Trabalhos Originais Archives - Page 3 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):527-533
DOI 10.1590/S0100-72032004000700004
PURPOSE: to evaluate the diagnostic accuracy of hysterosalpingography (HSG) and transvaginal sonography (TVS) in terms of detecting uterovaginal anomalies in women with a history of recurrent miscarriage. METHODS: eighty patients who presented two or more consecutive miscarriages were submitted to HSG, TVS and hysteroscopy (HSC). The following diagnoses were considered separately: uterine malformations, intrauterine adhesions and polypoid lesions. Hysteroscopy was the gold standard. The matching among the different methods was evaluated by the kappa coefficient and its significance was tested. The significance level was 0.05 (alpha=5%). Sensitivity, specificity, positive and negative predictive values, with 95% of statistical confidence interval, were calculated. RESULTS: uterovaginal anomalies were detected in 29 (36.3%) patients: 11 (13.7%) were uterine malformations, 17 (21.3%) intrauterine adhesions and one (1.3%) a polypoid lesion. The global matching between HSG and HSC was 85.5%, while between TVS and HSC it was only 78.7%. The best accuracy of HSG appeared to be for the diagnosis of uterine malformations and intrauterine adhesions (diagnostic accuracy of 97.5 and 95%, respectively). For the diagnosis of polypoid lesions, HSG had a diagnostic accuracy of only 92.5%, due to the low rate of positive predictive value (14.3%). TVS had a worse accuracy for all diagnoses, 93.7% for the diagnosis of uterine malformations and 85% for intrauterine adhesions, due to low sensitivity. CONCLUSIONS: histerosalpingography showed a good diagnostic accuracy for the diagnosis of uterine cavity diseases. TVS had good specificity, but with low sensitivity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):527-533
DOI 10.1590/S0100-72032004000700004
PURPOSE: to evaluate the diagnostic accuracy of hysterosalpingography (HSG) and transvaginal sonography (TVS) in terms of detecting uterovaginal anomalies in women with a history of recurrent miscarriage. METHODS: eighty patients who presented two or more consecutive miscarriages were submitted to HSG, TVS and hysteroscopy (HSC). The following diagnoses were considered separately: uterine malformations, intrauterine adhesions and polypoid lesions. Hysteroscopy was the gold standard. The matching among the different methods was evaluated by the kappa coefficient and its significance was tested. The significance level was 0.05 (alpha=5%). Sensitivity, specificity, positive and negative predictive values, with 95% of statistical confidence interval, were calculated. RESULTS: uterovaginal anomalies were detected in 29 (36.3%) patients: 11 (13.7%) were uterine malformations, 17 (21.3%) intrauterine adhesions and one (1.3%) a polypoid lesion. The global matching between HSG and HSC was 85.5%, while between TVS and HSC it was only 78.7%. The best accuracy of HSG appeared to be for the diagnosis of uterine malformations and intrauterine adhesions (diagnostic accuracy of 97.5 and 95%, respectively). For the diagnosis of polypoid lesions, HSG had a diagnostic accuracy of only 92.5%, due to the low rate of positive predictive value (14.3%). TVS had a worse accuracy for all diagnoses, 93.7% for the diagnosis of uterine malformations and 85% for intrauterine adhesions, due to low sensitivity. CONCLUSIONS: histerosalpingography showed a good diagnostic accuracy for the diagnosis of uterine cavity diseases. TVS had good specificity, but with low sensitivity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):535-541
DOI 10.1590/S0100-72032004000700005
PURPOSE: to evaluate the validity of transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio in the diagnosis of fetal growth restriction (FGR), determining its best cutoff value and accuracy in symmetric and asymmetric FGR. METHOD: a prospective cross-sectional study, carried out in 250 pregnant women with singleton pregnancies, gestational age between 20 and 42 weeks, with ultrasound confirmation. The TCD measurement was obtained by placing the calipers at the outer margins of the cerebellum, after its localization in the posterior fossa, and slightly rotating the transducer below the plane of the thalami. The abdominal circumference was measured at the on junction of the left portal and umbilical veins. The best TCD/AC cutoff ratio was established by the receiver operator characteristic (ROC) curve. Neonates with TCD/AC ratio greater than the cutoff value were diagnosed as having FGR. We classified as gold standard for FGR the newborn infants who presented birth weight below the 10th percentile. Neonates showing FGR and Rohrer ponderal index between 2.2 and 3 were labeled as symmetric and below 2.2, asymmetric. RESULTS: the cutoff value calculated by the ROC curve for TCD/AC ratio was 16.15. The sensitivity, specificity, accuracy, positive and negative predictive values, and likelihood ratio for positive and negative tests were 77.4, 82.6, 38.7, 96.3, 82, 4.5 and 3.7%, respectively. In the symmetric FGR, sensitivity and specificity were 80.8 and 81.7%, respectively. In the asymmetric FGR, sensitivity and specificity were 60 and 75%, respectively. CONCLUSION: TCD/AC ratio is an effective method in symmetric and asymmetric FGR diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):535-541
DOI 10.1590/S0100-72032004000700005
PURPOSE: to evaluate the validity of transverse cerebellar diameter (TCD)/abdominal circumference (AC) ratio in the diagnosis of fetal growth restriction (FGR), determining its best cutoff value and accuracy in symmetric and asymmetric FGR. METHOD: a prospective cross-sectional study, carried out in 250 pregnant women with singleton pregnancies, gestational age between 20 and 42 weeks, with ultrasound confirmation. The TCD measurement was obtained by placing the calipers at the outer margins of the cerebellum, after its localization in the posterior fossa, and slightly rotating the transducer below the plane of the thalami. The abdominal circumference was measured at the on junction of the left portal and umbilical veins. The best TCD/AC cutoff ratio was established by the receiver operator characteristic (ROC) curve. Neonates with TCD/AC ratio greater than the cutoff value were diagnosed as having FGR. We classified as gold standard for FGR the newborn infants who presented birth weight below the 10th percentile. Neonates showing FGR and Rohrer ponderal index between 2.2 and 3 were labeled as symmetric and below 2.2, asymmetric. RESULTS: the cutoff value calculated by the ROC curve for TCD/AC ratio was 16.15. The sensitivity, specificity, accuracy, positive and negative predictive values, and likelihood ratio for positive and negative tests were 77.4, 82.6, 38.7, 96.3, 82, 4.5 and 3.7%, respectively. In the symmetric FGR, sensitivity and specificity were 80.8 and 81.7%, respectively. In the asymmetric FGR, sensitivity and specificity were 60 and 75%, respectively. CONCLUSION: TCD/AC ratio is an effective method in symmetric and asymmetric FGR diagnosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):551-556
DOI 10.1590/S0100-72032004000700007
PURPOSE: to report three cases of gestational trophoblastic disease with intense hemorrhagic complications, in which exceptional surgical procedures were used to obtain hemostasis. METHODS: the study comprised three patients: the first, a young woman, 27 years old, nullipara, was submitted to total abdominal hysterectomy and, thereafter, to chemotherapy until remission was achieved. Another patient bled from an extensive vaginal metastasis that could only be treated with hypogastric arterial ligation. Definitive sustained remission was obtained after chemotherapy. Two years after the episode, the patient achieved a new, normal pregnancy. The third patient, with persistent trophoblastic disease, presented a mass of molar tissue within the uterine inferior segment and cervix, extending to the right vaginal cul-de-sac, heavily bleeding at each attempt of surgical removal, whether by sharp or suction curettage. As a consequence of the invasive maneuvers she became seriously infected with sepsis; although being submitted to intensive antibiotic therapy and total abdominal hysterectomy she died a few days later. RESULTS: of the two patients who were submitted to total abdominal hysterectomy, one survived and the other died of septicemia. The third patient, who was submited to hypogastric arterial ligation, had a favorable outcome and achieved a new and normal pregnancy. CONCLUSION: albeit gestational trophoblastic disease usually has an undisturbed course and spontaneous remission, unexpected complications may demand radical approaches leading sometimes to unfavorable results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):551-556
DOI 10.1590/S0100-72032004000700007
PURPOSE: to report three cases of gestational trophoblastic disease with intense hemorrhagic complications, in which exceptional surgical procedures were used to obtain hemostasis. METHODS: the study comprised three patients: the first, a young woman, 27 years old, nullipara, was submitted to total abdominal hysterectomy and, thereafter, to chemotherapy until remission was achieved. Another patient bled from an extensive vaginal metastasis that could only be treated with hypogastric arterial ligation. Definitive sustained remission was obtained after chemotherapy. Two years after the episode, the patient achieved a new, normal pregnancy. The third patient, with persistent trophoblastic disease, presented a mass of molar tissue within the uterine inferior segment and cervix, extending to the right vaginal cul-de-sac, heavily bleeding at each attempt of surgical removal, whether by sharp or suction curettage. As a consequence of the invasive maneuvers she became seriously infected with sepsis; although being submitted to intensive antibiotic therapy and total abdominal hysterectomy she died a few days later. RESULTS: of the two patients who were submitted to total abdominal hysterectomy, one survived and the other died of septicemia. The third patient, who was submited to hypogastric arterial ligation, had a favorable outcome and achieved a new and normal pregnancy. CONCLUSION: albeit gestational trophoblastic disease usually has an undisturbed course and spontaneous remission, unexpected complications may demand radical approaches leading sometimes to unfavorable results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):557-562
DOI 10.1590/S0100-72032004000700008
PURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):557-562
DOI 10.1590/S0100-72032004000700008
PURPOSE: to determine the prevalence of koilocytosis in penile biopsies of partners of women with HPV-induced genital lesions, and to analyze the risk factors associated with the penile viral infection. METHODS: a total of 80 partners of HPV-infected women with genital lesions were included in this transversal cohort study. The study was carried out between May 2002 and June 2003. The mean age was 34.1 years (16 to 63). No patient reported any kind of genital lesion. They answered questions regarding the presence of urethral symptoms, history of sexually transmitted diseases, number of sexual partners, use of condoms, and circumcision. The patients were submitted to peniscopy with acetic acid and toluidine blue solutions and finally to biopsy of the suspected lesions. Data were analyzed statistically by the chi2 test. RESULTS: the examination was considered negative in 24 patients (30%). All remaining 56 patients (70%) showed white lesions and toluidine blue-positive lesions. Of these, 53 were submitted to biopsy and 41 (77.3%) presented histological changes suggestive of HPV infection. CONCLUSIONS: the prevalence of the male genital infection was 51.2% and no risk factor analyzed was associated with an increased prevalence of HPV genital infection.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):563-571
DOI 10.1590/S0100-72032004000700009
PURPOSE: to measure changes and predictors of changes in mammographic density of climacteric women, before and one year after hormone replacement therapy. METHODS: seventy climacteric women of 45 years or more participated in the study. They were followed-up at a Climacteric Outpatient Service. All of them used regularly either estrogenic or estroprogestative HRT for one year. They were submitted to one basal mammography and another at the end of the first year. HRT schedules could be different from each other, although with the same bioequivalence. Mammographic density was evaluated blindly at the beginning and at the end of the treatment. Age, ovarian function, time since menopause, body mass index, waist/hip ratio, age at menarche, age at first pregnancy, and smoking were evaluated as well. Mammographic density was classified according to the American College of Radiology BI-RADS system into one of the following four parenchymal patterns: A) entirely liposubstituted breasts, B) liposubstituted breasts with disperse glandular parenchyma, C) heterogeneously dense breasts, and D) extremely dense breasts. We proposed a subdivision of each category in to A e A1, B e B1, C and C1, D and D1 in order to identify smaller variations in mammographic density. Therefore, we attributed initial and final scores of 1-8 to each of the patients according to the mammographic density before and after HRT, corresponding to categories A to D1. The proportions of women that presented increase, decrease and no variation in mammographic density after 1 year of HRT were calculated. In addition, we estimated initial to final score variation using the paired t-test of the Statistical Package for Social Sciences (SPSS). RESULTS: mammographic density increased in 22.9%, decreased in 7.1% and did not change in 70% of the studied cases. A significant difference was observed between the score means before (2.2±1.82) and after HRT (2.5±1.9) (p=0.019). The androgenic distribution of body fat was associated with a denser mammographic pattern. CONCLUSIONS: an increase in mammographic density was shown in women undergoing HRT, and was most pronounced in women with androgenic fat distribution. Additional studies must be carried out in order to evaluate if this increment in mammographic density could impair the mammographic screening of breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):563-571
DOI 10.1590/S0100-72032004000700009
PURPOSE: to measure changes and predictors of changes in mammographic density of climacteric women, before and one year after hormone replacement therapy. METHODS: seventy climacteric women of 45 years or more participated in the study. They were followed-up at a Climacteric Outpatient Service. All of them used regularly either estrogenic or estroprogestative HRT for one year. They were submitted to one basal mammography and another at the end of the first year. HRT schedules could be different from each other, although with the same bioequivalence. Mammographic density was evaluated blindly at the beginning and at the end of the treatment. Age, ovarian function, time since menopause, body mass index, waist/hip ratio, age at menarche, age at first pregnancy, and smoking were evaluated as well. Mammographic density was classified according to the American College of Radiology BI-RADS system into one of the following four parenchymal patterns: A) entirely liposubstituted breasts, B) liposubstituted breasts with disperse glandular parenchyma, C) heterogeneously dense breasts, and D) extremely dense breasts. We proposed a subdivision of each category in to A e A1, B e B1, C and C1, D and D1 in order to identify smaller variations in mammographic density. Therefore, we attributed initial and final scores of 1-8 to each of the patients according to the mammographic density before and after HRT, corresponding to categories A to D1. The proportions of women that presented increase, decrease and no variation in mammographic density after 1 year of HRT were calculated. In addition, we estimated initial to final score variation using the paired t-test of the Statistical Package for Social Sciences (SPSS). RESULTS: mammographic density increased in 22.9%, decreased in 7.1% and did not change in 70% of the studied cases. A significant difference was observed between the score means before (2.2±1.82) and after HRT (2.5±1.9) (p=0.019). The androgenic distribution of body fat was associated with a denser mammographic pattern. CONCLUSIONS: an increase in mammographic density was shown in women undergoing HRT, and was most pronounced in women with androgenic fat distribution. Additional studies must be carried out in order to evaluate if this increment in mammographic density could impair the mammographic screening of breast cancer.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):573-578
DOI 10.1590/S0100-72032004000700010
PURPOSE: to evaluate the effects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women. METHODS: twenty-four healthy postmenopausal women, aged 50 to 70 years, with osteopenia and/or osteoporosis, were submitted to raloxifene therapy, 60 mg/day, for six months. Plasma homocysteine concentration was determined before and after three and six months of therapy, as well as total cholesterol, HDL-cholesterol LDL-cholesterol and triglyceride levels. Plasma homocysteine was measured by a polarized immunofluorescence assay and serum lipids by the enzymatic and colorimetric method. Data were analyzed statistically by ANOVA, Newman-Keuls test and Pearson's correlation test. RESULTS: a significant decrease in total cholesterol of 15.3% (227.6±56.3 vs 200.6±29.8 vs 192.8±32.1 mg/dl; p<0.001) and LDL-cholesterol of 21.4% (151.4±46.3 vs 122.7±29.4 vs 119.0±28.6 mg/dl; p<0.001), and a significant increase in HDL-cholesterol of 9.5% (44.7±10.8 vs 52.2±12.6 vs 49.0±10.8 mg/dl; p<0.05) were observed. There was no reduction in triglyceride levels (134.9±50.3 vs 127.5±50.0 vs 121.0±36.0 mg/dl; p>0.05). Although not significant, a decrease in homocysteine by 4.5% (11.7±3.0 vs 11.0±2.9 vs 11.2±2.1 muM/l; p>0.05) was observed between the pre-and posttreatment periods, with a significant negative correlation between basal levels and posttreatment percentual reduction (r=-0.71; p<0.0001). CONCLUSIONS: raloxifene treatment, 60 mg/day, for six months caused a significant decrease in total and LDL-cholesterol and an increase in HDL-cholesterol in postmenopausal women. Plasma homocysteine concentration tended to decrease, this effect being more favorable in patients with elevated baseline levels.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(7):573-578
DOI 10.1590/S0100-72032004000700010
PURPOSE: to evaluate the effects of raloxifene on plasma homocysteine concentration and lipid profile in postmenopausal women. METHODS: twenty-four healthy postmenopausal women, aged 50 to 70 years, with osteopenia and/or osteoporosis, were submitted to raloxifene therapy, 60 mg/day, for six months. Plasma homocysteine concentration was determined before and after three and six months of therapy, as well as total cholesterol, HDL-cholesterol LDL-cholesterol and triglyceride levels. Plasma homocysteine was measured by a polarized immunofluorescence assay and serum lipids by the enzymatic and colorimetric method. Data were analyzed statistically by ANOVA, Newman-Keuls test and Pearson's correlation test. RESULTS: a significant decrease in total cholesterol of 15.3% (227.6±56.3 vs 200.6±29.8 vs 192.8±32.1 mg/dl; p<0.001) and LDL-cholesterol of 21.4% (151.4±46.3 vs 122.7±29.4 vs 119.0±28.6 mg/dl; p<0.001), and a significant increase in HDL-cholesterol of 9.5% (44.7±10.8 vs 52.2±12.6 vs 49.0±10.8 mg/dl; p<0.05) were observed. There was no reduction in triglyceride levels (134.9±50.3 vs 127.5±50.0 vs 121.0±36.0 mg/dl; p>0.05). Although not significant, a decrease in homocysteine by 4.5% (11.7±3.0 vs 11.0±2.9 vs 11.2±2.1 muM/l; p>0.05) was observed between the pre-and posttreatment periods, with a significant negative correlation between basal levels and posttreatment percentual reduction (r=-0.71; p<0.0001). CONCLUSIONS: raloxifene treatment, 60 mg/day, for six months caused a significant decrease in total and LDL-cholesterol and an increase in HDL-cholesterol in postmenopausal women. Plasma homocysteine concentration tended to decrease, this effect being more favorable in patients with elevated baseline levels.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):429-433
DOI 10.1590/S0100-72032004000600002
OBJECTIVE: to correlate serum leptin concentration with bone mineral density (BMD) in postmenopausal women. METHODS: twenty-two healthy postmenopausal women were included in the present study. BMD was measured by dual energy X-ray absorptiometry at the lumbar spine and femoral neck. Serum leptin concentrations were determined using an immunoradiometric assay. Statistical analysis was performed by ANOVA and Dunn and Pearson's correlation tests. RESULTS: mean BMD values were 0.898 ± 0.140 g/cm² at the lumbar spine and 0.760 ± 0.152 g/cm² at the femoral neck. Mean serum leptin concentration was 17.2 ± 9.4 ng/ml and no significant differences were observed among women with normal BMD, osteopenia and osteoporosis (18.6 ± 7.8, 18.9 ± 9.9 and 15.6 ± 10.6, respectively; p > 0.05). No significant correlations were observed between serum leptin levels and BMD measurements at the lumbar spine and femoral neck, when the whole sample was considered and when patients were divided into groups with osteoporosis and/or osteopenia and a control group. We observed a positive significant correlation between serum leptin levels and body mass index (BMI) (r = 0.66; p = 0.0044). CONCLUSIONS: there was no direct correlation between leptin and BMD in postmenopausal women, although we observed positive significant correlation between leptin and BMI. This fact indicates a possible indirect effect of leptin on bone metabolism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):429-433
DOI 10.1590/S0100-72032004000600002
OBJECTIVE: to correlate serum leptin concentration with bone mineral density (BMD) in postmenopausal women. METHODS: twenty-two healthy postmenopausal women were included in the present study. BMD was measured by dual energy X-ray absorptiometry at the lumbar spine and femoral neck. Serum leptin concentrations were determined using an immunoradiometric assay. Statistical analysis was performed by ANOVA and Dunn and Pearson's correlation tests. RESULTS: mean BMD values were 0.898 ± 0.140 g/cm² at the lumbar spine and 0.760 ± 0.152 g/cm² at the femoral neck. Mean serum leptin concentration was 17.2 ± 9.4 ng/ml and no significant differences were observed among women with normal BMD, osteopenia and osteoporosis (18.6 ± 7.8, 18.9 ± 9.9 and 15.6 ± 10.6, respectively; p > 0.05). No significant correlations were observed between serum leptin levels and BMD measurements at the lumbar spine and femoral neck, when the whole sample was considered and when patients were divided into groups with osteoporosis and/or osteopenia and a control group. We observed a positive significant correlation between serum leptin levels and body mass index (BMI) (r = 0.66; p = 0.0044). CONCLUSIONS: there was no direct correlation between leptin and BMD in postmenopausal women, although we observed positive significant correlation between leptin and BMI. This fact indicates a possible indirect effect of leptin on bone metabolism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):435-439
DOI 10.1590/S0100-72032004000600003
OBJECTIVES: The aim of the present study was to evaluate the nuclear grade, the expressions of p53 and c-erbB-2 proteins, and the estrogen receptors (ER) of 38 women with ductal carcinoma in situ (DCIS) and invasive carcinoma of the same breast. METHODS: the protein profile of 38 women was investigated in a descriptive and retrospective study, through the immune-histochemical technique. The cut-off limit for positive staining was chosen at 10% or more of positive cells for p53 and c-erbB-2 proteins and for ER. The analysis of the concordance between the expressions of proteins and the nuclear grade was done by the kappa coefficient, according to Landis and Koch's criteria. MacNemar's test was used to assess the differences between the two groups. RESULTS: there was a perfect concordance in the expression of p53 proteins (kappa coefficient = 1.00) and almost a perfect concordance for c-erbB-2 proteins, ER and nuclear grade (kappa coefficients = 0.84, 0.89 and 0.89) between in situ and invasive elements of the same tumor. CONCLUSION: there was no difference between the expressions of p53 and c-erbB-2 proteins, ER and nuclear grade in the DCIS and invasive carcinoma of the same breast.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(6):435-439
DOI 10.1590/S0100-72032004000600003
OBJECTIVES: The aim of the present study was to evaluate the nuclear grade, the expressions of p53 and c-erbB-2 proteins, and the estrogen receptors (ER) of 38 women with ductal carcinoma in situ (DCIS) and invasive carcinoma of the same breast. METHODS: the protein profile of 38 women was investigated in a descriptive and retrospective study, through the immune-histochemical technique. The cut-off limit for positive staining was chosen at 10% or more of positive cells for p53 and c-erbB-2 proteins and for ER. The analysis of the concordance between the expressions of proteins and the nuclear grade was done by the kappa coefficient, according to Landis and Koch's criteria. MacNemar's test was used to assess the differences between the two groups. RESULTS: there was a perfect concordance in the expression of p53 proteins (kappa coefficient = 1.00) and almost a perfect concordance for c-erbB-2 proteins, ER and nuclear grade (kappa coefficients = 0.84, 0.89 and 0.89) between in situ and invasive elements of the same tumor. CONCLUSION: there was no difference between the expressions of p53 and c-erbB-2 proteins, ER and nuclear grade in the DCIS and invasive carcinoma of the same breast.