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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.
Prog. obstet. ginecol. (Ed. impr.) ; 63(1): 23-28, ene.-feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197729

RESUMO

La técnica de la conización es un procedimiento muy empleado actualmente para el tratamiento de lesiones neoplasicas del cuello uterino; sin embargo, en la literatura sigue existiendo controversia acerca de cuál es el mejor método analgésico para su realización. OBJETIVO: conocer el grado de satisfacción y tolerancia al dolor de las pacientes sometidas a conizaciones ambulatorias utilizando anestesia intracervical. MATERIAL Y MÉTODOS: se llevó a cabo un estudio observacional de 55 conizaciones realizadas en nuestro centro; los criterios de inclusión fueron todas aquellas pacientes candidatas a una conización ambulatoria. Se hicieron un total de cuatro cuestionarios: dos a las pacientes y otros dos a los médicos que intervinieron en el procedimiento, uno el día de la conización y otro en la consulta de revisión. RESULTADOS: la mayoría de las pacientes definieron el dolor durante la intervención como tolerable o inferior, siendo la duración del dolor posquirúrgico muy escasa. El grado de satisfacción tanto de las pacientes como de los profesionales al realizar la técnica fue muy bueno. El sangrado posquirúrgico se limitó a la primera semana en la mayoría, lo que se correlaciona con una buena cicatrización objetivada en la revisión, sin que esto supusiera una disminución del tamaño del cono obtenido. CONCLUSIONES: la conización ambulatoria con la aplicación de anestesia local intracervical como método de analgesia es una técnica catalogada como de fácil aplicación por los profesionales y con muy buena colaboración y tolerancia por parte de las pacientes


The conization technique is a procedure currently used to treat neoplastic lesions of the cervix; however, in the literature there is still controversy about which is the best analgesic method for its realization. OBJECTIVE: To determine the degree of satisfaction and pain tolerance of patients undergoing ambulatory conization using intracervical anesthesia. MATERIAL AND METHODS: An observational study of 55 conizations made in our center was carried out; the inclusion criteria were all those patients who were candidates for ambulatory conization. A total of four questionnaires were made: Two to the patients and another two to the doctors who took part in the procedure, one on the day of the conization and the other one in the review consultation. RESULTS: The majority of the patients defined the pain during the intervention as tolerable or inferior, the duration of the postsurgical pain being very scarce. The degree of satisfaction of both the patients and the professionals when performing the technique was very good. Postsurgical bleeding was limited to the first week in the majority, which correlates with a good healing objectified in the review, without this implying a decrease in the size of the cone obtained. CONCLUSIONS: Ambulatory conization with the application of intracervical local anesthesia as an analgesic method is a technique cataloged as easy to apply by professionals and with very good collaboration and tolerance on the part of patients


Assuntos
Humanos , Feminino , Conização/métodos , Anestesia Local/métodos , Satisfação do Paciente , Colo do Útero/patologia , Neoplasia Intraepitelial Cervical/cirurgia , Procedimentos Cirúrgicos Ambulatórios , Anestésicos Locais/administração & dosagem , Inquéritos e Questionários , Dor Pós-Operatória , Midazolam/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Ibuprofeno/uso terapêutico , Analgésicos não Entorpecentes/uso terapêutico , Cuidados Pré-Operatórios
3.
Int J Gynaecol Obstet ; 148(3): 316-324, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31814122

RESUMO

OBJECTIVE: To analyze the relationship between large loop excision of the transformation zone (LLETZ) depth and the persistence of disease and human papillomavirus (HPV) infection in patients with cervical intraepithelial neoplasia grades 2 and 3. METHODS: A cross-sectional observational retrospective study included women with cervical intraepithelial neoplasia grades 2 and 3 who underwent LLETZ at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 1, 2011, to December 31, 2016. Follow-up of cytology and HPV detection were performed at 6 and 12-18 months after surgery. RESULTS: In this study of 256 women, multivariate analysis revealed that conization depth of 10 mm or less did not indicate an increase of persistence/recurrence of pathological cytology at 6 months (P=0.094) and after 12-18 months (P=0.234), or infection by HPV at 6 months (P=0.675) and 12-18 months (P=0.938) after LLETZ. The affected endocervical margin at 6 months is the sole independent risk factor for persistence, both in the lesion (P=0.003) and HPV (P=0.004). CONCLUSION: Conization depth lower than 10 mm at LLETZ did not increase disease persistence or infection by HPV in an 18 month monitoring period. Therefore, higher depth conizations would not be justified to ensure favorable oncological results.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Diatermia/métodos , Traquelectomia/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Neoplasia Intraepitelial Cervical/patologia , Conização/métodos , Estudos Transversais , Feminino , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Infecções por Papillomavirus/virologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias do Colo do Útero/patologia , Adulto Jovem
4.
BMJ Open ; 9(8): e028008, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31377697

RESUMO

INTRODUCTION: Local treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications. METHODS AND ANALYSIS: Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool. ETHICS AND DISSEMINATION: Ethical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public. PROSPERO REGISTRATION NUMBER: CRD42018115508.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Neoplasias do Colo do Útero/cirurgia , Neoplasia Intraepitelial Cervical/patologia , Conização/métodos , Criocirurgia , Feminino , Humanos , Terapia a Laser/métodos , Gradação de Tumores , Recidiva Local de Neoplasia , Neoplasia Residual , Metanálise em Rede , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Falha de Tratamento , Neoplasias do Colo do Útero/patologia
5.
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
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
8.
J Cell Physiol ; 234(9): 14975-14990, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30790275

RESUMO

Cervical cancer is one of the most common gynecological malignancies diagnosed during pregnancy although, fortunately, it is a rare event. In majority of cases, the management of cervical cancer in pregnant women is not different from nonpregnant women and prognosis seems not compromised by pregnancy. The association between cancer and pregnancy appears to be a significant challenge for women and specialists and the decisions about therapy must be individualized and taken by a multidisciplinary team. This review is focused on cervical cancer in pregnancy. The aim is to discuss the diagnosis, potential biomarkers and molecular aspects, therapeutic approaches, and prognosis from intraepithelial cervical neoplasia to invasive cervical cancer (early and advanced stages) in different gestational ages. We provide an overview of the current literature regarding the treatment strategies of concurrent pregnancy and cervical cancer cases and we propose some clinical advices to help clinicians to manage this condition. A mention about the effects of the conservative therapy (as conization) on fertility, the human papillomavirus vaccine in pregnant women and our center's experience with obstetrical and oncological outcomes are reported.


Assuntos
Neoplasia Intraepitelial Cervical/patologia , Fertilidade/fisiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasia Intraepitelial Cervical/diagnóstico , Conização/métodos , Feminino , Idade Gestacional , Humanos , Gravidez , Prognóstico
9.
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
10.
Arch Gynecol Obstet ; 299(3): 847-855, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30607592

RESUMO

PURPOSE: Annual cervical cancer screening is recommended in Germany as a part of the statutory preventive care. Abnormal results can provoke psychological distress and anxiety, compromising women's adherence. Little is known about how a cervical dysplasia impacts adherence follow-up visits and prevention habits over time. To optimize care strategies, this study aims to identify women at risk for nonadherence to follow-up visits after a screening event. METHODS: Between November 2015 and May 2017, participants with an abnormal Pap smear at the Heidelberg and Leipzig University Hospitals received a four-part questionnaire (sociodemographic data, PHQ-D, self-designed fear and prevention habit questions) at the first consultation (T1) and subsequently after 3 (T2) and 6 (T3) months; healthy controls completed the questionnaire at T1. RESULTS: 132 women with an abnormal Pap smear [with conization: S1 (n = 68, 51.5%), without intervention: S2 (n = 64, 48.5%)] and healthy controls (K, n = 101) generally adhered to gynecological checkups, except S1 6 months after the first diagnosis (S1/T3 - 0.47, signed rank p < 0.0005). Knowledge of primary prevention information, i.e., HPV vaccination, was significantly higher among K (K 58%, S1 29%, S2 44%, Chi-squared p = 0.01) as was vaccine uptake (K 39% versus S1/S2 7% and 17%, respectively, Chi-squared p = 0.0004). Fear of upcoming Pap smears rose significantly over time (S1/T1-S1/T2-S1/T3, Wilcoxon signed-rank test p < 0.001) and was higher among those with conization at T2 (Chi-square test, p = 0.01) and partially accompanied by panic disorders at T1 (Chi-square test p = 0.035). Realization of general preventive habits rose significantly among women without an operative procedure (S2) over the study. CONCLUSION: This study advances the understanding of non-participation in follow-up visits after a dysplasia diagnosis, identifying post-conization women as a special risk group for decreased adherence.


Assuntos
Conização/métodos , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
12.
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
13.
Acad Radiol ; 26(8): 1040-1047, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30385207

RESUMO

RATIONALE AND OBJECTIVES: To investigate the value of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in combination with conventional MRI in identifying the residual tumor after biopsy for early cervical carcinoma. MATERIALS AND METHODS: Eighty patients with histologically proven early cervical carcinoma were enrolled into this study. MRI sequences included two sets of MRI sequences including conventional MRI (T1WI, T2WI, and dynamic contrast-enhanced MRI) and IVIM DWI/conventional MRI combinations. The patients were classified into residual tumor and nonresidual tumor group after biopsy. IVIM parameters were quantitatively analyzed and compared between two groups. The diagnostic ability of two sets of MRI sequences were calculated and compared. RESULTS: The mean D and f values were significantly lower in residual tumor group than in nonresidual tumor group (p < 0.05). The areas under receiver operating characteristic curves of D and f for discriminating between residual tumor and nonresidual tumor group were 0.848 and 0.767, respectively. The sensitivity and accuracy of conventional MRI/IVIM DWI combinations for the detection of residual tumor were 82.7% and 83.8%, respectively, while the sensitivity and accuracy of conventional MRI were 52.4% and 53.8%, respectively. CONCLUSION: The addition of IVIM DWI to conventional MRI considerably improves the sensitivity and accuracy of the detection of residual tumor after biopsy for early cervical carcinoma.


Assuntos
Biópsia/métodos , Carcinoma , Colo do Útero/patologia , Conização , Imagem de Difusão por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Neoplasia Residual/diagnóstico por imagem , Neoplasias do Colo do Útero , Carcinoma/patologia , Carcinoma/cirurgia , Conização/efeitos adversos , Conização/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
14.
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
15.
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
16.
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
17.
Med Sci Monit ; 24: 9063-9072, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547901

RESUMO

BACKGROUND This study was conducted to observe the influence of different time intervals between prior cervical conization and posterior hysterectomy on postoperative infection in female patients with cervical intraepithelial neoplasia or cancer. MATERIAL AND METHODS Medical records of 170 patients who underwent hysterectomy following cervical conization between November 2010 and September 2016 at the Zhenjiang 4th Hospital were reviewed. According to the interval between hysterectomy and cervical conization, patients were classified into 1-2-week, 4-5-week, and 6-week groups. The outcomes of 46 patients who underwent conization with iodoform gauze inside the vagina were observed. RESULTS The total postoperative infection rate after hysterectomy was 25.3% (43/170). The expression levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and high mobility group box 1 (HMGB1) in the cervical secretions and tissues were found to gradually increase, peaking at 2 weeks after conization, then significantly decreasing 3-6 weeks onwards. Compared with the 1-2-week group, the 4-5-week and 6-week groups exhibited significantly lower infection rates (2/42, 4.8%, 4-5-week group; 0%, 0/33, 6-week group; vs. 41/95, 43.2%, 1-2-week group; p<0.001). In the 1-2-week group in particular, the postoperative infection rate after laparoscopic hysterectomy was significantly higher than the rate after abdominal hysterectomy (21/35, 60% vs. 20/60, 33%, p=0.0177). In addition, the vaginal and cervical wound infection rates after conization in patients treated with iodoform were significantly lower than the rates in those without iodoform treatment (p<0.05). CONCLUSIONS Hysterectomy should be performed at least 4 weeks after conization. Treatment with iodoform would be beneficial.


Assuntos
Colo do Útero/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Neoplasia Intraepitelial Cervical/cirurgia , Colo do Útero/citologia , China , Conização/métodos , Feminino , Proteína HMGB1/análise , Hospitais , Humanos , Hidrocarbonetos Iodados/farmacologia , Histerectomia/métodos , Interleucina-6/análise , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/análise , Neoplasias do Colo do Útero/cirurgia , Vagina/cirurgia
18.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 45(4): 146-150, oct.-dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180045

RESUMO

Objetivo: Analizar los resultados obstétricos en mujeres con antecedente de tratamiento escisional de cérvix y si existen diferencias en los mismos según la técnica de conización empleada: LEEP (procedimiento de escisión cervical con asa de diatermia) o LLETZ (escisión de la zona de transformación [TZ] con asa de diatermia). Material y métodos: Estudio observacional retrospectivo en el que se han incluido las conizaciones realizadas entre 2007 y 2014 y las siguientes variables: edad materna, paridad, tabaquismo, parto, aborto, intervalo entre la conización y el parto, tipo de parto, rotura prematura de membranas pretérmino (RPMP), edad gestacional y peso del recién nacido. Grupo control: 100 pacientes que habían quedado gestantes en el mismo periodo de tiempo. Resultados: Cincuenta y tres (7,9%) pacientes quedaron gestantes tras la conización, de estas 4(7,5%) abortaron y 49(92,5%) tuvieron un parto. Se observó mayor tasa de prematuridad (18 vs. 8%, p=0,049) y de RPMP (22,4 vs. 3%, p=0,001) en el grupo de conización. En relación a la técnica empleada, hubo más casos de prematuridad en el grupo de LEEP frente al de LLETZ (25 vs. 10,5%), RR=1,7 (IC 95%:1,1-2,9), no encontrando diferencias en cuanto a la RPMP y el bajo peso. Por otro lado, también se observó mayor proporción de cesárea en el grupo de conización frente al control (38,8 vs. 20%) (57%-LEEP vs. 5,3%-LLETZ, p=0,013). Discusión: Es importante hacer un manejo conservador en mujeres con deseos genésicos y lesiones cervicales premalignas y seleccionar correctamente a las pacientes candidatas a conización. Cuando se utilizó LEEP los resultados obstétricos (en términos de prematuridad y RPMP) son peores frente a las gestantes en las que se realizó LLETZ


Objective: The aim of our study was to analyse the obstetric outcomes in women with a history of excisional treatment for cervical intraepithelial neoplasia and whether there were differences according to the methods of treatment used (loop electrosurgical excision procedure [LEEP] vs. large loop excision of the transformation zone [LLETZ]). Material and methods: A retrospective cohort study was conducted on patients who underwent conization between 2007 and 2014. Outcome measures included maternal age, parity, smoking, childbirth, abortion, interval between conization and delivery, mode of delivery, preterm prelabour rupture of the membranes (PPROM), gestational age and birth weight. A group of 100 patients who had been pregnant during the same period was used as a control group. Results: 53 (7.9%) patients became pregnant after conization, resulting in 4 (7.5%) miscarriages and 49 (92.5%) deliveries. Increased rate of preterm deliveries (18 vs. 8%, p=.048) and PPROM (22.4 vs. 3%, p=.001) was observed in the conization group. According to technique used, there were more cases of prematurity in the LEEP group against LLETZ (25 vs. 10.5%), RR=1.7 (95% CI: 1.1-2.9), no differences were found in PPROM and low weight. On the other hand, a higher proportion of caesareans was also observed in the conization group versus the control group (38.8 vs. 20%) (57%: LEEP vs. 5.3%: LLETZ, p=.013). Discussion: Conservative management and appropriate selection of candidates for conization are important in women with premalignant cervical lesions who wish to become pregnant. Worse results were observed in LEEP group (preterm delivery and PPROM) compared to women who underwent LLETZ


Assuntos
Humanos , Feminino , Adulto , Neoplasias do Colo do Útero/cirurgia , Conização/métodos , Diatermia/métodos , Estudos Retrospectivos , Estudos de Coortes , Conização/estatística & dados numéricos , Diatermia/estatística & dados numéricos , Idade Gestacional , Neoplasias do Colo do Útero/epidemiologia
19.
Medicine (Baltimore) ; 97(41): e12640, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313051

RESUMO

The incidence of cervical intraepithelial neoplasia(CIN) among reproductive-aged women has increased in Japan. Cervical conization is commonly applied for local cervical treatment to preserve fertility. The Shimodaira-Taniguchi (S-T) conization procedure is widely used in Japan. S-T conization uses a high-frequency current and a triangular probe with a linear excision electrode to remove cervical tissue as a single informative specimen. However, alternative of an electrosurgical scalpel (ES) has the advantage of adjusting the surgical margin to the transformation zone in order to preserve the maximum amount of healthy cervical tissue with good hemostasis. The aim of this study is to retrospectively analyze data regarding surgical margin status, perioperative adverse events, cervical stenosis, and preterm birth between S-T and ES.Between January 2009 and December 2014, the medical records of 1166 patients who were diagnosed as CIN II, III, or stage 1a1 cervical cancer and who were treated with conization in 7 hospitals in Gunma Prefecture, Japan were enrolled for this retrospective study. The clinicopathological data was analyzed to statistically compare outcome between S-T and ES conization.There was no difference for age or post-operative follow-up period between ES and S-T treatments. However, positive surgical margins were significantly less frequent in patients who were treated with S-T than in those treated with ES, resulting in a reduced incidence of re-treatment for S-T in comparison with ES patients. In perioperative adverse events, S-T had more patients who were administered antibiotics. The incidence of preterm delivery and cervical stenosis did not differ significantly between the groups.We demonstrate here that S-T is an alternative procedure for cervical conization with a low risk of recurrence and acceptably low rate of adverse events such as cervical stenosis and preterm delivery. The results of this study can provide useful information for future management of patient with cervical intraepithelial neoplasia.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/métodos , Neoplasias do Colo do Útero/cirurgia , Adulto , Neoplasia Intraepitelial Cervical/patologia , Conização/efeitos adversos , Constrição Patológica , Feminino , Número de Gestações , Humanos , Margens de Excisão , Estadiamento de Neoplasias , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Fumar/epidemiologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
20.
BMC Pregnancy Childbirth ; 18(1): 277, 2018 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-29970019

RESUMO

BACKGROUND: The aim of this study was to determine the effect of cerclage in women who underwent cervical conization. METHODS: Study data were collected from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service for 2009-2013. Women who had a conization in 2009 and a subsequent first delivery between 2009 and 2013 in Korea were enrolled. RESULTS: Among the women who had conization in 2009, 1075 women had their first delivery between 2009 and 2013. A cerclage was placed in 161 of the women who were treated by conization. The rate of preterm birth was higher in the women who were treated with cerclage following a conization compared with those without cerclage (10.56 vs 4.27, p < 0.01, respectively). The multivariate regression analysis revealed that the women who were treated cerclage following a conization had an increased risk of preterm delivery compared with women without cerclage (odds ratio (OR), 2.6, 95% confidence interval (CI), 1.4-4.9). CONCLUSION: Our study showed that cerclage associated with an increased risk of preterm birth and preterm premature rupture of membranes in women who underwent conization. Further studies are required to clarify the mechanism by which cerclage affects the risk of preterm birth.


Assuntos
Cerclagem Cervical , Colo do Útero , Conização , Ruptura Prematura de Membranas Fetais/prevenção & controle , Trabalho de Parto Prematuro , Nascimento Prematuro , Adulto , Cerclagem Cervical/efeitos adversos , Cerclagem Cervical/métodos , Cerclagem Cervical/estatística & dados numéricos , Colo do Útero/patologia , Colo do Útero/cirurgia , Conização/efeitos adversos , Conização/métodos , Conização/estatística & dados numéricos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Humanos , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Trabalho de Parto Prematuro/prevenção & controle , Gravidez , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Gestão de Riscos
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