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Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):25-30
DOI 10.1590/S0100-72032008000100005
PURPOSE: to compare diagnostic hysteroscopy through vaginoscopy, using warm saline solution, with traditional technique, regarding to pain, patient satisfaction and feasibility of the procedure. METHODS: randomized clinical trial, involving 184 women, referred for diagnostic hysteroscopy, between May and December of 2006. Participants were randomized to be submitted to hysteroscopy by the proposed technique, which consisted of access through vaginoscopy using normal saline at 36ºC as distension medium, no speculum or cervical grasping, or by the traditional technique with CO2. In both techniques, a 2.7 mm hysteroscope was used. Pain was assessed by the analogical visual scale, during the procedure and every five minutes after it. RESULTS: the mean pain score was 1.60 in the proposed technique and 3.39 in the traditional technique (p<0.01). Lower pain scores were also observed after 5, 10 and 15 minutes (p<0,01) as well as after 20 minutes (p=0.056). In the proposed technique, 82.4% of the procedures were feasible, while, in the traditional technique, 84.9% were so (p=0.64). Satisfaction with the procedure was referred by 88.7% of women submitted to the proposed technique and by 76.3% of women submitted to the traditional technique (p<0.05). CONCLUSIONS: diagnostic hysteroscopy by the proposed technique resulted in less pain, same feasibility and greater satisfaction of patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(1):25-30
DOI 10.1590/S0100-72032008000100005
PURPOSE: to compare diagnostic hysteroscopy through vaginoscopy, using warm saline solution, with traditional technique, regarding to pain, patient satisfaction and feasibility of the procedure. METHODS: randomized clinical trial, involving 184 women, referred for diagnostic hysteroscopy, between May and December of 2006. Participants were randomized to be submitted to hysteroscopy by the proposed technique, which consisted of access through vaginoscopy using normal saline at 36ºC as distension medium, no speculum or cervical grasping, or by the traditional technique with CO2. In both techniques, a 2.7 mm hysteroscope was used. Pain was assessed by the analogical visual scale, during the procedure and every five minutes after it. RESULTS: the mean pain score was 1.60 in the proposed technique and 3.39 in the traditional technique (p<0.01). Lower pain scores were also observed after 5, 10 and 15 minutes (p<0,01) as well as after 20 minutes (p=0.056). In the proposed technique, 82.4% of the procedures were feasible, while, in the traditional technique, 84.9% were so (p=0.64). Satisfaction with the procedure was referred by 88.7% of women submitted to the proposed technique and by 76.3% of women submitted to the traditional technique (p<0.05). CONCLUSIONS: diagnostic hysteroscopy by the proposed technique resulted in less pain, same feasibility and greater satisfaction of patients.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(2):51-57
DOI 10.1590/S0100-72032005000200002
PURPOSE: to estimate the validity of visual inspection of cervical intraepithelial neoplasia (CIN) and HPV-induced lesion screening, after acetic acid application (VIA), and to compare its performance with that of colpocytology and colposcopy. METHODS: a diagnostic test validation study involving 893 women aged 18 to 65 years, simultaneously screened with colpocytology, VIA and colposcopy was carried out at a public health unit in Recife, PE. VIA was performed by applying 5% acetic acid onto the cervix and observing it with the help of a clinical spotlight. The finding of any aceto-white lesion on the cervix was considered positive. The gold standard was the histopathology of cervical biopsy, carried out whenever any of the three test results was abnormal. Validity indicators were estimated for each test, within 95% confidence intervals. The analysis of agreement between test results was done by the kappa coefficient. RESULTS: of 303 women submitted to biopsy, the histopathological study was abnormal in 24. Among this total, VIA was positive in 22, yielding an estimated 91.7% sensibility, 68.9% specificity, and 7.5% positive predictive value and 99.7% negative predictive value. Comparing 95% confidence intervals, VIA was more sensitive than colpocytology, despite a lower specificity and positive predictive value. There was poor agreement between VIA and colpocytology (k=0.02) and excellent agreement with colposcopy (k=0.93). CONCLUSION: VIA was much more sensitive than colpocytology in the screening of CIN and HPV-induced lesions and presented a performance similar to colposcopy. Its low specificity determined a high number of false-positive results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(2):51-57
DOI 10.1590/S0100-72032005000200002
PURPOSE: to estimate the validity of visual inspection of cervical intraepithelial neoplasia (CIN) and HPV-induced lesion screening, after acetic acid application (VIA), and to compare its performance with that of colpocytology and colposcopy. METHODS: a diagnostic test validation study involving 893 women aged 18 to 65 years, simultaneously screened with colpocytology, VIA and colposcopy was carried out at a public health unit in Recife, PE. VIA was performed by applying 5% acetic acid onto the cervix and observing it with the help of a clinical spotlight. The finding of any aceto-white lesion on the cervix was considered positive. The gold standard was the histopathology of cervical biopsy, carried out whenever any of the three test results was abnormal. Validity indicators were estimated for each test, within 95% confidence intervals. The analysis of agreement between test results was done by the kappa coefficient. RESULTS: of 303 women submitted to biopsy, the histopathological study was abnormal in 24. Among this total, VIA was positive in 22, yielding an estimated 91.7% sensibility, 68.9% specificity, and 7.5% positive predictive value and 99.7% negative predictive value. Comparing 95% confidence intervals, VIA was more sensitive than colpocytology, despite a lower specificity and positive predictive value. There was poor agreement between VIA and colpocytology (k=0.02) and excellent agreement with colposcopy (k=0.93). CONCLUSION: VIA was much more sensitive than colpocytology in the screening of CIN and HPV-induced lesions and presented a performance similar to colposcopy. Its low specificity determined a high number of false-positive results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):579-584
DOI 10.1590/S0100-72032002000900003
Purpose: to evaluate the sensitivity, specificity, positive and negative predictive values of a clinical and an ecographic method for adenomyosis diagnosis. Methods: a transversal study of validation of the diagnostic method was done, including 95 women in menacme submitted to hysterectomy for various causes. Adenomyosis was diagnosed through a clinical method in women aged 40 years or older, with 2 or more deliveries, increased menstrual bleeding associated with dysmenorrhea. The ecographic diagnosis was established if at least one myometrial ill defined area of abnormal ecotexture was found, which could be hypoechoic, hyperchoic, heterogeneous or cystic. Gold standard was histopathology, defined as the finding of endometrial glands or stroma more than 2.5 cm above the endomiometrial junction. Results: the clinical method had 68.2% sensitivity, 78.1% specificity, 48.4% positive predictive value and 89.1% negative predictive value. For the echographic method this figures were, respectively, 45.5%, 84.9%, 47.6% and 83.8%. Likelihood ratio was 3.11 for the clinical and 3.03 for the echographic method. Considering only those simultaneously positive cases by both methods, sensitivity was below 30% and specificity was near 100%. Considering all positive cases by one or the other method or concomitanty by both, the sensitivity reached 86% and specificity was 60%. Conclusion: the echographic method was not better than the clinical for the diagnosis of adenomyosis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(9):579-584
DOI 10.1590/S0100-72032002000900003
Purpose: to evaluate the sensitivity, specificity, positive and negative predictive values of a clinical and an ecographic method for adenomyosis diagnosis. Methods: a transversal study of validation of the diagnostic method was done, including 95 women in menacme submitted to hysterectomy for various causes. Adenomyosis was diagnosed through a clinical method in women aged 40 years or older, with 2 or more deliveries, increased menstrual bleeding associated with dysmenorrhea. The ecographic diagnosis was established if at least one myometrial ill defined area of abnormal ecotexture was found, which could be hypoechoic, hyperchoic, heterogeneous or cystic. Gold standard was histopathology, defined as the finding of endometrial glands or stroma more than 2.5 cm above the endomiometrial junction. Results: the clinical method had 68.2% sensitivity, 78.1% specificity, 48.4% positive predictive value and 89.1% negative predictive value. For the echographic method this figures were, respectively, 45.5%, 84.9%, 47.6% and 83.8%. Likelihood ratio was 3.11 for the clinical and 3.03 for the echographic method. Considering only those simultaneously positive cases by both methods, sensitivity was below 30% and specificity was near 100%. Considering all positive cases by one or the other method or concomitanty by both, the sensitivity reached 86% and specificity was 60%. Conclusion: the echographic method was not better than the clinical for the diagnosis of adenomyosis.
