RESUMEN
OBJECTIVE: To evaluate the interobserver and intraobserver reliability of smartphone colposcopy (SPC) versus conventional colposcopy and to determine diagnostic performance. METHODS: A smartphone back camera was used to capture cervical images before and after application of acetic acid, and after application of lugol solution. Captured images were reviewed independently by two experienced colposcopists and findings were noted as per colposcopy. Smartphone-based diagnostic performance was calculated, and kappa statistics were used for measurement of agreement between SPC and conventional colposcopy findings. RESULTS: A total of 114 women were included in the study. The kappa statistic for intraobserver reliability was 0.77 for both normal colposcopic findings and the transformation zone, indicating substantial agreement. Kappa values were 0.54 for acetowhite epithelium, 0.51 for lugol staining, and 0.51-0.60 for atypical vascularization. Kappa values for interobserver reliability were 0.76 for normal colposcopic findings, 0.56 for acetowhite epithelium, and 0.60 for lugol staining. The sensitivity, specificity, PPV, and NPV of SPC for CIN2+ were 88.2 (95% CI, 72.5-96.7), 48.7 (95% CI, 37.4-60.2), 0.42 (95% CI, 0.36-0.48), and 0.91 (95% CI, 0.79-0.96), respectively. CONCLUSION: SPC showed substantial agreement between the histologic diagnoses based on the captured images and conventional colposcopic findings.
Asunto(s)
Displasia del Cuello del Útero , Neoplasias del Cuello Uterino , Colposcopía , Femenino , Humanos , Embarazo , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Teléfono Inteligente , Neoplasias del Cuello Uterino/diagnóstico , Displasia del Cuello del Útero/diagnósticoRESUMEN
Objective: Uterine leiomyomas are the most common pelvic tumor in women. The calculated prevalence of prolapsed pedunculated leiomyoma was 2.5% in patients who underwent surgery. Although vaginal removal is safe and effective, hysterectomy demand is questionable. We aimed to analyze the association between patient characteristics, clinical features of prolapsed pedunculated submucosal leiomyoma, and the probability of successful vaginal myomectomy. Material and Methods: This study was conducted in 35 women who presented with prolapsed pedunculated uterine leiomyoma. Patients were grouped according to the treatment procedure, either vaginal myomectomy or hysterectomy. Results: Hysterectomy was performed in 14 patients and vaginal myomectomy was performed in 21 women. The mean ages and menopausal status were similar. Parity was higher in the hysterectomy group (p=0.02). The preoperative hematocrit value of patients undergoing vaginal myomectomy was significantly lower (p=0.04). There was no significant difference between the groups regarding the largest leiomyoma diameter. However, the median calculated leiomyoma volume was lower in the vaginal myomectomy group (p=0.04). None of the variables were independently associated with successful vaginal myomectomy on multivariable logistic regression analysis. Conclusion: The feasibility and choice of vaginal myomectomy is associated with low parity, absence of coexisting leiomyoma, high volume of leiomyoma estimated via ultrasound measurement, and severe anemia.
RESUMEN
Endometrial polyps are benign pathologies originating as localized overgrowths of basal endometrium. Risk factors include endogenous and exogenous estrogen excess and tamoxifen (TAM) exposure. Our main objective was to investigate the role of an apoptosis-inhibiting protein, survivin, in endometrial polyps. We performed a cross-sectional, analytical study; our samples were obtained from the archives of the Department of Pathology. Sixty samples were included, comprising 20 TAM polyps, 20 simple endometrial polyps, and 20 cases of simple endometrial hyperplasia without atypia not associated with TAM use. Immunohistochemical staining with rabbit monoclonal anti-human survivin, clone EP 119, was performed. Survivin staining score was highest in the endometrial polyp group and lowest in the TAM polyp group (P<0.001). There was no correlation between survivin staining score and the age of patient (r=0.09), TAM exposure (r=-0.02), nor endometrial thickness (r=0.25). Endometrial polyps are frequently associated with TAM. The low expression of the antiapoptotic marker survivin in TAM polyps but high expression in other polypoid endometrium illustrates that different mechanisms are responsible in the pathogenesis of endometrial polyps. It is possible that there is a direct effect of TAM on apoptosis or indirect effect through a progesterone-related mechanism.