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    Avaliação de peças resultantes de cirurgia com alça de ondas de alta frequência no colo de útero com neoplasia intraepitelial escamosa
    (Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Bittencourt, Dulcimary Dias [UNIFESP]; Ribalta, Julisa Chamorro Lascasas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Evaluate the results of LETZ surgery for Cervical Intraepithelial Neoplasia (CIN). Methods: 118 patients diagnosed with severe cervical lesions were selected and submitted to loop excision of the transformation zone (LETZ). The results were evaluated by patient age, degree of lesion, number of fragments removed, state of compromise of the margins, and degree of thermal artifact. Results: Patient age varied between 17 and 55, with the average being 27; 63.6% of patients had been diagnosed with cervical intraepithelial neoplasia grade II (CIN II) and 36.4% with CIN III. The lesion was removed in one fragment in 79.6% of the cases and in two or more fragments in 20.3% of the cases. The margins were free of intraepithelial neoplasia in 85.6% of the cases, compromised in the endocervical margin in 6.8% of the cases, compromised in the ectocervical margin in 1.7% of the cases, and compromised in both margins in 3.4% of the cases. Fragment damage by artifact occurred in 2.5% of the cases, and there were no cases of fragmented material adversely affecting evaluation. The degree of artifact was light in 46.6% of the cases, moderate in 30.5 %, and serious in 22.8%. The relation between the variables shows that women who were 30 years old or more presented more cases of CIN III than those below 30 (p<0.0004). Neoplasic compromise of the surgical margins and severe grade artifact occurred more often in the cases in which two or more fragments were removed from patients who were 30 years old or more. The same was observed when the cervical lesion grade was CIN III. Conclusion: Grade III cervical intraepithelial neoplasia in women 30 years old or more when removed in two or more fragments during LETZ surgery presents a greater number of margins compromised and a more severe degree of thermal artifact.
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    Avaliação do Grau e da Extensão das Alterações Térmicas Produzidas pela Cirurgia de Alta Freqüência no Colo Uterino
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2001-02-01) Taha, Nabiha Saadi Abrahão [UNIFESP]; Focchi, José [UNIFESP]; Ribalta, Julisa Chamorro Lascalas [UNIFESP]; Stávale, João Norberto [UNIFESP]; Dores, Gerson Botacini das [UNIFESP]; Lima, Geraldo Rodrigues De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: to evaluate the incidence of thermal damage to the specimens excised through large loop excision of the transformation zone (LLETZ) and to determine qualitatively and quantitatively the thermal injury to the ectocervical and endocervical epithelia as well as the influence of the menstrual phase on such process. Methods: we performed a prospective study of 100 patients with high-grade squamous intraepithelial lesions (HGSIL). Thermal damage was subdivided into three grades according to Messing et al¹. Results: thermal injury occurred in all the cases, however, through statistical analysis we found that in 91% of the cases it was insignificant, thus leading to a precise histological evaluation, hence to measure the thermal injury was unnecessary. The grade and extent of thermal damage in excised specimens using LLETZ had no relation to the menstrual phase. The extension of thermal tissue alteration in the endocervical epithelia was 271,6 mu while the extension in ectocervical epithelia was 254,8 mu, showing that the extension of thermal damage is significantly higher in endocervical epithelia. Of the one hundred patients, 80 were in menacme and 20 in menopause correlating the grade and extension of thermal damage with the menstrual state. Conclusion: there was no significant difference in both qualitative and quantitative evaluations. There is no need to measure the thermal damage.
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    Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia
    (Associação Paulista de Medicina - APM, 2012-01-01) Bittencourt, Dulcimary Dias [UNIFESP]; Zanine, Rita Maira; Sebastião, Ana Martins; Taha, Nabiha Saadi Abrahão [UNIFESP]; Speck, Neila Maria de Góis [UNIFESP]; Ribalta, Julisa Chamorro Lascasas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Paraná Department of Obstetrics and Gynecology; Centro Universidade Positivo
    CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (UNIFESP). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.
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    Resultado da cirurgia com alça de alta freqüência e localização colposcópica da área com atipia ectocervical
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2001-07-01) Cardoso, Maria Silvana [UNIFESP]; Ribalta, Julisa Chamorro Lascasas [UNIFESP]; Taha, Nabiha Saadi Abrahão [UNIFESP]; Focchi, José [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Lima, Geraldo Rodrigues [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: to evaluate the histopathologic results of cone specimens of patients undergoing loop electrosurgical excision procedure (LEEP) and their relationship with the localization of the lesion. Methods: in a retrospective study, 134 clinical reports of patients with abnormal findings of cervical cytology and/or biopsy undergoing LEEP were reviewed. The colposcopic findings were divided into three groups according to the localization of the lesion. Group I (n = 36): patients with ectocervical lesions and fully visible squamocolumnar junction; Group II (n = 50): patients with lesions at the ectocervix and endocervix, and Group III (n = 48): patients with unsatisfactory colposcopy. Results: the mean age in Group I was 33 years and there were 8.3% positive margins. In Group II the mean age was 39 years, with 36% positive margins. Group III had a mean age of 48 years and presented 29.2% positive margins. The percentage of residual disease was 4.2% in Group I, 31.6% in Group II and 35.5% in Group III. Conclusion: patients with lesions at the endocervical canal showed a higher rate of positive margins. Patients with high-grade cervical intraepithelial neoplasia at the endocervical canal and older than 40 years have a greater chance of showing positive margins and residual disease, therefore requiring stricter cytologic and colposcopic follow-up.
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    Valor do dilatador higroscópico para visualização do canal endocervical na conização com cirurgia de alta freqüência
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2004-04-01) Ferreira, Maria Silvana Cardoso; Ribalta, Julisa Chamorro Lascasas [UNIFESP]; Focchi, José [UNIFESP]; Taha, Nabiha Saadi Abrahão [UNIFESP]; Stávale, João Norberto [UNIFESP]; Linhares, Elizabete Rautman Cezarino [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Faculdade de Medicina de Itajubá; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: to evaluate the effectiveness of the hygroscopic dilator in the colposcopic examination of the endocervical canal in patients with high-grade lesion in the cytopathology and unsatisfactory colposcopy. METHODS: prospective study, including 62 patients with unsatisfactory colposcopic examination and cytology compatible with high-grade intraepithelial lesion. The patients were submitted to dilation of the endocervical canal by means of a hygroscopic dilator. After dilation, the new colposcopic findings were recorded, and then conization was made through loop electrosurgical excision procedure. The incidence of neoplasic involvement of surgical margins was compared between patients with examinations modified toward satisfactory results and those that remained with unsatisfactory colposcopy. In order to compare the incidence of involved margins and the incidence of residual disease, two retrospective control-groups were used: the GinSat group (n = 35): patients with unsatisfactory colposcopy; GSat group (n = 38): patients with satisfactory colposcopy and endocervical atypy. RESULTS: 80.6% of the cases presented satisfactory colposcopic vision after dilation. 80.4% of those presented disease-free resection margins. The incidence of disease-free resection margins in patients with persistent unsatisfactory colposcopy after dilation was 36.3%. Affected surgical margins occurred in 28% of the group that had undergone dilation, 28.5% of the cases in GinSat group, and 31.5% in the Gsat group. Follow-up showed the incidence of residual disease in 7.5% of the patients under dilation, 28.5% in the GinSat group and 28.9% in the GSat group. CONCLUSION: the use of hygroscopic dilation improved visualization of lesions of difficult access to the colposcopic examination, thus permitting reduction in the percentage of residual neoplasic disease in patients with unsatisfactory colposcopy treated with loop electrosurgical excision procedure.
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    Valor do dilatador higroscopico para visualizacao do canal endocervical uterino na cirurgia de alta frequencia
    (Universidade Federal de São Paulo (UNIFESP), 2003) Ferreira, Maria Silvana Cardoso [UNIFESP]
    Objetivo: Avaliar a eficacia do dilatador higroscopico em auxiliar o exame colposcopio do canal endocervical, em pacientes com lesao de alto grau e colposcopia insatisfatoria. Metodos: Estudo prospectivo' de, 62I pacientes com exames' colposcopicos insatisfatorios e lesao intra-epitelial de alto grau, submetidas a dilatacao) do canal endocervical por meio de dilatador higroscopico, seguido de conizacao poro cirurgia de alta frequencias Para formacao do grupo controle foram analisadas retrospectivamente 73 pacientes submetidas a conizacao por cirurgia de alta frequencia no ambulatorio de Patologia do trato genital inferior da UNIFESP-EPM no periodo de 1993 a 1999. As pacientes foram separadas em dois grupos de acordo com a localizacao das atipias: Grupo~ (n=35): pacientes com colposcopias insatisfatorias Grupo II (n=38): pacientes com colposcopias satisfatorias e atipia de localizacao endocervical. Resultado: Em 80,65 por cento dos casos a visao colposcopica apos a dilatacao foi satisfatoria. Destes, 80,40 por cento dos casos apresentaram margens de resseccao livres de doenca O mesmo ocorreu com 36,36 por cento das pacientes com colposcopias insatisfatorias persistentes apos a dilatacao O comprometimento das margens cirurgicas ocorreu em 28,07 por cento no grupo submetido a dilatacao, em 28,57 por cento dos casos i no grupo e em 31,58 por cento dos casos no grupo li. No acompanhamento das pacientes verificou-se que a porcentagem de doenca residual nas pacientes submetidas a dilatacao foi de 7,55 por cento dos casos, no grupo controle) ocorreu em 28,57 por cento e no grupo controle II em 28,95 por cento dos casos) Conclusoes O uso do dilatador higroscopico melhorou a visualizacao de lesoes de dificil acesso ao exame colposcopico, permitindo a diminuicao da porcentagem de doenca residual em pacientes com colposcopia insatisfatoria tratadas com cirurgia de alta frequencia