testing, as compared with HPV testing alone, for screening of cervical cancer and pre-cancerous lesions. METHODS: This was a cross-sectional study among 488 women in Baoshan County, Yunnan. The women underwent HPV testing followed by Gynocular portable colposcopy with visual inspection with acetic acid. Obvious lesions were biopsied. If portable colposcopy testing was negative but HPV testing was positive, the women underwent follow-up testing with thin-prep cytology and traditional colposcopy. Cervical biopsies were performed for any abnormalities. Histopathology was followed up with diagnosis and treatment. RESULTS: Among 488 women screened with portable colposcopy, 24 women underwent biopsy based on positive colposcopy screening. Of these 24 women, three were HPV positive and 21 were HPV negative. Five women had cervical intra-epithelial neoplasia (CIN) I and one had advanced cervical cancer. Forty-six women tested positive for HPV. Three of these women had screened positive on preliminary colposcopy, with one positive for CIN III/squamous cell carcinoma and one woman with CIN I. Forty-three women underwent follow-up testing with thin-prep cytology. Two women had atypical squamous cells of undetermined significance and five had low-grade squamous intra-epithelial lesions and were biopsied; three women had CIN I, one had CIN II and one had CIN III. HPV testing and portable colposcopy was more sensitive but slightly less specific than portable colposcopy or HPV testing alone. CONCLUSION: While HPV testing has high sensitivity and specificity for the detection of pre-cancerous and cancerous lesions and portable colposcopy has lower specificity, both methods of detection have low positive predictive value and high negative predictive value. In tandem, HPV testing and portable colposcopy had higher sensitivity for detection among women who underwent biopsies. In clinical practice, portable colposcopy was an effective, easy and affordable tool to transport to villages where cytology is not currently feasible.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/diagnóstico , Adulto , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasia Intraepitelial Cervical/virologia , China/epidemiologia , Colposcopia/instrumentação , Estudos Transversais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Prognóstico , População Rural , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia
8.
J Low Genit Tract Dis ; 23(2): 110-115, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30694884

RESUMO

OBJECTIVE: The aim of the study was to characterize colposcopy practice and management of women with cervical abnormalities in US community-based clinics. MATERIALS AND METHODS: IMPROVE-COLPO was a 2-arm study of colposcopy patients with an abnormal screening result. The prospective arm recruited women to undergo examination with a commercial digital colposcope. The retrospective-control arm collected data (chart review) from previous colposcopies performed using standard equipment and methods. From the retrospective arm, we analyzed referral trends, colposcopy and biopsy practice, and management patterns. RESULTS: We collected data of 3,602 eligible women (median age = 34 years) that had been examined from 2012 to 2017 by 154 colposcopists at 44 clinics across 12 states. Most patients were premenopausal (87.9%), privately insured (88.2%), and had a low-grade (low-grade squamous intraepithelial lesion/atypical squamous cells of undetermined significance/human papillomavirus positive) indication (87.2%). Most colposcopists performed less than 3 colposcopies monthly and their biopsy rate was 1.47 biopsies/patient for high-grade referrals and 0.97 for low-grade referrals (p < .001). Random biopsy was rare (0.4% of biopsies). Most women (74.9%) underwent endocervical sampling, including 62.5% of women aged 21 to 24 years. Colposcopic impression was frequently not reported (58.8%), and its sensitivity to predict histology-confirmed cervical intraepithelial neoplasia (CIN) 2+ as "high-grade" was 56.5% for high-grade referrals and 23.2% for low-grade referrals. Excisions often (44.5%) returned

Assuntos
Colposcopia/estatística & dados numéricos , Serviços de Saúde Comunitária/estatística & dados numéricos , Gerenciamento Clínico , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/complicações , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Biópsia/estatística & dados numéricos , Colposcopia/métodos , Serviços de Saúde Comunitária/métodos , Estudos Transversais , Feminino , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Estados Unidos , Neoplasias do Colo do Útero/terapia , Adulto Jovem
9.
J Obstet Gynaecol ; 39(2): 184-189, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30257594

RESUMO

The aim of this study was to determine the additional values of multiple cervical biopsies when any colposcopy was performed. We developed a cross-sectional study of 92 women, who had been referred for a colposcopy because of their abnormal cervical cytology. Colposcopy-directed biopsies were taken from lesions and random non-directed biopsies were added, if their directed biopsies were fewer than four in number. The biopsy sites were ranked according to the impression of the clinicians. Among the 92 women, the first biopsy was normal in 29.4%, revealing CIN1 in 28.3% and CIN2+ in 42.3%. In the second and third biopsies, the CIN2+ was found to have increased to 35.8% and 36.8%, respectively. The accumulative sensitivity for detecting CIN2+ was 84.8%, for a single biopsy. This increased to 97.0%, after two biopsies and then to 100%, after three and four biopsies. To conclude, although the taking of the additional biopsies increased the CIN2+ detection, collecting three cervical biopsies might be sufficient. Impact Statement What is already known on this subject? The colposcopy is considered to be the standard procedure in the detection of precancerous lesions of the cervix. However, nowadays, colposcopic biopsy practices do not have any single, acceptable guideline for the number of biopsies performed, and whilst a single biopsy is the most commonly adopted practice, some centres have used a biopsy protocol with multiple biopsies. What the results of this study add? This study determined the rate of the detection of CIN2+ by using multiple biopsy protocols during colposcopy for women who were referred with their abnormal cervical cytology. We explored the benefit of collecting additional lesion-directed biopsies and additional biopsies of a normal-appearing cervix in addition to a single biopsy. We found that two or three biopsies from a colposcopy should be enough for increasing the detection of CIN2+. Also, multiple biopsies increased the sensitivity of CIN2+ detection, especially in colposcopic impression for the low grade lesions. What the implications are of these findings for clinical practice and/or further research? We suggest that colposcopy-directed biopsies should be supplied by one or two random biopsies from other quadrants of the cervix.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biópsia/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
10.
Int J Cancer ; 144(6): 1460-1473, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30353911

RESUMO

Little is known about the effect of evolving risk-based cervical cancer screening and management guidelines on United States (US) clinical practice and patient outcomes. We describe the National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR I) consortium, methods and baseline findings from its cervical sites: Kaiser Permanente Washington, Kaiser Permanente Northern California, Kaiser Permanente Southern California, Parkland Health & Hospital System/University of Texas Southwestern (Parkland-UTSW) and New Mexico HPV Pap Registry housed by University of New Mexico (UNM-NMHPVPR). Across these diverse healthcare settings, we collected data on human papillomavirus (HPV) vaccinations, screening tests/results, diagnostic and treatment procedures/results and cancer diagnoses on nearly 4.7 million women aged 18-89 years from 2010 to 2014. We calculated baseline (2012 for UNM-NMHPVPR; 2010 for other sites) frequencies for sociodemographics, cervical cancer risk factors and key screening process measures for each site's cohort. Healthcare delivery settings, cervical cancer screening strategy, race/ethnicity and insurance status varied among sites. The proportion of women receiving a Pap test during the baseline year was similar across sites (26.1-36.1%). Most high-risk HPV tests were performed either reflexively or as cotests, and utilization pattern varied by site. Prevalence of colposcopy or biopsy was higher at Parkland-UTSW (3.6%) than other sites (1.3-1.4%). Incident cervical cancer was rare. HPV vaccination among age-eligible women not already immunized was modest across sites (0.1-7.2%). Cervical PROSPR I makes available high-quality, multilevel, longitudinal screening process data from a large and diverse cohort of women to evaluate and improve the effectiveness of US cervical cancer screening delivery.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/estatística & dados numéricos , Colo do Útero/diagnóstico por imagem , Colo do Útero/patologia , Estudos de Coortes , Colposcopia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Estudos Longitudinais , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
11.
Womens Health Issues ; 29(1): 38-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30401612

RESUMO

BACKGROUND: Although preventive measures have greatly decreased the national burden of cervical cancer, racial/ethnic and geographic disparities remain, including the disproportionate incidence and mortality among African American women in the Mississippi Delta. Along with structural barriers, health perceptions and cultural beliefs influence participation in cervical screening. This study examined perceived susceptibility to cervical cancer among African American women in the Delta across three groups: 1) women attending screening appointments (screened), 2) women attending colposcopy clinic following an abnormal Papanicolaou test (colposcopy), and 3) women with no screening in 3 years or longer (unscreened/underscreened). METHODS: Data were collected during a study assessing the feasibility/acceptability of self-collected sampling for human papillomavirus (HPV) testing as a cervical screening modality. A questionnaire assessed demographics, health care access, and cervical cancer knowledge and beliefs (including perceived susceptibility). Participants were asked, "Do you think you are at risk for cervical cancer?", and responses included yes, no, and I don't know. Multinomial logistic regression models compared variables associated with answers among each group. RESULTS: Of 524 participants, one-half did not know if they were at risk of cervical cancer (50%) or HPV exposure (53%). Between the unscreened/underscreened (n = 160), screened (n = 198), and colposcopy (n = 166) groups, age (p < .001), education (p = .02), and perceived risk of HPV exposure (p < .01) differed. Older age and younger age at first intercourse (unscreened/underscreened), family history and screening recommendations (screened), and family history and perceived risk of HPV exposure (colposcopy) were associated with perceived susceptibility to cervical cancer. CONCLUSIONS: Differences in the perceived susceptibility to cervical cancer exist between African American women in the Delta. Understanding these variations can help in developing strategies to promote screening among this population with a high burden of disease.


Assuntos
Suscetibilidade a Doenças/etnologia , Detecção Precoce de Câncer/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Infecções por Papillomavirus/etnologia , Neoplasias do Colo do Útero/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Colposcopia/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Mississippi/etnologia , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Cooperação do Paciente/etnologia , Gravidez , Fatores de Risco , Inquéritos e Questionários , Neoplasias do Colo do Útero/etiologia
12.
J Obstet Gynaecol Can ; 40(11): 1401-1408, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30477637

RESUMO

OBJECTIVE: This study seeks to identify barriers to colposcopy examination faced by patients living in Northern BC to improve outcomes for women at risk of developing cervical cancer. METHODS: A retrospective chart review (n = 309) was conducted in the four colposcopy clinics in Northern BC to collect information regarding patients who were referred for colposcopy after abnormal cytology. Demographic factors associated with non-attendance were identified as barriers to accessing care. Aggregate data from the Cervical Cancer Screening Program (n = 4265) were used to calculate wait times by health region across BC. RESULTS: The odds of having missed an appointment was highest for women who were pregnant (OR 4.0) or attending site D vs. site A (OR 6.0); however, only clinic location remained significant in a multivariable model. Wait times were longer for women who had ever missed appointments, and varied among the sites, with site A and D having significantly longer wait times than the remaining sites. The Northern Health Authority had the longest overall median colposcopy wait time for high-grade cytology in the province at 41 days longer than the provincial average of 62 days. CONCLUSION: The Northern Health Authority faces unique challenges associated with geography and patient population that are associated with longer wait times for colposcopy when compared with other health authorities in the province.


Assuntos
Colposcopia/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Displasia do Colo do Útero/diagnóstico , Adulto , Colúmbia Britânica/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Serviços de Saúde Rural , Adulto Jovem
13.
Rev. esp. patol ; 51(3): 147-153, jul.-sept. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179069

RESUMO

Objetivo: Determinar la concordancia entre citología, colposcopia y biopsia cervical ante una citología alterada. Material y métodos: Se realizó un estudio observacional transversal, de base clínica, en un único centro. La población seleccionada consistió en 416 mujeres, de entre 25 y 65 años, con citología alterada, del 1 de agosto de 2014 al 30 de septiembre de 2016, y remitidas para estudio colposcópico y anatomopatológico al Hospital Reina Sofía de Córdoba. Se realizaron análisis estadísticos, utilizando el índice de Kappa para el grado de concordancia entre citología, colposcopia y biopsia. Resultados: Se encontró una concordancia insignificante entre citología y colposcopia (k=0,16; IC 95% 0,09-0,22); una concordancia moderada entre colposcopia y biopsia (k=0,57; IC 95% 0,47-0,68); y una concordancia insignificante entre citología y biopsia (k=0,21; IC 95% 0,08-0,34). Conclusiones: El grado de acuerdo fue mejor entre colposcopia y biopsia que entre citología y biopsia o entre citología y colposcopia


Objective: To determine the concordance between cytology, colposcopy and cervical biopsy in abnormal cytologies. Material and methods: An observational cross-sectional, clinically based, single center study was performed. The selected population consisted of 416 women between the ages of 25 and 65 who had undergone colposcopy for abnormal cytologies at the Reina Sofía Hospital, Córdoba, between August 1st, 2014, and September 30th, 2016. Statistical analysis was performed using the Kappa index for the degree of concordance between cytology, colposcopy and biopsy. Results: There was an insignificant concordance between cytology and colposcopy (k=0.16; 95% CI 0.09-0.22), a moderate concordance between colposcopy and biopsy (k=0.57; 95% CI 0.47-0.68) and an insignificant concordance between cytology and biopsy (k=0.21 (95% CI 0.08-0.34). Conclusions: Better concordance was found between colposcopy and biopsy than between either cytology and biopsy or cytology and colposcopy


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Colposcopia/estatística & dados numéricos , Neoplasias do Colo do Útero/patologia , Histologia/estatística & dados numéricos , Biópsia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Estudos Transversais , Sensibilidade e Especificidade , Programas de Rastreamento/estatística & dados numéricos
14.
Eur J Obstet Gynecol Reprod Biol ; 229: 76-81, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30118992

RESUMO

OBJECTIVE: To investigate the reliability of colposcopy during pregnancy and to evaluate the concordance between colposcopic patterns and histopathological findings in these women. STUDY DESIGN: Multicenter observational study of women diagnosed with an abnormal cervical cytology, who subsequently underwent a colposcopic evaluation with cervical biopsy during pregnancy. The "colpo-histopathological concordance‿ was evaluated. The "colposcopic overestimation and underestimation‿ were evaluated as well. RESULTS: 69 women, fulfilling the study inclusion/exclusion criteria, constituted the study cohort. Among them, on colposcopic examination, 14 women (20.3%) showed "grade I abnormal colposcopic findings‿, 52 (75.4%) showed "grade II abnormal colposcopic findings‿ and the remaining 3 women (4.3%) had a "suspicious for invasion‿ colposcopy. The histopathological diagnosis showed 2 negative biopsies, 12 (17.4%) cases of CIN1, 50 (72.5%) cases of CIN2 and 5 (7.2%) cases of invasive cervical cancer. We found a colposcopic overestimation in 10 cases (14.5%), underestimation in 12 cases (17.4%), and a concordance in 47 cases (68.1%). A better reliability of colposcopy in women in the firsts two trimesters and in particular in women ≤20 weeks pregnant was found (Cohen's weighted kappa: 0.65). CONCLUSIONS: When performed by gynecologists with expertise, colposcopy is a reliable diagnostic tool, even during pregnancy. Whenever possible, a colposcopic evaluation during the first half of pregnancy is preferable.


Assuntos
Carcinoma/diagnóstico , Colposcopia/estatística & dados numéricos , Complicações Neoplásicas na Gravidez/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Carcinoma/patologia , Colo do Útero/patologia , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/patologia , Adulto Jovem
15.
JAMA ; 320(7): 706-714, 2018 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-30140882

RESUMO

Importance: Evidence on the relative benefits and harms of primary high-risk human papillomavirus (hrHPV) testing is needed to inform guidelines. Objective: To inform the US Preventive Services Task Force by modeling the benefits and harms of various cervical cancer screening strategies. Design, Setting, and Participants: Microsimulation model of a hypothetical cohort of women initiating screening at age 21 years. Exposures: Screening with cytology, hrHPV testing, and cytology and hrHPV cotesting, varying age to switch from cytology to hrHPV testing or cotesting (25, 27, 30 years), rescreening interval (3, 5 years), and triage options for hrHPV-positive results (16/18 genotype, cytology testing). Current guidelines-based screening strategies comprised cytology alone every 3 years starting at age 21 years, with or without a switch to cytology and hrHPV cotesting every 5 years from ages 30 to 65 years. Complete adherence for all 19 strategies was assumed. Main Outcomes and Measures: Lifetime number of tests, colposcopies, disease detection, false-positive results, cancer cases and deaths, life-years, and efficiency ratios expressing the trade-off of harms (ie, colposcopies, tests) vs benefits (life-years gained, cancer cases averted). Efficient strategies were those that yielded more benefit and less harm than another strategy or a lower harm to benefit ratio than a strategy with less harms. Results: Compared with no screening, all modeled cervical cancer screening strategies were estimated to result in substantial reductions in cancer cases and deaths and gains in life-years. The effectiveness of screening across the different strategies was estimated to be similar, with primary hrHPV-based and alternative cotesting strategies having slightly higher effectiveness and greater harms than current guidelines-based cytology testing. For example, cervical cancer deaths associated with the guidelines-based strategies ranged from 0.30 to 0.76 deaths per 1000 women, whereas new strategies involving primary hrHPV testing or cotesting were associated with fewer cervical cancer deaths, ranging from 0.23 to 0.29 deaths per 1000 women. In all analyses, primary hrHPV testing strategies occurring at 5-year intervals were efficient. For example, 5-year primary hrHPV testing (cytology triage) based on switching from cytology to hrHPV screening at ages 30 years, 27 years, and 25 years had ratios per life-year gained of 73, 143, and 195 colposcopies, respectively. In contrast, strategies involving 3-year hrHPV testing had much higher ratios, ranging from 2188 to 3822 colposcopies per life-year gained. In most analyses, strategies involving cotesting were not efficient. Conclusions and Relevance: In this microsimulation modeling study, it was estimated that primary hrHPV screening may represent a reasonable balance of harms and benefits when performed every 5 years. Switching from cytology to hrHPV testing at age 30 years yielded the most efficient harm to benefit ratio when using colposcopy as a proxy for harms.


Assuntos
Técnicas de Apoio para a Decisão , Detecção Precoce de Câncer , Papillomaviridae/isolamento & purificação , Guias de Prática Clínica como Assunto , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal , Adulto , Comitês Consultivos , Idoso , Colo do Útero/patologia , Colo do Útero/virologia , Colposcopia/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Incidência , Expectativa de Vida , Programas de Rastreamento , Pessoa de Meia-Idade , Estados Unidos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Adulto Jovem
16.
J Gynecol Oncol ; 29(4): e55, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29770625

RESUMO

OBJECTIVE: To investigate the progression risk of atypical squamous cells of undetermined significance (ASCUS) with different clinical managements. METHODS: Women with their first diagnosis of ASCUS cytology were retrieved from the national cervical cancer screening database and linked to the national health insurance research database to identify the management of these women. The incidences of developing cervical intraepithelial neoplasia grade 3 and invasive cervical cancer (CIN3+) were calculated, and the hazard ratios (HRs) were estimated using a Cox proportional hazards model. This study was approved by the Research Ethics Committee of the National Taiwan University Hospital and is registered at ClinicalTrials.gov (Identifier: NCT02063152). RESULTS: There were total 69,741 women included. Various management strategies including colposcopy, cervical biopsies and/or endocervical curettage, and cryotherapy, failed to reduce the risk of subsequent CIN3+ compared with repeat cervical smears. Loop electrosurgical excision procedure/conization significantly decreased risk of subsequent CIN3+ lesions (HR=0.22; 95% confidence interval [CI]=0.07-0.68; p=0.010). Women in their 40s-50s had an approximately 30% risk reduction compared to other age groups. Women with a previous screening history >5 years from the present ASCUS diagnosis were at increased risk for CIN3+ (HR=1.24; 95% CI=1.03-1.49; p=0.020). CONCLUSION: In women of first-time ASCUS cytology, a program of repeat cytology can be an acceptable clinical option in low-resource settings. Caution should be taken especially in women with remote cervical screening history more than 5 years.


Assuntos
Células Escamosas Atípicas do Colo do Útero/citologia , Neoplasia Intraepitelial Cervical/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Distribuição por Idade , Idoso , Biópsia/estatística & dados numéricos , Neoplasia Intraepitelial Cervical/diagnóstico , Estudos de Coortes , Colposcopia/estatística & dados numéricos , Conização/estatística & dados numéricos , Crioterapia/estatística & dados numéricos , Detecção Precoce de Câncer , Feminino , Humanos , Incidência , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Gradação de Tumores , Teste de Papanicolaou/estatística & dados numéricos , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/terapia , Vigilância da População , Modelos de Riscos Proporcionais , Medição de Risco , Taiwan/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Adulto Jovem
17.
Medicine (Baltimore) ; 97(1): e9560, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29505536

RESUMO

After treatment for cervical intraepithelial neoplasia (CIN), in the UK women who are cytology-negative, high-risk (HR) human papilloma virus (HPV) positive are referred to colposcopy. This pilot study assessed the incidence of residual/recurrent CIN and the diagnostic accuracy of colposcopy with dynamic spectral imaging (DSI) mapping in their detection.This was a prospective service evaluation carried out in a UK National Health Service (NHS) colposcopy clinic. All women, referred with negative cytology/HR-HPV positive result following treatment for CIN from March 2013 until November 2014, who were examined with the DSI digital colposcope were included. We excluded 3 cases because of poor-quality imaging from user errors. Everyday clinical practice was followed. Initial colposcopic impression, DSI map indication, and biopsy site selections were recorded. CIN2+ was considered the primary outcome and CIN of any grade a secondary outcome.A total of 105 women were included of which 5 (4.8%) had CIN2+ histology and 24 (22.9%) had CIN1. Pre-DSI map colposcopy suggested normal/low grade in all 5 of the CIN2+ cases and DSI suggested high-grade (HG) CIN in 4 of the 5 cases. Sensitivity of standard colposcopy for CIN2+ was 0%, improving to 80% with the incorporation of the DSI map.The CIN burden in this population is higher than previously expected. Colposcopic identification of HG CIN appears to improve significantly with DSI in this cohort leading to refinement in patient management. A larger, multicentric prospective study (DySIS colposcopy 2) is planned to confirm these initial findings.


Assuntos
Neoplasia Intraepitelial Cervical/diagnóstico , Colposcopia/estatística & dados numéricos , Recidiva Local de Neoplasia/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Neoplasia Intraepitelial Cervical/cirurgia , Neoplasia Intraepitelial Cervical/virologia , Colposcopia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/virologia , Papillomaviridae , Projetos Piloto , Estudos Prospectivos , Análise Espectral , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/virologia
18.
J Low Genit Tract Dis ; 22(2): 97-103, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29570564

RESUMO

OBJECTIVE: To inform impending postcolposcopy guidelines, this analysis examined the subsequent risk of CIN 3+ among women with a grade lower than CIN 2 (< CIN 2) colposcopy results, taking into account the referring results that brought them to colposcopy and cotest results postcolposcopy. METHODS: We analyzed 107,005 women from 25 to 65 years old, recommended for colposcopy at Kaiser Permanente Northern California. We estimated absolute risks of CIN 3+ among women: (1) recommended for colposcopy (precolposcopy), (2) following colposcopy and with histology results < CIN 2 (postcolposcopy), and (3) with cotest results 12 months after a < CIN 2 colposcopy (return cotest). RESULTS: After colposcopy showing < CIN 2 (n = 69,790; 87% of the women at colposcopy), the 1-year risk of CIN 3+ was 1.2%, compared with 6.3% at the time of colposcopy recommendation. Negative cotest results 1 year after colposcopy identified a large group (37.1%) of women whose risk of CIN 3+ (i.e., <0.2% at 3 years after postcolposcopy cotest) was comparable with women with normal cytology in the screening population. These risks are consistent with current guidelines recommending repeat cotesting 12 months after colposcopy < CIN 2 and a 3-year return for women with a negative postcolposcopy cotest. CONCLUSIONS: Most women are at low risk of subsequent CIN 3+ after a colposcopy showing < CIN 2, especially those who are human papillomavirus-negative postcolposcopy, consistent with current management guidelines for repeat testing intervals. Before the finalizing the upcoming guidelines, we will consider additional rounds of postcolposcopy cotesting.


Assuntos
Neoplasia Intraepitelial Cervical/patologia , Colposcopia/estatística & dados numéricos , Lesões Pré-Cancerosas/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , California , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Infecções por Papillomavirus/complicações , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/virologia , Medição de Risco , Fatores de Risco , Neoplasias do Colo do Útero/virologia
19.
J Low Genit Tract Dis ; 22(2): 110-114, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29474235

RESUMO

OBJECTIVE: In United Kingdom., test of cure after treatment of any grade of cervical intraepithelial neoplasia (CIN) incorporates high-risk human papillomavirus (Hr-HPV) test and cytology at 6-month follow-up. The aims of the study were to determine the rate of recurrent CIN in women who are Hr-HPV positive and cytology negative and to explore possible associated risk factors. METHODS: A retrospective observational cohort study was performed in women treated for any grade CIN between 2010 and 2015 from a regional population, who were Hr-HPV positive and cytology negative at first follow-up. RESULTS: A total of 2729 women were identified as treated for any grade CIN, and 213 (7.8%) were re-referred to colposcopy having Hr-HPV-positive test and negative cytology at test of cure. Their mean age was 31.56 years (range = 19-62 years). The mean time of follow-up per woman was 30.50 months (range = 2-63 months). At colposcopy, 171 (80.3%) had colposcopy examination only and 42 women (19.7%) had a biopsy. Twenty-four cases (11.3%) of CIN were identified of which 4 (1.9%) were CIN 2/3. Eleven women (5.2%) in total had a repeat treatment. Five women (2.3%) had biopsy-proven CIN 2/3 within 12-months after treatment. No cases of CIN 3+ after negative colposcopy were identified during the follow-up period. CONCLUSIONS: The incorporation of Hr-HPV testing yielded a very small number of women with residual CIN within 12 months of treatment. Our results suggest that women who are Hr-HPV positive and cytology negative after treatment of CIN with normal and adequate colposcopy could be discharged to routine recall if confirmed by larger national data.


Assuntos
Neoplasia Intraepitelial Cervical/patologia , Neoplasia Intraepitelial Cervical/terapia , Colposcopia/estatística & dados numéricos , Papillomaviridae/isolamento & purificação , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Reino Unido , Neoplasias do Colo do Útero/virologia , Adulto Jovem
20.
Int Urogynecol J ; 29(10): 1537-1542, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29464301

RESUMO

INTRODUCTION AND HYPOTHESIS: Resident involvement in complex surgeries is under scrutiny with increasing attention paid to health care efficiency and quality. Outcomes of urogynecological surgery with resident involvement are poorly described. We hypothesized that resident surgical involvement does not influence perioperative outcomes in minimally invasive abdominal sacrocolpopexy (ASC). METHODS: Using the 2006-2012 National Surgical Quality Improvement Program database, we identified 450 cases of laparoscopic or robotic ASC performed with resident involvement. Resident operative participation was stratified by experience (junior [PGY 1-3] vs senior level [PGY ≥4]). The primary outcome was operative time, and multinomial logistic regression was used to determine the effects of resident involvement and experience. Chi-squared analyses were used to assess the relationship between resident participation with length of stay (LOS) and 30-day complications and readmissions. RESULTS: Residents participated in 74% (n = 334) of these surgeries, and these cases were significantly longer (median 220 vs 195 min, p = 0.03). On multivariate analysis, senior level resident involvement was associated with longer operative times across all time intervals compared with <2 h (2 to ≤4 h relative risk reduction [RRR] 4.1, p = 0.007, CI 1.47-11.40; 4 to ≤6 h RRR 6.6, p = 0.001, CI 2.23-19.44; ≥6 h RRR 4.7, p = 0.020, CI 1.28-17.43). Resident participation was not associated with LOS, readmissions, or complications. CONCLUSIONS: Senior level resident involvement in minimally invasive ASC is associated with longer operative times, with no association with LOS or adverse perioperative outcomes. The educational benefit of surgical training does not adversely affect patient outcomes for ASC.


Assuntos
Competência Clínica/estatística & dados numéricos , Colposcopia/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Abdome/cirurgia , Colposcopia/métodos , Colposcopia/normas , Bases de Dados Factuais , Feminino , Humanos , Laparoscopia/métodos , Laparoscopia/normas , Tempo de Internação , Modelos Logísticos , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Sacro/cirurgia , Resultado do Tratamento
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