RESUMEN
This study aimed to compare the quality of histological endometrial samples collected through Pipelle aspiration and hysteroscopic biopsies to assess the agreement between these 2 biopsies in the histological diagnosis of malignancy and to compare the costs of both biopsies.This was a cross-sectional study. Forty-five women were biopsied, first using Pipelle and immediately after using hysteroscopy. The material collected was sent for analysis, and hysteroscopy was considered the gold standard. The results were divided into the following 3 categories: normal (atrophic, proliferative, and secretory endometrium); polyps; and malignancies. We report the agreement between Pipelle and hysteroscopy in the diagnosis of malignancy and compare their costs.The study showed that while analyzing endometrial malignancies, Pipelle sampling had 100% sensitivity and specificity. In the detection of polyps, Pipelle sampling showed 26.1% sensitivity, 88.9% specificity, 75% positive predictive value, 48.5% negative predictive value, and 53.7% accuracy. Agreement with hysteroscopy in the diagnosis of malignancy was 100%. The Pipelle device costs 27 times less than hysteroscopic biopsy for health insurance companies. This cost is 13.7 times lower in the Brazilian Unified Health System.Endometrial biopsies using the Pipelle have a high accuracy for endometrial cancer and a low accuracy for polyps. We detected 100% agreement between the reports of Pipelle and hysteroscopy with regard to malignancy. Pipelle is the most cost-effective method of endometrial biopsy.
Asunto(s)
Biopsia con Aguja/métodos , Neoplasias Endometriales/patología , Endometrio/patología , Histeroscopía/métodos , Adulto , Anciano , Biopsia con Aguja/economía , Biopsia con Aguja/normas , Brasil , Estudios Transversales , Femenino , Humanos , Histeroscopía/economía , Histeroscopía/normas , Menopausia/fisiología , Persona de Mediana Edad , Pólipos , Sensibilidad y EspecificidadRESUMEN
Cervical cancer is the third leading cause of cancer-related death among women in low-to-middle income countries. Pap testing and pathological services are difficult to implement under these settings. Alternative techniques for the diagnosis of cervical precancer in these settings are needed to reduce the burden of the disease. The objective of this study was to evaluate the diagnostic accuracy of a low-cost, high-resolution microendoscope imaging system in identifying precancerous lesions of the cervix in vivo. A retrospective study of 59 patients undergoing colposcopy for an abnormal Pap test was performed at Hospital de Câncer de Barretos in Brazil. All patients underwent colposcopy as per standard of care, and acetowhite lesions were recorded. High-resolution microendoscopy (HRME) images were obtained from one colposcopically normal region and from all lesions observed on colposcopy. Biopsies of abnormal areas were obtained and reviewed by three independent, blinded pathologists and compared with HRME findings. The mean nuclear area and the median nuclear eccentricity were calculated from HRME images acquired from each site. A diagnostic algorithm to distinguish histopathologically diagnosed cervical intraepithelial neoplasias of grade 2 or more severe lesions (high grade) from less severe lesions (low grade) was developed using these parameters. A test of trend was used to analyze the relationship between HRME positivity and severity of histopathogical diagnosis. Fisher's exact test was used to analyze differences in HRME positivity between high-grade and low-grade lesions. Evaluable images were obtained from 108 of 143 discrete sites. Of these, 71 sites were colposcopically normal or low grade according to histopathology and 37 were diagnosed as high grade on the basis of histopathology. Using the mean nuclear area and the median nuclear eccentricity, HRME images from 59 colposcopically abnormal sites were classified as high grade or low grade with 92% sensitivity and 77% specificity compared with histopathological findings. Increasing HRME positivity showed a significant trend with increasing severity of diagnosis (Ptrend<0.001). We found a strong association (P<0.001) between HRME positivity and a histopathological diagnosis of cervical intraepithelial neoplasia of grade 2 or higher. HRME demonstrated an accurate in-situ diagnosis of high-grade dysplasia. In low-resource settings in which colposcopy and histopathology services are severely limited or unavailable, HRME may provide a low-cost, accurate method for diagnosis of cervical precancer without the need for biopsy, allowing for a single 'screen-and-treat' approach.
Asunto(s)
Colposcopía/economía , Recursos en Salud/economía , Área sin Atención Médica , Sistemas de Atención de Punto/economía , Displasia del Cuello del Útero/economía , Adolescente , Adulto , Anciano , Brasil/epidemiología , Colposcopía/normas , Femenino , Tecnología de Fibra Óptica/economía , Tecnología de Fibra Óptica/normas , Recursos en Salud/normas , Humanos , Histeroscopía/economía , Histeroscopía/normas , Microscopía Fluorescente/economía , Microscopía Fluorescente/normas , Persona de Mediana Edad , Proyectos Piloto , Sistemas de Atención de Punto/normas , Estudios Retrospectivos , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography. METHODS: Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5%). Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULTS: Uterine synechiae were identified in 16 patients (26.7%). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9% and 92.7%, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. % vs. 20.0%) and a higher degree of agreement with hysteroscopy (Kappa = 80% vs. Kappa = 27%). CONCLUSION: For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.
Asunto(s)
Aborto Habitual/diagnóstico por imagen , Histeroscopía/métodos , Ultrasonografía/métodos , Enfermedades Uterinas/diagnóstico por imagen , Aborto Habitual/epidemiología , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Histeroscopía/economía , Histeroscopía/normas , Valor Predictivo de las Pruebas , Prevalencia , Recurrencia , Adherencias Tisulares/diagnóstico por imagen , Adherencias Tisulares/epidemiología , Ultrasonografía/economía , Ultrasonografía/normas , Enfermedades Uterinas/epidemiología , VaginaRESUMEN
OBJETIVO: Avaliar a prevalência de sinéquias uterinas em pacientes com aborto recorrente e a acurácia diagnóstica da ultra-sonografia transvaginal (US-TV) e da histerossonografia (HS). MÉTODOS: Sessenta pacientes não grávidas com passado de três ou mais abortos espontâneos consecutivos foram avaliadas por US-TV, HS e histeroscopia (HTC) para a pesquisa de sinéquias uterinas. A HTC foi considerada o padrão ouro do estudo. A concordância dos achados da US-TV e da HS foram avaliadas pelo coeficiente Kappa e sua significância foi testada. O nível de significância adotado foi de 0,05 (alfa = 5 por cento). Foram calculadas as medidas de sensibilidade, especificidade e valor preditivo positivo e negativo para cada um dos métodos. RESULTADOS: Observou-se a presença de sinéquias uterinas em 16 (26,7 por cento) pacientes. A acurácia da US-TV e da HS foram, respectivamente, de 78,9 por cento e 92,7 por cento. Comparativamente à US-TV, a HS foi muito superior quanto à sensibilidade (78,6 por cento versus 20 por cento) e concordância com a HTC (Kappa = 80 por cento versus Kappa = 27 por cento). CONCLUSÃO: Observou-se boa concordância da HS e concordância ruim da US-TV em relação à HTC para o diagnóstico de sinéquias uterinas. Devido à sua baixa sensibilidade, a US-TV não demonstrou ser um método aplicável à investigação de sinéquias uterinas em pacientes com aborto recorrente. A HS, por sua vez, parece oferecer importante contribuição nesta pesquisa, particularmente por sua simplicidade técnica, baixo custo e elevada acurácia diagnóstica.
BACKGROUND: The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography. METHODS: Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5 percent). Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULTS: Uterine synechiae were identified in 16 patients (26.7 percent). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9 percent and 92.7 percent, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. percent vs. 20.0 percent) and a higher degree of agreement with hysteroscopy (Kappa = 80 percent vs. Kappa = 27 percent). CONCLUSION: For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.
Asunto(s)
Humanos , Femenino , Aborto Habitual , Histeroscopía/métodos , Ultrasonografía/métodos , Enfermedades Uterinas , Adherencias Tisulares , Aborto Habitual/epidemiología , Brasil/epidemiología , Estudios Transversales , Histeroscopía/economía , Histeroscopía/normas , Valor Predictivo de las Pruebas , Prevalencia , Recurrencia , Ultrasonografía/economía , Ultrasonografía/normas , Enfermedades Uterinas/epidemiología , VaginaRESUMEN
Os autores fazem uma análise dos custos médicos e hospitalares da reduçåo endometrial por histeroscopia, diante dos custos da histerectomia total abdominal, no tratamento do sangramento uterino anormal de causa benigna. Concluem pelo menor custo da cirurgia endoscópica, levando a uma diminuiçåo do ônus para a paciente ou para seu convênio e uma maior produtividade para o médico e para o estabelecimento hospitalar
Asunto(s)
Humanos , Femenino , Análisis Costo-Beneficio , Endometrio , Hospitalización/economía , Histerectomía/economía , Histeroscopía/economíaRESUMEN
En el ejercicio médico diario es difícil introducir innovaciones, más aún si ellas están en contraposición con enseñanzas de larga data. Esta dificultad la ha enfrentado la histeroscopia. En Venezuela, nuestro Servicio de Ginecología fue el primero en institucionalizar esta técnica, teniendo, por lo tanto, las mayores estadísticas al respecto. Sin embargo, muchos gineco-obstetras rechazan la técnica parcialmente, argumentando "los altos costos del equipo" y la necesidad de personal entrenado. Nosotros realizamos 450 histeroscopias y llenamos una hoja de balance económico, encontrando: 1. "Económicamente", el equipo se paga completamente en las primeras 33 histeroscopias en hemorragias postmenopáusicas, evitándose un alto porcentaje de curetajes fraccionarios y, por ende, costos de hospitalización, anestesia y cupos quirúrgicos, además de evitar al paciente riesgos hospitalarios y pérdida de días de trabajo. 2. El entrenamiento de un ginecólogo en histeroscopias amerita la realización de aproximadamente 30 de estos procedimientos bajo supervisión