[Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests by the SPCPTGI]

Cervical cancer is one of the most common types of cancer in women. Cervical cancer screening is needed for the detection and treatment of cervical neoplastic lesions that can evolve to neoplasia and to reduce the incidence of cervical cancer. Recently, changes were made to increase the efficiency of the screening process such as employing the human papilloma virus detection test as the gold standard for cervical cancer screening and acknowledging the importance of adapting clinical practice to consider the risk of developing this neoplasia. Considering this paradigm shift, new clinical practice guidelines are now needed. For this purpose, a group of experts analyzed and discussed the most recent literature, defining recommendations and proposing clinical practice guidelines that focus on risk stratification, diagnostic evaluation, and on the therapeutical approach and follow-up of women with altered screening results. The aim of this article is to guide clinical practice regarding actions to take in face of altered results of cervical cancer screening and, consequently, to improve the secondary prevention of this condition.

Mondor's disease in puerperium: case report

Mondor's disease is a rare entity characterized by sclerosing thrombophlebitis classically involving one or more of the subcutaneous veins of the breast and anterior chest wall. It is usually a self-limited, benign condition, despite of rare cases of association to cancer. We present the case of a 32 year-old female, breast-feeding, who went to emergency due to left mastalgia for the past week. She was taking antibiotics and non-steroidal anti-inflammatory drugs, previously prescribed for suspicious of mastitis, for three days, with no clinical improvement. Physical examination showed an enlarged left breast, an axillary lump and a painful cord-like structure in the upper outer quadrant of the same breast. Ultrasound scan showed a markedly dilated superficial vein in the upper outer quadrant of left breast. The patient was given a ventropic therapy and was kept in anti-inflammatory, with progressive pain improvement. Ultrasound control was performed after four weeks, showing reperfusion.

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

<strong>Introduction:</strong> It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided.<br /><strong>Material and Methods:</strong> We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student’s t-test.<br /><strong>Results:</strong> Myometrial invasion &gt; 50% (p &lt; 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p &lt; 0.001).<br /><strong>Discussion:</strong> The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80).<br /><strong>Conclusion:</strong> Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women.

[Factors predictive of retroperitoneal lymph node metastasis in endometrial cancer]

INTRODUCTION

It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided.

MATERIAL AND METHODS

We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student's t-test.

RESULTS

Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001).

DISCUSSION

The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80).

CONCLUSION

Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women.