Evaluación De La Capacidad De La Citología Cervicovaginal Para Detectar Recurrencias De Cancer Cervicouterino.

[Evaluación De La Capacidad De La Citología Cervicovaginal Para Detectar Recurrencias De Cancer Cervicouterino.]

Johana Contreras1, Jorge Lasso de la Vega2

1. Departamento de Ginecología, Hospital Santo Tomás, Panamá.; 2. **Departamento de Ginecología oncológica, Instituto Oncológico Nacional, Panamá..

Publicado: 2018-08-14

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Resumen

[Evaluation of Cervicovaginal Cytology Capacity to Detect Cervical Cancer Recurrences.]

Resumen
Objetivo: Evaluar la capacidad de la citología cervicovaginal convencional en detectar recurrencias en el seguimiento de pacientes tratadas por cáncer cervicouterino. Métodos: Se realizó un estudio de cohorte retrospectivo con 483 pacientes con diagnóstico de cáncer cervicouterino en el Instituto Oncológico Nacional(ION) de Panamá en el período de 2012 a 2015 y se evalúo la capacidad diagnostica de la citología cervicovaginal convencional para detectar recurrencia de cáncer de cérvix.Resultados: De las 483 pacientes tratadas por cáncer cervicouterino, 65 (13%) presentaron recurrencias.Las recurrencias fueron detectadas por citología cervicovaginal convencional sólo en 7 pacientes (11%). La sensibilidad de la citología cervicovaginal fue de 11% con una especificidad de 100%. El VPP fue de 100% y el VPN de 88%. El cociente de probabilidad negativo fue de 0.89. La tasa de falsos positivos fue de 0% y la de falsos negativos de 89%. Conclusiones: La citología cervicovaginal de rutina no demostró sensibilidad adecuada para la detección de las recurrencias.La mayoría de las pacientes presentaron recurrencias sintomáticas asociadas a citologías negativas.

Abstract
Objective: To evaluate the ability of conventional cervicovaginal cytology to detect recurrences in the follow-up of patients treated for cervical cancer. Methods: A retrospective cohort study was conducted with 483 patients with a diagnosis of cervical cancer at the National Oncological Institute (ION) of Panama in the period from 2012 to 2015, and the diagnostic capacity of conventional cervicovaginal cytology to detect cancer recurrence was evaluated. of the cervix. Results: Of the 483 patients treated for cervical cancer, 65 (13%) presented recurrences. Recurrences were detected by conventional cervicovaginal cytology in only 7 patients (11%). The sensitivity of cervicovaginal cytology was 11% with a specificity of 100%. The VPP was 100% and the NPV was 88%. The negative likelihood ratio was 0.89. The false positive rate was 0% and the false negative rate was 89%. Conclusions: The routine cervicovaginal cytology did not demonstrate adequate sensitivity for the detection of recurrences. The majority of the patients presented symptomatic recurrences associated with negative cytologies.


Abstract

[Evaluation of Cervicovaginal Cytology Capacity to Detect Cervical Cancer Recurrences.]

Resumen
Objetivo: Evaluar la capacidad de la citología cervicovaginal convencional en detectar recurrencias en el seguimiento de pacientes tratadas por cáncer cervicouterino. Métodos: Se realizó un estudio de cohorte retrospectivo con 483 pacientes con diagnóstico de cáncer cervicouterino en el Instituto Oncológico Nacional(ION) de Panamá en el período de 2012 a 2015 y se evalúo la capacidad diagnostica de la citología cervicovaginal convencional para detectar recurrencia de cáncer de cérvix.Resultados: De las 483 pacientes tratadas por cáncer cervicouterino, 65 (13%) presentaron recurrencias.Las recurrencias fueron detectadas por citología cervicovaginal convencional sólo en 7 pacientes (11%). La sensibilidad de la citología cervicovaginal fue de 11% con una especificidad de 100%. El VPP fue de 100% y el VPN de 88%. El cociente de probabilidad negativo fue de 0.89. La tasa de falsos positivos fue de 0% y la de falsos negativos de 89%. Conclusiones: La citología cervicovaginal de rutina no demostró sensibilidad adecuada para la detección de las recurrencias.La mayoría de las pacientes presentaron recurrencias sintomáticas asociadas a citologías negativas.

Abstract
Objective: To evaluate the ability of conventional cervicovaginal cytology to detect recurrences in the follow-up of patients treated for cervical cancer. Methods: A retrospective cohort study was conducted with 483 patients with a diagnosis of cervical cancer at the National Oncological Institute (ION) of Panama in the period from 2012 to 2015, and the diagnostic capacity of conventional cervicovaginal cytology to detect cancer recurrence was evaluated. of the cervix. Results: Of the 483 patients treated for cervical cancer, 65 (13%) presented recurrences. Recurrences were detected by conventional cervicovaginal cytology in only 7 patients (11%). The sensitivity of cervicovaginal cytology was 11% with a specificity of 100%. The VPP was 100% and the NPV was 88%. The negative likelihood ratio was 0.89. The false positive rate was 0% and the false negative rate was 89%. Conclusions: The routine cervicovaginal cytology did not demonstrate adequate sensitivity for the detection of recurrences. The majority of the patients presented symptomatic recurrences associated with negative cytologies.

Citas

[1] Haie-Meder C, Morice P, Castiglione M. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010; 21(5):37-40.

[2] Quinn M, Benedet J, Odicino F, Maisonneuve P, Beller U, Creasman W et al. Carcinoma of the Cervix Uteri. Int J Gynaecol Obstet. 2006; 95(1):43-103.

[3] Randall ME, Fracasso PM, Toita T, Tedjarati SS, Michael H. Cervix. In: Barakat R, Berchuck A, Markman M, Randall M. Principles and practice of gynecologic oncology. 6th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.598p.

[4] Wiebe E, Denny L, Thomas G. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2012; 119(2):100-109.

[5] Campion MJ, Canfell K. Cervical Cancer screening and Preinvasive Disease. In: Berek J, Hacker N. Berek & Hacker's gynecologic oncology. 5th ed. Philadelphia, Pa [u.a.]. : Lippincott, Williams & Wilkins; 2010.242p.

[6] Sankaranarayanan R, Ferlay J. Worldwide burden of gynecological cancer: The size of the problem. Best Pract Res Clin Obstetric Gynaecol. 2006; 20(2):207-225.

[7] Estadísticas de cáncer en los Estados Unidos. Informe electrónico sobre incidencia y mortalidad 1999–2012. Atlanta (GA): Departamento de Salud y Servicios Humanos, Centros para el Control y la Prevención de Enfermedades e Instituto Nacional del Cáncer; 2015 [citado 26 de junio de 2016]. . Recuperado a partir de: http://www.cdc.gov/uscs.

[8] Shanta V, Krishnamurthi S, Gajalakshmi CK, Swaminathan R, Ravichandran K.. Epidemiology of cancer of the cervix: global and national perspective. J Indian Med Assoc. 2000:98(2): 49-52.

[9] National Health and Medical Research Council (NHMRC). Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities.Canberra, ACT: NHMRC, 2005.

[10] Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009; 105(2):103-104.

[11] Landoni F, Maneo A, Cormio G, et al. Class II versus Class III Radical Hysterectomy in Stage IB–IIA Cervical Cancer: A Prospective Randomized Study. Gynecol Oncol . 2001; 80(1):3-12.

[12] Eralp Y, Saip P, Sakar B, et al. Prognostic factors and survival in patients with metastatic or recurrent carcinoma of the uterine cervix.Int J Gynecol Cancer. 2003;13(4):497-504

[13] Lee S, Kim Y, Son W, et al. The efficacy of conservative management after conization in patients with stage IA1 micro invasive cervical carcinoma. Act Obstetric Gynecol Scand. 2009; 88(2):209-215.

[14] Peters W, Liu P, Barrett R, et al. Concurrent Chemotherapy and Pelvic Radiation Therapy Compared With Pelvic Radiation Therapy Alone as Adjuvant Therapy After Radical Surgery in High-Risk Early-Stage Cancer of the Cervix. Obstet Gynecol Surv. 2000; 55(8):491-492.

[15] Rotman M, Sedlis A, Piedmonte M, et al. A phase III randomized trial of postoperative pelvic irradiation in stage IB cervical carcinoma with poor prognostic features: Follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys. 2006; 65(1):169-176.

[16] Moore D, Blessing J, McQuellon R, et al. Phase III Study of Cisplatin With or Without Paclitaxel in Stage IVB, Recurrent, or Persistent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study. J Clin Oncol. 2004;22(15):3113-3119.

[17] Koh WJ, Greer, BE, Abu-Rustum NR, et al. Cervical Cancer Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network (NCCN). 2013;2(6):612

[18] Ansink A, Barros Lopes A, Naik R, Monaghan J. Recurrent Stage IB cervical carcinoma: evaluation of the effectiveness of routine follow up surveillance. BJOG. 1996; 103(11):1156-1158.

[19] Haasbeek C, Uitterhoeve A, van der Velden J, González D, Stalpers L. Long-term results of salvage radiotherapy for the treatment of recurrent cervical carcinoma after prior surgery. Radiother Oncol. 2008; 89(2):197-204.

[20] Instituto Nacional de Estadística y Censo (INEC), de la Contraloría General de la República, 2014.

[21] Elit L, Fyles A, Oliver T, Devries-Aboud M, Fung-Kee-Fung M. Follow-up for women after treatment for cervical cancer. Curr Oncol. 2010; 17(3).

[22] Lim K, Howells R, Evans A. The role of clinical follow up in early stage cervical cancer in South Wales. BJOG.2004; 111(12):1444-1448.

[23] Gibb RK, Martens MG. The Impact of Liquid-Based Cytology in Decreasing the Incidence of Cervical Cancer. Rev Obstet Gynecol. 2011;4(1):2-11.

[24] National Institute for Clinical Excellence (NICE). Guidance on the use of liquid-based cytology for cervical screening.October2003.NICE: Technology Appraisal.

[25] Departamento de registros y estadísticas de Salud. Instituto oncológico nacional de Panamá. 2014.

[26] Lai, C.H. Management of recurrent cervical cancer. Chang Gung Med J. 2004; 27(10):711-717

[27] Aguilar P, Valdivia H. Características clínico patológicas del cáncer de cérvix uterino recurrente después de cirugía radical primaria. Rev. Med Hered. 2012; 23(1):30-35.

[28] Soisson A, Geszler G, Soper J, Berchuck A, Clarke-Pearson D. A comparison of symptomatology, physical examination, and vaginal cytology in the detection of recurrent cervical carcinoma after radical hysterectomy. Int J Gynaecol Obstet. 1991;34(3):296-296.

[29] Carley S, Dosman S, Jones SR, Harrison M. Simple nomogram to calculate sample size diagnostic studies. Emerg Med J 2005;22:180-181.

[30] Larson D, Copeland L, Stringer C, Gershenson D, Malone J, Edwards C. Recurrent cervical carcinoma after radical hysterectomy.

[31] Gynecol Oncol. 1988; 30(3):381-387.

[32] Bodurka-Bevers D, Morris M, Eifel P, et al. Posttherapy Surveillance of Women with Cervical Cancer: An Outcomes Analysis.

[33] Gynecol Oncol. 2000;78(2):187-193.

[34] Rimel B, Ferda A, Erwin J, et al. Cervicovaginal Cytology in the Detection of Recurrence after Cervical Cancer Treatment. Obstet Gynecol. 2011;118(3):548-553

[35] Owen P, Duncan ID. Is there any value in the long term follow up of women treated for endometrial cancer? BJOG. 1996; 103(7):710-713.

[36] Elliott P, Coppleson M, Russell P, et al. Early invasive (FIGO stage IA) carcinoma of the cervix: a clinic-pathologic study of 476 cases.Int J Gynecol Cancer. 2000;10(1):42-52.

[37] Benn T, Brooks R, Zhang Q, et al. Pelvic exenteration in gynecologic oncology: A single institution study over 20 years.Gynecol Oncol. 2011; 122(1):14-18.

[38] Höckel M, Dornhöfer N. Pelvic exenteration for gynecological tumors: achievements and unanswered questions. Lancet Oncol. 2006; 7(10):837-847.

[39] Zola P, Fuso L, Mazzola S, et al. Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis. Gynecol Oncol. 2007; 107(1):150–154.

[40] Ghaemmaghami F, Saleh-Gargari S, Sahebdel B, Behtash N, Samiei F. Risk Factors and Clinical Aspects of Recurrent Invasive Cervical Carcinoma. J Obstet Gynaecol India. 2012; 62(6):674-678.

[41] Friedlander M, Grogan M, U.S. Preventative Services Task Force. Guidelines for the treatment of recurrent and metastatic cervical cancer. Oncologist. 2002; 7(4):342-347

[42] Morice P, Deyrolle C, Rey A, et al. Value of routine follow-up procedures for patients with stage I/II cervical cancer treated with combined surgery–radiation therapy. Ann Oncol. 2004; 15(2):218-223.

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