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- ItemAcesso aberto (Open Access)Exame histopatológico de congelação e citologia na análise de linfonodos no melanoma cutâneo(Universidade Federal de São Paulo (UNIFESP), 2016-11-30) Oliveira, Andrea Fernandes de [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; http://lattes.cnpq.br/2430172074494397; http://lattes.cnpq.br/1439516161210110; Universidade Federal de São Paulo (UNIFESP)Background: The sentinel lymph node biopsy brought great advance to melanoma treatment bringing better disease staging. This technique allows the lymph node complete histology analysis with a less invasive procedure. Nevertheless, the presence of metastasis in the sentinel lymph node requires additional lymphadenectomy. The intraoperative diagnosis of metastasis is an alternative to avoid the morbidity, but it is not a standard procedure. Purpose: The purpose was to analyze the accuracy of the cytopathology imprint and freezing biopsy in the sentinel limph node biopsy for the melanoma metastasis detection. Methods: A sample of 47 non-sentinel lymph nodes was evaluated by two independent pathologists using three histological techniques (cytology imprint, frozen section and permanent section).. The lymph nodes were excised during the lymphadenectomy. The presence or absence of atypical cells suggesting metastasis and lymph nodes were classified as positive or negative by pathologists. Results: Cytology imprint and frozen section had high concordance to permanent section for both pathologists (Kappa > 0,8). Specificity and positive predictive value were 100% to each sample, while sensibility and negative predictive value reached values higher then 75%. Conclusion: Cytology imprint and frozen section were able diagnose melanoma metastasis to the non-sentinel lymph nodes in the clinical stage III patients.
- ItemSomente MetadadadosStrategies for the management of ohss: results from freezing-all cycles(Revista De Saude Publica, 2016) Borges Junior, Edson; Braga, Daniela Paes Almeida Ferreira [UNIFESP]; Setti, Amanda Souza; Vingris, Livia S.; Figueira, Rita Cássia Savio; Iaconelli Junior, AssumptoObjective: To compare the use of GnRH agonist (GnRHa) or hCG trigger in potential OHSS patients undergoing freeze-all programs. We also compared the clinical outcomes when fresh versus freeze-thawed embryo transfers were performed in cycles with a high number of retrieved oocytes. Methods: The study included potential OHSS patients who received GnRHa (n= 74) or hCG (n= 49) trigger. The protocols were compared with respect to the clinical outcomes. We also compared the clinical outcomes of cycles in which hCG trigger was used and more than 20 MII oocytes were retrieved when: fresh embryo transfer protocol (n= 153) or freeze-all protocol (n= 123) were performed. Results: A decreased serum estradiol level, a decreased number of retrieved oocytes, an increased MII retrieved rate, and decreased fertilization rate was observed in the hCG when compared with the GnRHa group. No significant differences were noted concerning clinical outcomes. When fresh cycles were compared with frozen-thawed cycles, the estradiol serum level and the number of cryopreserved embryos were higher in the frozen-thawed cycles. The clinical pregnancy rate was higher among freeze-all cycles, as well as the implantation and cumulative pregnancy rates, when compared with fresh embryo transfer cycles. Conclusion: The use of GnRHa trigger may be a good alternative to prevent the OHSS in patients presenting an extreme ovarian response to COS, leading to similar clinical outcomes, when compared with the traditional hCG trigger. Moreover, our findings demonstrated that the strategy of freezing-all embryos not only decreases the risk of OHSS but also leads to a better pregnancy rate.