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Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(1):19-26
DOI 10.1590/S0100-72032000000100004
Purpose: to evaluate gestational and delivery complications as risk factors for perinatal death. Methodology - Patients: the cases (perinatal deaths) were identified among a total of 3,031 deliveries from the maternity of the Rio de Janeiro State Military Police. Methods: the study design was a nested case-control one. Cases (n = 82) were perinatal deaths with a minimum gestational age of 28 weeks or a weight of 1,000 g. Controls (n = 246) were live babies for the first week of life. The analysis was made in three steps: univariate, stratified and multivariate (logistic regression). Results: the gestational complications showed an odds ratio of 4.21 and the delivery complications, 5.26. The newborn weight showed an OR = 0.999 per gram over 1,000 g weight. The gestational age showed an OR = 0.729 per week of gestation over 28 weeks. Conclusions: the gestational complications and the delivery complications were important risk factors for perinatal death. The gestational age and the weight of the newborn were important protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(1):19-26
DOI 10.1590/S0100-72032000000100004
Purpose: to evaluate gestational and delivery complications as risk factors for perinatal death. Methodology - Patients: the cases (perinatal deaths) were identified among a total of 3,031 deliveries from the maternity of the Rio de Janeiro State Military Police. Methods: the study design was a nested case-control one. Cases (n = 82) were perinatal deaths with a minimum gestational age of 28 weeks or a weight of 1,000 g. Controls (n = 246) were live babies for the first week of life. The analysis was made in three steps: univariate, stratified and multivariate (logistic regression). Results: the gestational complications showed an odds ratio of 4.21 and the delivery complications, 5.26. The newborn weight showed an OR = 0.999 per gram over 1,000 g weight. The gestational age showed an OR = 0.729 per week of gestation over 28 weeks. Conclusions: the gestational complications and the delivery complications were important risk factors for perinatal death. The gestational age and the weight of the newborn were important protective factors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):193-200
DOI 10.1590/S0100-72031999000400003
Purpose: to evaluate the efficacy of cytology and colposcopy-directed biopsy to distinguish preclinical invasive cervical carcinoma from intraepithelial lesions. Patients and Methods: 441 patients submitted to conization, hysterectomy and Wertheim-Meigs operation from 1978 to 1995 in the University Hospital "Clementino Fraga Filho", Federal University of Rio de Janeiro, Cervical Pathology Outpatient Clinic. We estimated sensitivity, specificity, predictive values, likelihood ratio and confidence intervals of each study, which were divided into four classes: 1) normal and inflammatory; 2) mild and moderate dysplasias; 3) severe dysplasia and carcinoma in situ; 4) microcarcinoma and invasive carcinoma. Biopsies were analyzed as a whole and separated in accordance with the type of the colposcopic result (satisfactory and unsatisfactory). Results: cytology has shown sensitivity of 50%, specificity of 89%, positive predictive value of 63% and negative predictive value of 82%. The likelihood ratios were 4.4 for stromal invasion diagnosis, 0.7 for severe dysplasia and carcinoma in situ, 0.1 for mild and moderate dysplasia, 2.2 for normal and inflammatory report and 0.6 for the negative results for invasion as a whole. Satisfactory colposcopic guided biopsy white a visible lesion showed sensitivity of 59%, specificity of 100% positive predictive value of 100% and negative predictive value of 83%. Likelyohood ratios were: tending to infinity for invasion, 0.5 for severe dysplasia and carcinoma in situ, zero for mild and moderate dysplasia, zero for negative and inflammatory and 0.4 for all negative results for invasion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(4):193-200
DOI 10.1590/S0100-72031999000400003
Purpose: to evaluate the efficacy of cytology and colposcopy-directed biopsy to distinguish preclinical invasive cervical carcinoma from intraepithelial lesions. Patients and Methods: 441 patients submitted to conization, hysterectomy and Wertheim-Meigs operation from 1978 to 1995 in the University Hospital "Clementino Fraga Filho", Federal University of Rio de Janeiro, Cervical Pathology Outpatient Clinic. We estimated sensitivity, specificity, predictive values, likelihood ratio and confidence intervals of each study, which were divided into four classes: 1) normal and inflammatory; 2) mild and moderate dysplasias; 3) severe dysplasia and carcinoma in situ; 4) microcarcinoma and invasive carcinoma. Biopsies were analyzed as a whole and separated in accordance with the type of the colposcopic result (satisfactory and unsatisfactory). Results: cytology has shown sensitivity of 50%, specificity of 89%, positive predictive value of 63% and negative predictive value of 82%. The likelihood ratios were 4.4 for stromal invasion diagnosis, 0.7 for severe dysplasia and carcinoma in situ, 0.1 for mild and moderate dysplasia, 2.2 for normal and inflammatory report and 0.6 for the negative results for invasion as a whole. Satisfactory colposcopic guided biopsy white a visible lesion showed sensitivity of 59%, specificity of 100% positive predictive value of 100% and negative predictive value of 83%. Likelyohood ratios were: tending to infinity for invasion, 0.5 for severe dysplasia and carcinoma in situ, zero for mild and moderate dysplasia, zero for negative and inflammatory and 0.4 for all negative results for invasion.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):51-57
DOI 10.1590/S0100-72032002000100008
Purpose: to evaluate p53 overexpression value in vulvar intraepithelial neoplasia (VIN) III recurrence/progression. Methods: twenty patients with undifferentiated VIN III were selected and followed up every six months for four years and divided into two groups: fourteen without and six with recurrence/progression lesion. The recurrence/progression cases were distributed as follows: in three patients recurrence occurred only once; in two, twice, and only one progressed to squamous cancer. In both groups the site of vulvar lesion and p53 overexpression and immunostaining pattern were analyzed. A similar study was performed in recurrence/progression cases, besides the analysis of the time interval to occur the arise of recurrence/progression. Results: recurrence was observed in 25% of the cases and, in 5%, progression to carcinoma. The mean time interval for recurrence was 24.5 months. Multifocal location of the initial lesion was the predominant form (50%) in both groups. In the majority of the cases (87.5%) recurrence/progression occurred at the same site of the initial vulvar lesion. p53 overexpression was observed in 50% of the VIN III primary lesions and in 75% of the recurrence/progression cases. Conclusions: p53 overexpression seems to play an important role in VIN III pathogenesis and may predict the clinical course of the lesions. VIN III recurrence/progression has a tendency to occur in the same area of the initial lesion, suggesting the presence of molecular disturbance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(1):51-57
DOI 10.1590/S0100-72032002000100008
Purpose: to evaluate p53 overexpression value in vulvar intraepithelial neoplasia (VIN) III recurrence/progression. Methods: twenty patients with undifferentiated VIN III were selected and followed up every six months for four years and divided into two groups: fourteen without and six with recurrence/progression lesion. The recurrence/progression cases were distributed as follows: in three patients recurrence occurred only once; in two, twice, and only one progressed to squamous cancer. In both groups the site of vulvar lesion and p53 overexpression and immunostaining pattern were analyzed. A similar study was performed in recurrence/progression cases, besides the analysis of the time interval to occur the arise of recurrence/progression. Results: recurrence was observed in 25% of the cases and, in 5%, progression to carcinoma. The mean time interval for recurrence was 24.5 months. Multifocal location of the initial lesion was the predominant form (50%) in both groups. In the majority of the cases (87.5%) recurrence/progression occurred at the same site of the initial vulvar lesion. p53 overexpression was observed in 50% of the VIN III primary lesions and in 75% of the recurrence/progression cases. Conclusions: p53 overexpression seems to play an important role in VIN III pathogenesis and may predict the clinical course of the lesions. VIN III recurrence/progression has a tendency to occur in the same area of the initial lesion, suggesting the presence of molecular disturbance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):69-76
DOI 10.1590/S0100-72031999000200003
Purpose: to evaluate core biopsy (CB) for the diagnosis of subclinical breast lesions, comparing with surgical biopsy previously identified by stereotaxic mammography. Methods: this is a cross-sectional study of 41 subclinical lesion cases over 35 years of age, between January 1995 and February 1997 at the Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. The cases were classified mammographically as benign, probably benign, suspicious and malignant. Benign and probably benign lesions were studied together for statistical purposes. The histopathologic diagnosis of CB was classified as inadequate for diagnosis, absence of malignancy, suspicious and malignant. The histopathologic diagnosis of the surgical biopsy was classified as absence of malignancy, pre-malignant and malignant. The sensitivity, especificity and predictive values of CB were evaluated. Mammography likelihood ratio and core biopsy likelihood ratio were evaluated to predict breast cancer. Results: CB coincided with surgical biopsy in 86.2% of the 29 cases of absence of malignancy. All cases suspected by CB were malignant by surgical biopsy. All cases malignant by CB were also malignant by surgical biopsy. CB sensitivity and specificity were 36.4% and 100%, respectively. Positive predictive value was 100% and negative predictive value was 78.1%. In the group classified mammographically as malignant the likelihood ratio was 9.7; for suspicious lesions it was 1.3 and for probably benign lesions it was 0.1. Core biopsy likelihood ratio was infinite (¥) for suspicious and malignant lesions, 0.4 for cases classified as absence of malignancy and 1.4 for inadequate for diagnosis cases. Conclusions: after analysis of the results, with the use of the likelihood ratio, we conclude that CB report of absence of malignancy did not allow to rule out the diagnosis of malignancy. In these cases, we should correlate the result with mammography. If CB shows absence of malignancy and there is no correlation with mammography, the research must be continued. When the report of CB was suspicious, the probability of a breast carcinoma was very high. In these cases, we should perform a surgical biopsy to establish a definitive diagnosis, because an infiltrating carcinoma needs a different therapy when compared with carcinoma in situ and atypical hyperplasia. In the cases of histopathologic report of malignancy, the probability of breast cancer was high, since we did not observe any false positive CB. In these cases, CB allowed a quick diagnosis without the need of surgical biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):69-76
DOI 10.1590/S0100-72031999000200003
Purpose: to evaluate core biopsy (CB) for the diagnosis of subclinical breast lesions, comparing with surgical biopsy previously identified by stereotaxic mammography. Methods: this is a cross-sectional study of 41 subclinical lesion cases over 35 years of age, between January 1995 and February 1997 at the Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. The cases were classified mammographically as benign, probably benign, suspicious and malignant. Benign and probably benign lesions were studied together for statistical purposes. The histopathologic diagnosis of CB was classified as inadequate for diagnosis, absence of malignancy, suspicious and malignant. The histopathologic diagnosis of the surgical biopsy was classified as absence of malignancy, pre-malignant and malignant. The sensitivity, especificity and predictive values of CB were evaluated. Mammography likelihood ratio and core biopsy likelihood ratio were evaluated to predict breast cancer. Results: CB coincided with surgical biopsy in 86.2% of the 29 cases of absence of malignancy. All cases suspected by CB were malignant by surgical biopsy. All cases malignant by CB were also malignant by surgical biopsy. CB sensitivity and specificity were 36.4% and 100%, respectively. Positive predictive value was 100% and negative predictive value was 78.1%. In the group classified mammographically as malignant the likelihood ratio was 9.7; for suspicious lesions it was 1.3 and for probably benign lesions it was 0.1. Core biopsy likelihood ratio was infinite (¥) for suspicious and malignant lesions, 0.4 for cases classified as absence of malignancy and 1.4 for inadequate for diagnosis cases. Conclusions: after analysis of the results, with the use of the likelihood ratio, we conclude that CB report of absence of malignancy did not allow to rule out the diagnosis of malignancy. In these cases, we should correlate the result with mammography. If CB shows absence of malignancy and there is no correlation with mammography, the research must be continued. When the report of CB was suspicious, the probability of a breast carcinoma was very high. In these cases, we should perform a surgical biopsy to establish a definitive diagnosis, because an infiltrating carcinoma needs a different therapy when compared with carcinoma in situ and atypical hyperplasia. In the cases of histopathologic report of malignancy, the probability of breast cancer was high, since we did not observe any false positive CB. In these cases, CB allowed a quick diagnosis without the need of surgical biopsy.
