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dos Santos BM, Araujo E, Zanine RM. Is the colposcopic lesion size a predictor of high-grade lesions in young patients? EINSTEIN-SAO PAULO 2024; 22:eAO0462. [PMID: 38985016 PMCID: PMC11213560 DOI: 10.31744/einstein_journal/2024ao0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 12/04/2023] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age. METHODS This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05. RESULTS The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings. CONCLUSION The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.
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Affiliation(s)
- Beatriz Mokwa dos Santos
- Universidade Federal do ParanáHospital das ClínicasDepartment of Obstetrics and GynecologyCuritibaPRBrazilDepartment of Obstetrics and Gynecology, Hospital das Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Edward Araujo
- Universidade Federal de São PauloEscola Paulista de MedicinaDepartment of ObstetricsSão PauloSPBrazilDepartment of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | - Rita Maira Zanine
- Universidade Federal do ParanáHospital das ClínicasDepartment of Obstetrics and GynecologyCuritibaPRBrazilDepartment of Obstetrics and Gynecology, Hospital das Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Kovács I, Székely T, Pogány P, Takács S, Erős M, Járay B. Utilizing the open-source programming language Python to create interactive Quality Assurance dashboards for diagnostic and screening performance in Cytology. J Am Soc Cytopathol 2024; 13:309-318. [PMID: 38702208 DOI: 10.1016/j.jasc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Effective feedback on cytology performance relies on navigating complex laboratory information system data, which is prone to errors and lacks flexibility. As a comprehensive solution, we used the Python programming language to create a dashboard application for screening and diagnostic quality metrics. MATERIALS AND METHODS Data from the 5-year period (2018-2022) were accessed. Versatile open-source Python libraries (user developed program code packages) were used from the first step of LIS data cleaning through the creation of the application. To evaluate performance, we selected 3 gynecologic metrics: the ASC/LSIL ratio, the ASC-US/ASC-H ratio, and the proportion of cytologic abnormalities in comparison to the total number of cases (abnormal rate). We also evaluated the referral rate of cytologists/cytotechnologists (CTs) and the ratio of thyroid AUS interpretations by cytopathologists (CPs). These were formed into colored graphs that showcase individual results in established, color-coded laboratory "goal," "borderline," and "attention" zones based on published reference benchmarks. A representation of the results distribution for the entire laboratory was also developed. RESULTS We successfully created a web-based test application that presents interactive dashboards with different interfaces for the CT, CP, and laboratory management (https://drkvcsstvn-dashboards.hf.space/app). The user can choose to view the desired quality metric, year, and the anonymized CT or CP, with an additional automatically generated written report of results. CONCLUSIONS Python programming proved to be an effective toolkit to ensure high-level data processing in a modular and reproducible way to create a personalized, laboratory specific cytology dashboard.
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Santos GRBD, Cunha APA, Batista ZDS, Silva MACND, Figueiredo FVD, Santos FRBD, Fraga EDC, Barros MC, Vidal FCB, Nascimento MDDSB. HPV 18 variants in women with cervical cancer in Northeast Brazil. Braz J Infect Dis 2022; 27:102734. [PMID: 36587927 PMCID: PMC9871062 DOI: 10.1016/j.bjid.2022.102734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/16/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Human Papillomavirus (HPV) is the main etiological factor for the development of cervical cancer. HPV 18 is the second most frequent type, accounting for up to 65% of all cases. HPV intratypic variation may influence the potential for progression to invasive cancer. The aim of this study was to evaluate the prevalence of human papillomavirus 18 intratypic variants in cervical cancer samples from women in the state of Maranhão, Brazil. METHODS The study included 118 women over 18 years of age with a diagnosis of cervical cancer. Tumor fragments were collected and subjected to DNA extraction and Polymerase Chain Reaction (PCR) for HPV detection using the PGMY09/11 and GP+5/6 primers. Positive samples were submitted to automated sequencing for viral genotyping. To determine the HPV 18 lineages, positive samples were submitted to PCR, using specific primers to amplify the LCR and E6 regions of HPV 18 virus. RESULTS HPV was present in 88 women (73.3%). Of those, 48 (54%) were HPV 16, the most prevalent, followed by 12 (13.6%) HPV 18. Histologically, squamous cell carcinoma was predominant (79.1%). Among the HPV 18 variants identified, 10 (80%) belonged to lineage A, and sublineages A1, A2, A3, and A4. Two (29%) HPV 18 B variant was also detected, with the sublineages B1 and B2. In this study, the C variant was not found. There was no statistically significant association between the HPV 18 lineages found and sociodemographic and lifestyle variables (p > 0.05). CONCLUSIONS A higher frequency of HPV 16 and 18 were found in women with cervical cancer in the state of Maranhão, Brazil, with a high prevalence of the lineage A among women with HPV 18.
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Affiliation(s)
| | - Ana Paula Almeida Cunha
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde do Adulto, São Luís, MA, Brazil
| | - Zulmira da Silva Batista
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde do Adulto, São Luís, MA, Brazil
| | | | - Fábio Vidal de Figueiredo
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Saúde do Adulto, São Luís, MA, Brazil
| | | | - Elmary da Costa Fraga
- Centro de Estudos Superiores de Caxias (CESC), da Universidade Estadual do Maranhão (UEMA), Caxias, MA, Brazil
| | - Maria Claudene Barros
- Centro de Estudos Superiores de Caxias (CESC), da Universidade Estadual do Maranhão (UEMA), Caxias, MA, Brazil
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Hovhannisyan L, Coelho LE, Velasque L, De Boni RB, Clark J, Cardoso SW, Lake J, Veloso VG, Grinsztejn B, Luz PM. Multilevel Analysis of Individual and Neighborhood Characteristics Associated with Viral Suppression Among Adults with HIV in Rio de Janeiro, Brazil. AIDS Behav 2022; 26:947-962. [PMID: 34564777 PMCID: PMC8898026 DOI: 10.1007/s10461-021-03450-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
Understanding the impact of neighborhood context on viral suppression outcomes may help explain health disparities and identify future interventions. We assessed the relationship between individual characteristics, neighborhood socioeconomic context, and viral suppression using multilevel logistic regression models. Adults with HIV initiating antiretroviral therapy (ART) between 2000 and 2017, who resided in Rio de Janeiro and had an HIV-1 RNA level (viral load) measured 90-270 days after ART initiation were included. Overall, 83.9% achieved viral suppression. Participants who were older, had a higher level of education, and identified as heterosexual cisgender men and cisgender men-who-have-sex-with-men had increased odds of viral suppression. Later calendar year of ART initiation carried the strongest association with viral suppression, reflecting the increased effectiveness and tolerability of ART over time. Neighborhood socioeconomic indicators did not predict viral suppression in unadjusted or adjusted analyses, which may result from the integrated care provided in our health care facility together with Brazil's universal treatment.
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Affiliation(s)
- Lyolya Hovhannisyan
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA.
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA.
| | - Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Raquel B De Boni
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jesse Clark
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jordan Lake
- South American Program in HIV Prevention Research (SAPHIR), University of California Los Angeles, Los Angeles, USA
- Department of Medicine, Division of Infectious Diseases, McGovern Medical School at University of Texas Health Science Center at Houston (UTHealth) , Houston, USA
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Bueno AX, Firmino RT, Pordeus IA, Mattos FF, Granville-Garcia AF, Ferreira FM, Paiva SM. Human Development and Dental Caries in 12-Year-Old Brazilian Schoolchildren. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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da Silva RL, da Silva Batista Z, Bastos GR, Cunha APA, Figueiredo FV, de Castro LO, Dos Anjos Pereira L, da Silva MACN, Vidal FCB, Barros MC, da Costa Fraga E, Brito LMO, do Carmo Lacerda Barbosa M, Moreira MÂM, do Desterro Soares Brandão Nascimento M. Role of HPV 16 variants among cervical carcinoma samples from Northeastern Brazil. BMC Womens Health 2020; 20:162. [PMID: 32738888 PMCID: PMC7395427 DOI: 10.1186/s12905-020-01035-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cervical cancer is the fourth most common type of cancer affecting women globally. In Brazil, it is the third most frequent type of cancer in women and HPV is present in approximately 90% of cases. Evidence suggests that variants of HPV 16 can interfere biologically and etiologically during the development of cervical cancer. METHODS Cervix tumor fragments were collected, their DNA was extracted, and nested PCR was used to detect HPV. Positive samples were sequenced to determine the viral genotype. To characterize the HPV 16 strains, positive samples PCR was used to amplify the LCR and E6 regions of the HPV 16 virus. RESULTS Data from 120 patients with cervical cancer were analyzed. Most women were between 41 and 54 years of age, had schooling until primary school, a family income between 1 and 2 times the minimum wage and were married/in a consensual union. There was no statistically significant association between HPV or socio-demographic variables and risk factors for cervical cancer (P < 0.05). HPV was present in 88 women (73%). The most prevalent types were HPV 16 (53.4%), HPV 18 (13.8%), HPV 35 (6.9%) and HPV 45 (5.7%). Of the 47 HPV 16 positive cases, variant A (49%) was present in 23 samples, followed by variant D in 20 cases (43%), and variants B and C in 2 cases each (4%). The most prevalent histological type of HPV 16 tumors was squamous cell carcinoma, followed by adenocarcinoma. There was a statistically significant association between HPV 16 variants and the tumors' histological types (P < 0.001). CONCLUSIONS Knowledge of HPV 16 variants will provide data on their influence on the pathological and oncogenic aspects of cervical lesions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Maria Claudene Barros
- Center of Advanced Studies of Caxias (CESC), State University of Maranhão (UEMA), Caxias, Maranhão, Brazil
| | - Elmary da Costa Fraga
- Center of Advanced Studies of Caxias (CESC), State University of Maranhão (UEMA), Caxias, Maranhão, Brazil
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Costa RFA, Longatto-Filho A, de Lima Vazquez F, Pinheiro C, Zeferino LC, Fregnani JHTG. The Quality of Pap Smears from the Brazilian Cervical Cancer Screening Program According to the Human Development Index. Cancer Prev Res (Phila) 2019; 13:299-308. [PMID: 31836602 DOI: 10.1158/1940-6207.capr-19-0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/13/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
Brazil is a country with strong socioeconomic disparities, which may explain the different rates of cervical cancer incidence and mortality and influence the quality of cervical cancer screening tests. The aim of this study was to perform a trend analysis of some quality indicators of Pap smears according to the Municipal Human Development Index (MHDI). Information about cytopathological exams (approximately 65,000,000) performed from 2006 to 2014 in women ages 25 to 64 years was obtained from the Cervical Cancer Information System (SISCOLO). The average annual percentage change (AAPC) for each indicator was calculated using the Joinpoint Regression Program, according to MHDI levels. Very low frequencies of unsatisfactory cases (<5%) were observed at different MHDI levels. Although the positivity index in the low- and medium-MHDI groups has increased, the values remained below international recommendations (3%-10%). The HSIL (high-grade squamous intraepithelial lesion) percentage remained stationary at all levels of the MHDI. In the low- and medium-MHDI groups, most quality indicators were below the recommendations by Brazilian National Cancer Institute INCA, with no improvement trend; in the high-MHDI group, the majority of the indicators also presented no improvement, although they show slightly better quality indicators. The MHDI should be considered in the definition of the policies of the screening program for cervical cancer in Brazil, and the current program may require adjustments to achieve improved efficiency.
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Affiliation(s)
- Ricardo Filipe Alves Costa
- Graduate Program on Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. .,Barretos School of Health Sciences Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo University, FMUSP, São Paulo, Brazil.,Life and Health Sciences Research Institute, ICVS, School of Health Sciences, Minho University, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Céline Pinheiro
- Barretos School of Health Sciences Dr. Paulo Prata-FACISB, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luiz Carlos Zeferino
- School of Medical Sciences, Women's Hospital CAISM, Unicamp, Campinas, São Paulo, Brazil
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Coelho RWP, Pinho JD, Moreno JS, Garbis DVEO, do Nascimento AMT, Larges JS, Calixto JRR, Ramalho LNZ, da Silva AAM, Nogueira LR, de Moura Feitoza L, Silva GEB. Penile cancer in Maranhão, Northeast Brazil: the highest incidence globally? BMC Urol 2018; 18:50. [PMID: 29843769 PMCID: PMC5975591 DOI: 10.1186/s12894-018-0365-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/14/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The objectives of this study were to determine the minimum incidence of penile cancer in the poorest Brazilian state, and to describe the epidemiologic and clinical characteristics of patients diagnosed with the disease. METHODS A retrospective study of 392 patients diagnosed with penile cancer in the three most important referral center in the state was conducted during 2004-2014. RESULTS The age-standardized incidence was 6.15 per 100,000 and the crude annual incidence was 1.18 per 100,000. More than half (61.1%) of the tumors were histological grades 2 and 3, and 66.4% of tumors were classified as at least stage T2. The average age of patients was 58.6 ± 15.7 years (range, 18 to 103 years), with 20.8% of patients ≤40 years of age at diagnosis. The vast majority underwent penectomy (93%). Only 41.8% underwent lymphadenectomy, 58 patients (14.8%) received chemotherapy, and 54 patients (13.8%) received radiotherapy. Stage 3/4 and vascular invasion were statically significant at disease-free survival analysis. CONCLUSION The state of Maranhão has the highest incidence of penile cancer in Brazil and globally. Tumors are locally advanced and at the time of diagnosis, and there is a high frequency among young individuals. Patients have a low socioeconomic status, making it difficult to complete treatment and receive appropriate follow-up.
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Affiliation(s)
| | - Jaqueline Diniz Pinho
- Federal University of Pará, Brazil, Gov. José Malcher Avenue, Belém, 66055-260, Brazil
| | - Janise Silva Moreno
- Aldenora Bello Cancer Hospital, Seroa da Mota Street, Apeadouro, São Luís, 65031-630, Brazil
| | | | | | - Joyce Santos Larges
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil
| | - José Ribamar Rodrigues Calixto
- Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil
| | - Leandra Naira Zambelli Ramalho
- Department of Radiology and Pathology, Ribeirão Preto Medical School of University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, 14049-900, Brazil
| | - Antônio Augusto Moura da Silva
- Public Heath Departament, Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
| | | | - Laisson de Moura Feitoza
- Federal University of Maranhão, São Luís, Brazil, dos Portugueses Avenue, Bacanga, São Luís, 65080-805, Brazil
| | - Gyl Eanes Barros Silva
- University Hospital of Federal University of Maranhão, Barão de Itapari Street, Centro, São Luís, Brazil.
- Department of Radiology and Pathology, Ribeirão Preto Medical School of University of São Paulo, Bandeirantes Avenue, Monte Alegre, Ribeirão Preto, 14049-900, Brazil.
- Ribeirão Preto Medical School - USP, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
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