Fabiana Resende Rodrigues

The occurrence of cervical high-grade lesions in women outside the recommended age screening

This study aimed to assess the prevalence of cervical High-Grade Squamous Intraepithelial Lesions (HSIL) in women outside the screening age recommended by the Brazilian Guidelines for Cervical Cancer Screening (under 25 and over 64 years old). The cross-sectional study was conducted at a reference hospital in Rio de Janeiro with a histopathological report of CIN 2 + from January 2010 to December 2020 through the analysis of medical records. Among 406 women diagnosed with Cervical Intraepithelial Neoplasia (CIN) 2+, 63 patients (15.5%) were outside the recommended screening age, 17(4.2%) of whom were under the age of 25, and 46 (11.3%) were older than 64 years. CIN 2 was most prevalent in women under 25 years old (29.4%); CIN 3 in those between 25 and 64 years old (55.1%); and invasive cancer predominated in women over 64 years old, with statistical significance (<0.001). The higher frequency of CIN 2 in young women under 25 years old supports the transient nature of these lesions, reinforcing that screening this age group may lead to unnecessary treatment. Conversely, the detection of high-grade lesions and cancer in older women is a consequence of inadequate screening earlier in life.

Association of Swede Score and 2011 IFCPC Nomenclature in Women with Abnormal Cytology

Abstract Objective To assess the association between two colposcopic indices, the Swede score and the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Nomenclature as well as to determine the efficacy of the Swede score with cutoffs of 7 and 8. Methods In the present cross-sectional pilot study, 34 women who had at least 1 colposcopy-directed biopsy due to abnormal cytology were enrolled. The colposcopic findings were scored by both the Swede score and the 2011 IFCPC Nomenclature and were compared with each other. The Kappa coefficient and the McNemar test were used. Accuracy, sensitivity, specificity, and positive and negative predictive values (NPV and PPV, respectively) were calculated, as well as the effectiveness with cutoffs of 7 and 8 in identifying cervical intraepithelial neoplasm (CIN) 2+ when using the Swede score. Results The correlation between the 2 colposcopic indices was 79.41%. The Kappa coefficient and the McNemar p-value were 0.55 and 0.37, respectively. The IFCPC Nomenclature had sensitivity, specificity, accuracy, PPV, and NPV of 85.71, 55.00, 67.64, 57.14, and 84.61%, respectively. The Swede score had sensitivity, specificity, accuracy, PPV, and NPV of 100, 63.15, 79.41, 68.18, and 100%, respectively. A Swede score cutoff of 7 for CIN 2+ detection had a specificity of 94.73%, while with a cutoff of 8 it increased to 100%. The sensitivity for both values was 60%. The PPV and NPV for cutoffs of 7 and 8 were 90 and 75 and 100 and 76%, respectively. Conclusion Although both colposcopic indices have good reproducibility, the Swede score showed greater accuracy, sensitivity, and specificity in identifying CIN 2 + , especially when using a cutoff of 8.

Human epidermal growth factor receptor 2 and proliferation Ki-67 biomarkers using a tissue microarray to refine the histopathological subtyping of hydatidiform moles: Limitations and prognostic value

The morphology-based differential diagnosis of Hydatidiform Mole (HM) of the Complete (CHM) and Partial (PHM) types is challenging because of earlier diagnosis of HM owing to the universal application of ultrasound during antenatal care. HMs may present with amplified oncogenes or other gene mutations, resulting in recurrent or neoplastic disease. The cell proliferation markers Ki-67 and HER2 may contribute to the final HM subtype and prognosis. Much is known about the basic mechanisms of HM development; however, other molecular diagnostic and predictive markers need to be investigated. This was an ambispective anatomopathological study of 108 HMs cases. A tissue microarray was used for Ki-67 or HER2 immunostaining analysis. Associations between immunomarker scores and postmolar Gestational Trophoblastic Neoplasia (GTN) were analyzed via Fisher's exact and linear-by-linear association tests. A statistically significant trend toward increased Ki-67 immunostaining in CHM samples was observed. Seventeen HM patients developed GTN, of whom 6 (35 %) had a Ki-67 score of 3+ and 9 (53 %) had Ki-67 score of 2+. Two (12 %) HM patients had a HER2 score of 3+, and 4 (23 %) HM patients had a HER2 score of 2+, of whom 2 (12 %) patients exhibited oncogene amplification by FISH HER2. Ki-67 and HER2 markers may be useful for the diagnosis and prediction of HM development, providing alternative targeted therapies. This study needs to be interpreted with caution due to its small sample size, high sample exclusion rate, and the absence of significant associations between biomarkers and clinical outcomes.