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- ItemAcesso aberto (Open Access)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.
- ItemAcesso aberto (Open Access)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 PositivoCONTEXT 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.
- ItemAcesso aberto (Open Access)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.