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1.
Rev Saude Publica ; 54: 27, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32187314

RESUMO

OBJECTIVES: To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS: Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS: The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS: The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/métodos , Crioterapia/métodos , Eletrocoagulação/métodos , Neoplasias do Colo do Útero/cirurgia , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Risco , Fatores de Risco , Neoplasias do Colo do Útero/patologia
2.
J Exp Ther Oncol ; 13(2): 165-167, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31881134

RESUMO

Objective: Cervical carcinosarcomas (Malignant Mixed Mullerian Tumour [MMMT] ) are very rare neoplasms. Fewer than 100 cases were documented until recently. Because of the rarity, etiologic factors, prognosis and treatment modalities are unclear. A 53 year-old woman presented with postmenauposal vaginal bleeding and abnormal cervical cytology. Cervical biopsy followed by loop electrosurgical excision procedure (LEEP) and cold knife conisation (CKC) was documented as cervical intraepithelial neoplasia III (CIN III). Without follow-up, two years later, the patient was referred with a cervical 6,5 cm mass invading vagina, parametriums and rectum. Biopsy was reported as cervical carcinosarcoma with squmous carcinoma and homologous sarcoma component. Neoadjuvant chemotherapy provided partial response. Subsequently external beam whole pelvis radiotherapy with chemotherapy and brachytherapy was applied. In despite of the treatment, the patient developed sistemic recurrence and died of disease within 10 months. In previous reports most of the patients were in early stage and had better prognosis than uterine carcinosarcomas. Here in we present a case who had a history of high-grade cervical displasia and presented at advanced stage, managed with neoadjuvant chemotherapy and definitive chemoradiotherapy.


Assuntos
Carcinossarcoma , Neoplasia Intraepitelial Cervical , Neoplasias do Colo do Útero , Carcinossarcoma/diagnóstico , Conização , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias do Colo do Útero/diagnóstico
3.
Zhonghua Fu Chan Ke Za Zhi ; 54(6): 393-398, 2019 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-31262123

RESUMO

Objective: To analyze the performance of colposcopy and investigate the diagnosis and treatment characteristics of high-grade squamous intraepithelial lesion (HSIL) diagnosed by cervical tissue sampling in post-menopausal women. Methods: A retrospective study was performed on 1 449 patients with HSIL diagnosed by cervical tissue sampling under colposcopy and treated by loop electrosurgical excision procedure (LEEP) or extrafascial hysterectomy as the primary therapy at the First Affiliated Hospital of Nanjing Medical University, from November 2015 to October 2017. In order to investigate the diagnosis and treatment of HSIL in post-menopausal women, a case-control study was conducted to compare the difference in performance of colposcopy and treatment modality between 213 post-menopausal patients (14.7%, 213/1 449) and 1 236 pre-menopausal patients (85.3%, 1 236/1 449). Results: (1)The proportion of cases pathologically upgraded to cervical cancer was significantly greater in post-menopausal patients (9.4%, 20/213) compared with pre-menopausal patients (3.8%, 47/1 236; P<0.05). (2) The proportion of ≥HSIL diagnosed by colposcopy showed no significant difference between post-menopausal patients (76.1%, 162/213) and pre-menopausal patients (78.2%, 967/1 236; P=0.479). The proportion of type Ⅲ transformation zone (TZ) was significantly greater in post-menopausal patients (91.1%, 194/213) compared with pre-menopausal patients (59.1%, 731/1 236; P<0.05). The rate of missed diagnosis of cervical cancer was significantly higher in type Ⅲ TZ (6.4%, 59/925) compared with type Ⅰ and(or) Ⅱ TZ (1.5%, 8/524; P<0.05). The proportion of HSIL detected by endocervical curettage alone was greater in post-menopausal patients (9.9%, 21/213) compared with pre-menopausal patients (2.6%, 32/1 236; P<0.05). (3)Initial treatment with LEEP: the positive rate of endocervical margin was significantly greater in post-menopausal patients (20.5%, 36/176) compared with pre-menopausal patients (10.5%, 130/1 236;P<0.05); in patients who were diagnosed as HSIL after LEEP, the positive rate of endocervical margin and the residual rate were both greater in post-menopausal patients compared with pre-menopausal patients [15.4% (25/162) versus 8.8% (105/1 189), P=0.008; 52.0% (13/25) versus 26.7% (28/105), P=0.014]. (4)Thirty-seven post-menopausal patients were treated by extrafascial hysterectomy as the primary therapy, 5 cases (13.5%, 5/37) were diagnosed as cervical cancer (stage Ⅰa1) after the surgery. Conclusions: (1) The lesions of HSIL in post-menopausal patients still have definite features under colposcopy as same as pre-menopausal patients. Endocervical curettage could help detect more HSIL in post-menopausal patients. Compared with pre-menopausal patients, post-menopausal HSIL patients have an increased risk of cervical cancer and are more likely missed by cervical tissue sampling. (2) LEEP has the dual effects of diagnosis and treatment, and is still the recommended treatment for post-menopausal HSIL patients. However, the increase in positive rate of endocervical margin and residual rate requires further active intervention. (3) Considering those post-menopausal HSIL patients who cannot accept conization as the initial treatment, the selection of hysterectomy type requires more thorough study.


Assuntos
Colo do Útero/patologia , Conização/métodos , Eletrocirurgia/métodos , Pós-Menopausa , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/terapia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Idoso , Estudos de Casos e Controles , Colposcopia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos
5.
PLoS One ; 14(6): e0217562, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163055

RESUMO

BACKGROUND: We aimed to determine demographic and clinicopathological predictors for residual disease in women with cervical intraepithelial neoplasia (CIN 2/3) with endocervical cone margin involvement. METHODS AND FINDINGS: A cross-sectional study was conducted. The eligible patients were women who underwent hysterectomy as a treatment option after having a positive endocervical margin for CIN 2/3 in cervix conization specimens from 2000 to 2015. The patients were divided into two groups based on the persistence of CIN 2/3 and absence of CIN 2/3 in hysterectomy specimens. Demographic, clinical and histology information were collected in both groups. A total of 80 patients were eligible for the study; 37 (46.3%) had no persistence of CIN 2/3 and 43 (53.7%) had persistence of CIN 2/3 in the hysterectomy specimens. Demographic, clinical, and cone specimen characteristics, and a visible squamocolumnar junction and type of conization were analyzed as possible risk factors for the presence of residual lesions at hysterectomy, and none of these variables were associated with residual disease. Menopausal status was strongly associated with a high risk of persistent residual disease 81.2% (OR 4.9, CI 1.27-18.9), P = 0.014. In the multivariate analysis, only a menopausal status (P = 0.04) was associated with a high risk of persistent lesions. CONCLUSION: This analysis found that menopausal status exhibited an important association with persistent residual disease. Menopausal women with endocervical margin involvement exhibit a greater than 80% risk of persistent lesions.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/efeitos adversos , Margens de Excisão , Menopausa/fisiologia , Neoplasia Residual/etiologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Feminino , Humanos , Histerectomia , Modelos Logísticos , Pessoa de Meia-Idade , Fatores de Risco
6.
Gynecol Oncol ; 154(1): 89-94, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31000470

RESUMO

OBJECTIVE: To evaluate the long-term outcomes of young early stage cervical cancer patients wishing to preserve their childbearing potential. METHODS: Data of young (aged <40 years) patients with early stage cervical cancer were prospectively collected. All patients with stage IA2, IB1 and IB2 cervical cancer were included; they have cervical conization and pelvic node dissection performed via minimally invasive surgery. Survival outcomes were assessed with the Kaplan-Meier model. RESULTS: Overall, 32 patients met the inclusion criteria. Mean (SD) age of the population included was 33 (±4). According to the FIGO 2018 staging system, the stage of disease was IA2, IB1 and IB2 in 9 (28%), 21 (66%) and 2 (6%) cases, respectively. All patients included had cervical conization and laparoscopic pelvic node assessment, including systematic pelvic lymphadenectomy (N = 30, 94%) and sentinel node mapping (N = 2, 6%). In six (19%) patients the planned conservative treatment was discontinued. Median follow-up was 75 (range, 12-184) months. No recurrent disease was diagnosed among patients undergoing conservative treatment; while 2 out of 6 patients having definitive surgical or radiotherapy treatments developed recurrent disease. Five-year disease free and overall survivals were 94% and 97%, respectively. Considering reproductive outcomes, 11 (69%) out of 16 patients who attempted to conceive got pregnant. CONCLUSIONS: Cervical conization and pelvic nodes assessment could be considered a valid treatment modality for early-stage cervical cancer patients who are wishing to preserve their childbearing potential.


Assuntos
Preservação da Fertilidade/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Conização/métodos , Feminino , Humanos , Excisão de Linfonodo/métodos , Estadiamento de Neoplasias , Gravidez , Resultado da Gravidez , Resultado do Tratamento , Neoplasias do Colo do Útero/patologia
7.
Eur J Obstet Gynecol Reprod Biol ; 236: 210-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30922526

RESUMO

OBJECTIVE: To evaluate the relationships between excisional treatment for high-grade cervical intra-epithelial neoplasia (CIN2+) and obstetric outcomes in terms of preterm delivery risk, premature rupture of membrane (PROM) and type of delivery, and between pre-term delivery and the type of excisional technique (radio frequency excision, laser conization). METHODS: This was a retrospective study of the obstetric outcomes of 2316 women aged 25-45 years who underwent excisional treatment for CIN2+ at the Obstetric and Gynecological Clinic of Ospedale Maggiore della Carità in Novara and at the Obstetric and Gynecological Department of Ospedale Sant'Anna in Torino in the period 2005-2014 and were evaluated until April 2016, and 57,937 untreated women of the same age, from the same centers. RESULTS: After treatment, 320 women had at least one pregnancy leading to delivery after a mean of 3.35 years. Treatment significantly increased the risk of preterm delivery. Compared with no treatment, the risk of preterm birth was higher in women who had undergone treatment (33.13% vs. 6.60%). Techniques removing or ablating more tissue, such as large loop excision of the transformation zone, were associated with worse outcomes (OR 2.96, 95% IC 1.72-5.10). Smoking habits significantly increase the risk of preterm delivery in the treated women (OR 2.82, 95% IC 1.61-4.9). The risk of premature rupture of the membranes (PROM) (40% vs. 23.22%), the risk of preterm PROM (pPROM) (13.13% vs. 2.71%) and dystocic births (18.75% vs 4.48%) were also significantly increased after treatment. Caesarean sections were less frequent among the treated women (15.94% vs. 32.41%). CONCLUSIONS: Our findings reveal a relationship between cervical excisional treatment and pre-term delivery, PROM, and the method of delivery. In order to minimise risk and guarantee the best obstetric outcome, patient treatment and follow-up should be personalised.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/efeitos adversos , Ruptura Prematura de Membranas Fetais/etiologia , Terapia a Laser/efeitos adversos , Nascimento Prematuro/etiologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Resultado do Tratamento
8.
J Gynecol Oncol ; 30(3): e37, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887758

RESUMO

OBJECTIVE: The purpose of this study was to assess the incidence rate of cervical intraepithelial neoplasia (CIN) and cervical cancer, and their costs according to age. METHODS: We collected data on annual incidence and medical costs of CIN and cervical cancer from 2010 until the end of 2014 from the Health Insurance Review and Assessment (HIRA) service. The CIN was classified into CIN3 (high-grade) requiring conization and CIN1/2 (low-grade) requiring observation. RESULTS: Incidence rates of CIN3 and cervical cancer are reducing over time, whereas CIN1/2 is increasing significantly (p for trend: <0.001). The peak ages of incidence were 25-29, 30-34, and 70-74 years old for CIN1/2, CIN3, and cervical cancer, respectively. The crude incidence of CIN1/2 increased by approximately 30% in 2014 compared to 5 years ago and demonstrated an increasing trend in all age groups. The CIN3 showed a significantly increasing trend in the age group of 30-39 years old, the cervical cancer was significantly reduced in all ages, except the 35-39 years old. The treatment for cervical cancer costs $3,342 per year, whereas the treatment for CIN3 and CIN1/2 cost $467 and $83, respectively. CONCLUSION: The crude incidence rate of cervical cancer is currently decreasing among Korean women, but the incidence rates and medical costs of CIN and cervical cancer are increasing in women in their 30s in Korea. These findings suggest that different strategies by age will be required for prevention of cervical cancer in Korea.


Assuntos
Neoplasia Intraepitelial Cervical/economia , Neoplasia Intraepitelial Cervical/epidemiologia , Custos de Cuidados de Saúde , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/economia , Biópsia/estatística & dados numéricos , Neoplasia Intraepitelial Cervical/terapia , Conização/economia , Conização/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Incidência , Pessoa de Meia-Idade , Gradação de Tumores , República da Coreia/epidemiologia , Neoplasias do Colo do Útero/terapia , Conduta Expectante/economia , Conduta Expectante/estatística & dados numéricos , Adulto Jovem
9.
J Gynecol Oncol ; 30(3): e42, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887760

RESUMO

OBJECTIVE: To show noninferiority of a limited-excision (resection of the dysplastic lesion only) vs. classical Large Loop Excision of the Transformation Zone (LLETZ). METHODS: In this prospective, randomized, multicenter trial, women with human papillomavirus (HPV) positive cervical intraepithelial neoplasia grade 3 were randomized into two groups (1:1). Primary outcome was the rate of negative HPV tests after 6 months, secondary outcomes included cone size, complete resection rates as well as cytological and histological results after 6 and 12 months. A sample size of 1,000 was calculated to show noninferiority of the limited-excision compared to the LLETZ group using a noninferiority margin of 5%. Enrollment was stopped after 100 patients due to slow accrual. RESULTS: Patients in the limited-excision group did not show a lower number of negative HPV tests (78% [LLETZ]-80% [limited-excision]=-2%; 90% confidence interval=-15%, 12%). The limited-excision resulted in a substantially lower cone size (LLETZ: 1.97 mL vs. limited-excision: 1.02 mL; p<0.001) but higher numbers of involved margins (LLETZ: 8% vs. limited-excision: 20%). Although postoperative cytological results slightly differed, histological results were similar in both groups. One limited-excision patient received immediate re-conisation, whereas one patient in each group was scheduled for re-conisation after 6 months. CONCLUSION: The limited-excision could represent a promising option to reduce the surgical extent of conisations while maintaining oncological safety. The trial was not sufficiently powered to reach statistical significance due to early termination. Nevertheless, the study provides important insights in the feasibility of a limited-excision and could serve as a pilot study for future trials. TRIAL REGISTRATION: German Clinical Trials Register Identifier: DRKS00006169.


Assuntos
Transformação Celular Viral , Neoplasia Intraepitelial Cervical/patologia , Colo do Útero/cirurgia , Margens de Excisão , Infecções por Papillomavirus/patologia , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Neoplasia Intraepitelial Cervical/virologia , Colo do Útero/patologia , Conização , Estudos de Equivalência como Asunto , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Infecções por Papillomavirus/complicações , Carga Tumoral , Displasia do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem
10.
Gynecol Oncol ; 153(2): 255-258, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30718123

RESUMO

OBJECTIVE: The impact of pathologic features of a cone biopsy on the management of women with early stage cervical cancer is understudied. Our objective was to evaluate the additive value of pathologic features of a cone biopsy toward identifying patients with high risk tumors for which adjuvant therapy may be indicated. METHODS: Patients with early stage cervical cancer undergoing a conization followed by radical hysterectomy from 1995 to 2016 were retrospectively identified. Clinical and pathologic data were abstracted from patient medical records. RESULTS: A total of 115 patients were identified. Based on final pathology, 70.5% were low risk, 10.4% intermediate risk, and 19.1% were high risk. The additive pathologic features of the conization specimen would have reclassified five patients from low into the intermediate risk group. Though depth of invasion did not correlate with final pathology results, when lymphovascular space invasion (LVSI) was present in the conization specimen, 51.2% of patients were noted to meet intermediate/high risk; compared to only 9.5% without LVSI. CONCLUSIONS: In women with early stage cervical cancer, additive pathology of the conization and hysterectomy specimen did not significantly impact risk stratification, only affecting 4.3% of patients. However, presence of LVSI in the conization was associated with intermediate risk criteria in 60% of cases and high risk criteria in 37% of cases. As patients with intermediate/high risk criteria would meet recommendations for adjuvant therapy, the evaluation of LVSI in conization specimens may influence the selection of primary treatment for women with cervical cancer.


Assuntos
Colo do Útero/patologia , Conização , Histerectomia , Seleção de Pacientes , Neoplasias do Colo do Útero/patologia , Adulto , Colo do Útero/cirurgia , Quimiorradioterapia Adjuvante/métodos , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Neoplasias do Colo do Útero/terapia
11.
Asian Pac J Cancer Prev ; 20(2): 417-420, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30803201

RESUMO

Objective: Current guidelines suggest annual co-test follow-up in non-16/18 high-risk HPV positive patients without abnormal cytologic findings. Considering the relatively high false-negative rates of cervical cytology, a follow-up period of one year might constitute an additional risk for development of cervical malignancies in these patients. The current study aims to evaluate colposcopic biopsy results of cytologically normal patients detected to carry high risk HPV by screening tests. Materials and Methods: A total of 160 patients with normal cervical cytology and high-risk HPV subtypes who underwent colposcopic examination were included in the study. Patients were divided into two groups according to their HPV results: HPV 16-18 and other types (non-16/18 high-risk subtypes). ECC, cervical biopsy, LEEP/ conization results were analyzed for both groups. Histopathological results of the groups were compared in terms of ≤LSIL, HSIL and cervical cancer rates. Results: Cervical biopsy results in the "16-18" group were assessed as HSIL in 40 (48.2%) patients, LSIL in 6 patients (7.2%) and normal in 37 (44.6%) patients. ECC results revealed HSIL in 9 (10.8%) patients and LSIL in 1 (1.2%) patient. Nineteen out of 42 patients who underwent LEEP/conization had HSIL (surgical margin positivity was reported in 4 cases), while 3 patients had LSIL. None of the cases had cervical carcinoma. Conclusion: The present study detected that 15.6% of women infected with non-16/18 high-risk HPV subgroups developed ≥HSIL lesions. Although this rate seems lower than HPV 16-18 group, it is still too high to be overlooked. In conclusion, we suggest further clinical trials with larger number of patients to be conducted on this topic.


Assuntos
Colposcopia/métodos , Citodiagnóstico/métodos , DNA Viral/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Biópsia , Conização , Diagnóstico Diferencial , Detecção Precoce de Câncer , Feminino , Seguimentos , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/genética , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal
12.
J Low Genit Tract Dis ; 23(2): 129-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30707116

RESUMO

OBJECTIVE: The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to "see-and-treat" approach, to identify subgroups of patients in which this approach could be more appropriate. MATERIALS AND METHODS: Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue. RESULTS: Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95-25.62, p < .001). CONCLUSIONS: See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.


Assuntos
Colposcopia/métodos , Conização/métodos , Sobremedicalização/estatística & dados numéricos , Lesões Intraepiteliais Escamosas Cervicais/diagnóstico , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Zhonghua Fu Chan Ke Za Zhi ; 54(1): 19-23, 2019 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-30695901

RESUMO

Objective: To investigate the relationship between various loop electrosurgical excision procedure (LEEP) margin status and residual high grade squamous intraepithelial lesion (HSIL) or worse at hysterectomy following conization. Methods: The relevant clinicopathological data were collected in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2014 to Dec. 2015, including 947 cases who underwent hysterectomy within 6 months of LEEP. The residual HSIL or worse at hysterectomy were analyzed among the groups. (1) Clear margins, involved margins, and without 1 mm negative margins. (2) Only one positive margin, two positive margins and three positive margins. (3) A positive margin of internal ostium of cervix, of external ostium of cervix and of the basement. Results: (1) The histological evaluation of the uterine specimens showed residual HSIL or worse in 234 cases (24.7%, 234/947). The proportion of residual lesions was 7.3% (21/286) in population with clear margins, 33.2% (211/635) with involved margins, 7.7% (2/26) without 1 mm negative margins, respectively. The positive margins group had significant difference at the aspect of residual rate in contrast to the negative margins group and the without 1 mm negative margins group (P<0.01). Further studies conclusively showed that the proportion of residual lesions was very similar between the negative margins group and the without 1 mm negative margins group (P>0.05). (2) The involved margins were interpretable in 621 cases. This was detected in 25.3% (111/438) patients with only one positive margin, 47.4% (74/156) with two positive margins and 77.8% (21/27) among three positive margins, respectively (P<0.01). (3) Furthermore, there were 418 cases only one positive margin was definite, and the proportion of residual lesions was 31.0% (62/200) in population with a positive margin of internal ostium of cervix, 18.2% (31/170) of external ostium of cervix and 33.3% (16/48) of the basement. The residual rates were higher in the endocervical and basal margin groups than that in the ectocervical margin group, and the differences were significant (P<0.05). Conclusions: The risk of residual HSIL or worse is significantly greater with involved margins at hysterectomy following LEEP. Both the positive endocervical and basal margin are excellent predictors of residual diseases, while the without 1 mm negative margin may be not. Clinicians should avoid treating it as positive margin and prevent overtreatment.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Eletrocirurgia/métodos , Histerectomia , Neoplasia Residual/patologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Neoplasias do Colo do Útero/cirurgia , Neoplasia Intraepitelial Cervical/patologia , Conização , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Lesões Intraepiteliais Escamosas Cervicais/patologia , Neoplasias do Colo do Útero/patologia
14.
J Low Genit Tract Dis ; 23(1): 43-47, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30260808

RESUMO

OBJECTIVE: The aim of this study was to compare the outcomes associated with the use of a novel monopolar scalpel with those associated with the use of an ultrasonic scalpel for cervical conization of cervical intraepithelial neoplasia. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study in patients treated in our institute between April 2010 and March 2017. We used either the VIO monopolar scalpel (VIO) or Harmonic ultrasonic scalpel (HS) for cervical conization. We analyzed operative outcomes, postoperative complications, and pathological findings associated with the use of the 2 devices. RESULTS: In 500 patients treated with cervical conization, VIO and HS were used in 249 and 251 patients, respectively. No significant difference in patient background was found between the groups. The mean operative time was shorter with VIO than with HS (18.2 min vs. 27.4 min). The mean estimated blood loss was greater with VIO (7.2 g vs. 3.1 g), but the postoperative bleeding rate was higher with HS (5% vs. 20%). Regarding other complications, cervical stenosis was only noted with VIO (4 cases, 1.6%). The positive margin (11% vs. 16%) and positive endocervical curettage rates (7% vs 10%) were not significantly different between the groups. No significant differences were also found in the pathological results and need for additional treatment (the rate of the additional treatment: 20% vs. 23%). CONCLUSIONS: Considering short operating time and less postoperative bleeding, VIO was preferred to HS. However, the excessive coagulation in VIO is considered to lead to cervical stenosis.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/instrumentação , Conização/métodos , Eletrocirurgia/instrumentação , Eletrocirurgia/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Resultado do Tratamento
15.
J Obstet Gynaecol ; 39(1): 74-81, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29884103

RESUMO

To assess the effect of cervical conisation on pregnancy outcome, a literature search strategy was conducted to identify all of the references lists of the relevant studies. The fixed or random effect model was used to calculate pooled RRs on the basis of heterogeneity. Twenty-seven publications with n cases and m controls were included in the meta-analysis. The results showed that conisation was associated with a higher risk of a preterm delivery (p = .010), PROM (p = .008), and a lower birth weight (p < .001) in overall effect. The subgroup analysis showed that CKC was associated with a significantly increased risk of a preterm delivery (p < .001), and a lower birth weight (p< .001). LLETZ was associated with preterm delivery (p = .004) and a lower birth weight (p = .020). The results suggested that cervical conisation increases the risk of a preterm delivery, PROM, and a lower birth weight, especially in a CKC and LLEETZ procedure. Impact statement What is already known on this subject? Currently, the three main excisional procedures for cervical intraepithelial neoplasia (CIN) treatment are laser conisation, cold-knife conisation (CKC), and a large loop excision of the transformation zone (LLETZ). CKC and LEEP/LLETZ were significantly associated with a preterm delivery and low birth weight, and that former was associated with higher relative risks than the latter one. What do the results of this study add? The present results showed that conisation was associated with a higher risk of a preterm delivery, PROM, and a lower birth weight in overall effect. A subgroup analysis showed that CKC was associated with a significantly increased risk of a preterm delivery, and a lower birth weight. LLETZ was associated with a preterm delivery and lower birth weight. What are the implications of these findings for clinical practice and/or further research? This study is of clinical significance by showing that cervical conisation increases the risk of preterm delivery, PROM, and a lower birth weight, especially in a CKC and a LLEETZ procedure.


Assuntos
Colo do Útero/cirurgia , Conização/efeitos adversos , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Estudos de Casos e Controles , Neoplasia Intraepitelial Cervical/cirurgia , Feminino , Humanos , Recém-Nascido de Baixo Peso , Gravidez , Fatores de Risco , Neoplasias do Colo do Útero/cirurgia
16.
Eur J Cancer Prev ; 28(2): 124-130, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29194280

RESUMO

The aim of this study was to assess whether negative psychological consequences of conization reported in questionnaire studies translated into increased use of the healthcare services that could relieve such symptoms. This was a population-based register study comparing women undergoing conization with a control group of women with normal cytology results. Data were derived from Danish registers. Using the difference-in-differences method, we measured contacts with general practitioners (GPs), hospitals, psychiatrist/psychologists, and use of anxiolytic and antidepressant prescription drugs over 5 years 'before' and 'after' the conization in the study group, and in comparable periods in the control group. During the 'before' period, women who later had a conization had greater contact with GPs and hospitals, and slightly more contact with psychiatrist/psychologists, than control women. In both groups, healthcare use increased significantly from the 'before' to the 'after' period. For contacts with GPs and hospitals, the increase was significantly larger for the conization group than for the control group, but this could be attributed to the standard postconization follow-up process. In the 'before' period, women who later had a conization used fewer drugs than women of the control-group, but their drug use increased similarly over time. The conization event did not result in an increased use of the healthcare services that could relieve potential negative side effects. However, women who underwent a conization seemed to constitute a select group as they already used GPs and hospitals more frequently, and anxiolytic and antidepressant drugs less frequently, than other women in the years 'before' the conization event.


Assuntos
Conização/métodos , Assistência à Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Clínicos Gerais , Humanos , Pessoa de Meia-Idade , Prognóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adulto Jovem
17.
Artigo em Inglês | MEDLINE | ID: mdl-30029960

RESUMO

Recent advances in screening and early diagnosis have decreased cervical cancer incidence and mortality rates in high-resource settings. The postponement of childbearing, combined with an increased number of cervical cancer survivors, has yielded new paradigms in patient care. In recent years, radical surgery has been challenged as the standard of care for early-stage cervical cancer owing to its significant morbidity and fertility impairment. Attention has been directed to assessing more conservative procedures that can reduce treatment-induced morbidity without compromising oncologic safety and reproductive potential of patients with early-stage disease. In those with more advanced disease, neoadjuvant chemotherapy followed by conservative surgery has also been considered. These conservative treatment modalities including cervical conization, simple trachelectomy, and simple hysterectomy have been studied in various settings. In this chapter, we discuss the role of conservative surgery in the management of cervical cancer and the resulting obstetrical outcomes.


Assuntos
Colo do Útero/cirurgia , Tratamento Conservador/métodos , Preservação da Fertilidade/métodos , Neoplasias do Colo do Útero/cirurgia , Conização/métodos , Feminino , Humanos , Histerectomia/métodos , Gravidez , Resultado da Gravidez , Resultado do Tratamento
18.
Arch Gynecol Obstet ; 299(1): 167-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30374649

RESUMO

BACKGROUND: Dental and cervical controls are two established screening programs in Germany. Compliance to orthodontic treatment in childhood is essential for dental health and one of the first health interventions that requires adherent behavior; therefore, it may be associated with participation in further screening programs in adulthood. However, it is not yet known whether early orthodontic treatment influences long-term screening adherence. METHODS: Using a questionnaire administered during a visit to a special dysplasia outpatient service, this case-control study evaluated women's personal history of orthodontic care, long-term satisfaction, and dental and gynecological screening adherence. Oral health status and dental anxiety were assessed with validated instruments. Cases were categorized as cervical dysplasia only (S2) or cervical dysplasia with conization (S1) and compared to healthy controls with a normal PAP smear. RESULTS: A study population of 233 participants included 132 cases and 101 controls. The control group had had orthodontic treatment during childhood more often than our study population with abnormal PAP smears (68.3% controls versus 56.1% subjects; p < 0.005). Orthodontic treatment was not associated with attending dental appointment or gynecological check-ups. However, women with an orthodontic treatment in childhood were significantly more often vaccinated against human papillomavirus than women without orthodontic treatment (p < 0.03). CONCLUSION: Data suggest that women with orthodontic treatment in childhood are more conscious about prevention strategies in adulthood; therefore, compliant behavior might be established in childhood.


Assuntos
Colo do Útero/patologia , Programas de Rastreamento/estatística & dados numéricos , Ortodontia/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Displasia do Colo do Útero/patologia , Adulto , Estudos de Casos e Controles , Criança , Conização , Ansiedade ao Tratamento Odontológico , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes , Humanos , Pessoa de Meia-Idade , Saúde Bucal , Inquéritos e Questionários , Displasia do Colo do Útero/epidemiologia , Esfregaço Vaginal/estatística & dados numéricos , Adulto Jovem
20.
J Low Genit Tract Dis ; 23(1): 24-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30371553

RESUMO

OBJECTIVE: The aim of the study was to analyze the clinical outcomes of high-grade squamous intraepithelial lesion (HSIL) 6 months after loop electrosurgical excision procedure (LEEP). We explored the risk factors of persistent cervical HSIL after LEEP and evaluated the methods of follow-up. PATIENTS AND METHODS: This retrospective study included women who underwent a LEEP and had a diagnosis of HSIL in their LEEP specimen during 2011 to 2015. The purpose was to determine the risk factors among these women for having persistent HSIL disease at their 6-month follow-up visit. At their follow-up visit, each woman underwent cervical cytology and high-risk human papilloma virus (hrHPV) testing, colposcopy-directed punch biopsy, and/or endocervical curettage. RESULTS: A total of 3582 women were enrolled. There were 9 cases invasive cervical cancer found and 101 women had persistent HSIL. The persistence rate was higher in women 50 years or older. The circumference, length, and width of LEEP specimens did not differ statistically between the persistent and nonpersistent group. The persistence rate among women with positive LEEP specimen margins was higher than among women with negative margins. Positive endocervical margins were associated with a higher rate of persistence than positive ectocervical margins. Multivariate logistic analysis showed that age, positive margins, abnormal cytology, and positive hrHPV during follow-up were all independent risk factors for persistent HSIL lesions. CONCLUSIONS: Being 50 years or older, positive margins, particularly endocervical margins, and having abnormal cytology and positive hrHPV testing during follow-up were risk factors for persistent HSIL lesions after LEEP conization. Colposcopy plays an indispensable role in the diagnosis of persistent HSIL and progression.


Assuntos
Conização/métodos , Eletrocirurgia/métodos , Lesões Intraepiteliais Escamosas Cervicais/epidemiologia , Lesões Intraepiteliais Escamosas Cervicais/cirurgia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Esfregaço Vaginal
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