RESUMO
This paper reports the experience obtained in the last 8 years with an instrument (articulated rotative brush) that allows access to the entire endometrial surface, obtaining material for both histological and cytological study. The latter has the advantage of reducing the number of cases in which insufficient material frustrates endometrial assessment. In addition to the overall experience gained with this instrument, the proportion of agreement with anatomo-pathological diagnosis after hysterectomy in 61 patients was high (96%) and the unweighted kappa statistic (0.862) indicated very good accordance between these techniques. Comparison between the present method and hysteroscopic observations in 84 patients with perimenopausal bleeding revealed a general conformity of 0.65 and an unweighted kappa statistic of 0.368 (fair agreement). In a group of 72 cases with postmenopausal bleeding a general conformity value of 0.92 was obtained, with an unweighted kappa statistic of 0.84 (very good agreement). In 90% of the cases the procedure was well accepted. In 57.3% of the cases, no difficulties were encountered using the brushing technique; in 25.9% slight dilatation was deemed necessary, whereas in 16.8% technical difficulties could not be overcome and general anesthesia was indicated. A total of 769 outpatients were investigated, 75.3% of which had normal endometria, 12.7% benign hyperplasias, 2.6% precursor lesions, 1.7% suspect carcinoma, and 4.2% carcinomas. Insufficient material for diagnosis occurred in 3.5% of cases tested. The combined cytohistological and hysteroscopic assessment of the endometrium provides satisfactory results in the etiological diagnosis of peri and postmenopausal bleeding, and in the follow up of patients undergoing hormonal replacement therapy (HRT).
Assuntos
Biópsia/instrumentação , Climatério/fisiologia , Endométrio/patologia , Histeroscópios , Hemorragia Uterina/patologia , Adulto , Idoso , Assistência Ambulatorial , Desenho de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
Four phenotypic cytologic parameters (koilocytotic changes, binucleation, multinucleation and the presence of metaplastic dysplastic cells) were evaluated in the initial cervical smears from 89 women who presented with slight or moderate dysplastic changes and had an adequate follow-up. The cases were divided in two groups according to their evolution: the 51 cases constituting group I showed persistence or progression of the lesions while the 38 cases in group II showed regression. Koilocytosis in 40% or more of the cells in a smear proved to have the greatest predictive value as an indicator of a lesion with less risk of progression. Multinucleation may have a similar value, but to a lesser degree. Binucleation and metaplastic dysplastic cells showed no statistical differences between persistence cases and regression cases. A fifth parameter, positivity to human papillomavirus capsid antigen by the immunoperoxidase technique, doubled its frequency in the regression group. The evaluation of these variables may provide a means of assessing the evolutionary potential of precursor cervical lesions, based on these lesions' cytologic phenotypic profiles.
Assuntos
Colo do Útero/patologia , Regressão Neoplásica Espontânea , Displasia do Colo do Útero/patologia , Feminino , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Metaplasia , Fenótipo , Valor Preditivo dos Testes , Displasia do Colo do Útero/diagnóstico , Esfregaço VaginalRESUMO
Seventy-four symptomatic postmenopausal women received conjugated equine estrogens, 0.625 mg daily, alternating 3 wk of treatment with 1 wk free. Medroxyprogesterone acetate, 10 mg daily, was added from day 12 to day 21 of the estrogen therapy. The length of treatment ranged between 36 and 50 mth (media 42.8). This sequential treatment appears to be an effective medication for menopausal women as 86.4% of patients showed a complete regression of symptoms. Its acceptability may be considered good since few side effects and low incidence of abandons (12.2%) were registered. Medroxyprogesterone seems to be a useful agent to counteract the possible cocarcinogenetic effect of conjugated estrogens on account of the high incidence of induced secretory endometrium obtained (92.2%), the reversal of six pretreatment endometrial hyperplasias and the absence of any premalignant endometrial lesion after at least 3 yr of this sequential treatment. The only case of endometrial cancer registered does not jeopardize this conclusion as was observed in a women who took medroxyprogesterone very irregularly.