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Revista de Investigacion Clinica;... 2010Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In...
INTRODUCTION
Endometrial cancer (EC) is the second most common gynecologic malignancy worldwide in the peri and postmenopausal period. Most often for the endometrioid variety. In early clinical stages long-term survival is greater than 80%, while in advanced stages it is less than 50%. In our country there is not a standard management between institutions. GICOM collaborative group under the auspice of different institutions have made the following consensus in order to make recommendations for the management of patients with this type of neoplasm.
MATERIAL AND METHODS
The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of four days in which a debate was held. These statements are the conclusions reached by agreement of the participant members.
RESULTS
Screening should be performed women at high risk (diabetics, family history of inherited colon cancer, Lynch S. type II). Endometrial thickness in postmenopausal patients is best evaluated by transvaginal US, a thickness greater than or equal to 5 mm must be evaluated. Women taking tamoxifen should be monitored using this method. Abnormal bleeding in the usual main symptom, all post menopausal women with vaginal bleeding should be evaluated. Diagnosis is made by histerescopy-guided biopsy. Magnetic resonance is the best image method as preoperative evaluation. Frozen section evaluates histologic grade, myometrial invasion, cervical and adnexal involvement. Total abdominal hysterectomy, bilateral salpingo oophorectomy, pelvic and para-aortic lymphadenectomy should be performed except in endometrial histology grades 1 and 2, less than 50% invasion of the myometrium without evidence of disease out of the uterus. Omentectomy should be done in histologies other than endometriod. Surgery should be always performed by a Gynecologic Oncologist or Surgical Oncologist, laparoscopy is an alternative, especially in patients with hypertension and diabetes for being less morbid. Adjuvant treatment after surgery includes radiation therapy to the pelvis, brachytherapy, and chemotherapy. Patients with Stages III and IV should have surgery with intention to achieve optimal cytoreduction because of the impact on survival (51 m vs. 14 m), the treatment of recurrence can be with surgery depending on the pattern of relapse, systemic chemotherapy or hormonal therapy. Follow-up of patients is basically clinical in a regular basis.
CONCLUSIONS
Screening programme is only for high risk patients. Multidisciplinary treatment impacts on survival and local control of the disease, including surgery, radiation therapy and chemotherapy, hormonal treatment is reserved to selected cases of recurrence. This is the first attempt of a Mexican Collaborative Group in Gynecology to give recommendations is a special type of neoplasm.
Topics: Antineoplastic Agents; Carcinoma; Chemotherapy, Adjuvant; Combined Modality Therapy; Diagnostic Imaging; Endometrial Neoplasms; Estrogen Antagonists; Estrogen Replacement Therapy; Estrogens; Evidence-Based Medicine; Female; Humans; Hysterectomy; Laparoscopy; Lymph Node Excision; Mass Screening; Mexico; Neoplasm Staging; Radiotherapy, Adjuvant; Risk Factors; Salvage Therapy; Tamoxifen
PubMed: 21416918
DOI: No ID Found -
Archives of Gynecology and Obstetrics Mar 2011Endosalpingiosis is a disorder of Mullerian system characterized by benign glands lined by tubal type epithelium and involves the peritoneum, subperitoneal tissues, and... (Review)
Review
INTRODUCTION
Endosalpingiosis is a disorder of Mullerian system characterized by benign glands lined by tubal type epithelium and involves the peritoneum, subperitoneal tissues, and retroperitoneal lymph nodes. Endosalpingiosis is almost an incidental finding on microscopic examination. Seldom it appears as a cyst and it can be confused clinically for an ovarian tumor.
DESIGN
A case report and a systematic review about pelvic mass-like florid endosalpingiosis of the uterus from PUB MED database were performed.
PATIENT(S)
We describe a case report of a 50-year-old woman with a pedunculated uterine neoformation, for which the preoperative exams could be compatible with an adnexal mass. Twelve patients with similar clinical history were discussed in the review.
TREATMENT
Laparoscopy with radical exeresis was performed.
RESULTS
Microscopic exam revealed florid cystic endosalpingiosis of the uterus.
CONCLUSIONS
Endosalpingiosis is a rare mullerian disorder and the main problem is that the symptomatology is not specific and it may be initially misinterpreted. In relation to the papillary aspect of the lesion and focal calcifications, the histological differential diagnosis could include serous adenocarcinoma, but the lack of cellular stratification in absence of mitotic activity, and the presence of slight nuclear atypia contradict the diagnosis of carcinoma. The differential diagnosis for endosalpingiosis also includes multiple peritoneal inclusion cysts (benign cystic mesothelioma). The aim of this case report has not been only to describe the rarity of this pathology, but it contributes to consider endosalpingiosis as a possible diagnostic hypothesis for which may be indicated a conservative surgical treatment.
Topics: Cysts; Diagnosis, Differential; Endometriosis; Fallopian Tube Diseases; Female; Humans; Laparoscopy; Middle Aged; Pelvis; Treatment Outcome
PubMed: 20931212
DOI: 10.1007/s00404-010-1700-1 -
Obstetrics and Gynecology Feb 2009To perform a systematic review of the literature on the accuracy of prediction models in the preoperative assessment of adnexal masses.
OBJECTIVE
To perform a systematic review of the literature on the accuracy of prediction models in the preoperative assessment of adnexal masses.
DATA SOURCES
Studies were identified through the MEDLINE and EMBASE databases from inception to March 2008. The MEDLINE search was performed using the keywords ["ovarian neoplasms"[MeSH] NOT "therapeutics"[MeSH] AND "model"] and ["ovarian neoplasms"[MeSH] NOT "therapeutics"[MeSH] AND "prediction"]. The Embase search was performed using the keywords [ovary tumor AND prediction], [ovary tumor AND Mathematical model], and [ovary tumor AND statistical model].
METHODS OF STUDY SELECTION
The search detected 1,161 publications; from the cross-references, another 116 studies were identified. Language restrictions were not applied. Eligible studies contained data on the accuracy of models predicting the risk of malignancy in ovarian masses. Models were required to combine at least two parameters.
TABULATION, INTEGRATION, AND RESULTS
Two independent reviewers selected studies and extracted study characteristics, study quality, and test accuracy. There were 109 accuracy studies that met the selection criteria. Accuracy data were used to form two-by-two contingency tables of the results of the risk score compared with definitive histology. We used bivariate meta-analysis to estimate pooled sensitivities and specificities and to fit summary receiver operating characteristic curves.Studies included in our analysis reported on 83 different prediction models. The model developed by Sassone was the most evaluated prediction model. All models has acceptable sensitivity and specificity. However, the Risk of Malignancy Index I and the Risk of Malignancy Index II, which use the product of the serum CA 125 level, an ultrasound scan result, and the menopausal state, were the best predictors. When 200 was used as the cutoff level, the pooled estimate for sensitivity was 78% for a specificity of 87%.
CONCLUSION
Based on our review, the Risk of Malignancy Index should be the prediction model of choice in the preoperative assessment of the adnexal mass.
Topics: Biomarkers; Female; Humans; Models, Biological; Ovarian Neoplasms; Predictive Value of Tests; ROC Curve; Risk Factors; Ultrasonography
PubMed: 19155910
DOI: 10.1097/AOG.0b013e318195ad17 -
International Journal of Epidemiology Apr 2009Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was... (Review)
Review
BACKGROUND
Screening programmes are promoted to control transmission of and prevent female reproductive tract morbidity caused by genital chlamydia. The objective of this study was to examine the effectiveness of register-based and opportunistic chlamydia screening interventions.
METHODS
We searched seven electronic databases (Cinahl, Cochrane Controlled Trials Register, DARE, Embase, Medline, PsycINFO and SIGLE) without language restrictions from January 1990 to October 2007 and reference lists of retrieved articles to identify studies published before 1990. We included studies examining primary outcomes (pelvic inflammatory disease, ectopic pregnancy, infertility, adverse pregnancy outcomes, neonatal infection, chlamydia prevalence) and harms of chlamydia screening in men and non-pregnant and pregnant women. We extracted data in duplicate and synthesized the data narratively or used random effects meta-analysis, where appropriate.
RESULTS
We included six systematic reviews, five randomized trials, one non-randomized comparative study and one time trend study. Five reviews recommended screening of women at high risk of chlamydia. Two randomized trials found that register-based screening of women at high risk of chlamydia and of female and male high school students reduced the incidence of pelvic inflammatory disease in women at 1 year. Methodological inadequacies could have overestimated the observed benefits. One randomized trial showed that opportunistic screening in women undergoing surgical termination of pregnancy reduced post-abortal rates of pelvic inflammatory disease compared with no screening. We found no randomized trials showing a benefit of opportunistic screening in other populations, no trial examining the effects of more than one screening round and no trials examining the harms of chlamydia screening.
CONCLUSION
There is an absence of evidence supporting opportunistic chlamydia screening in the general population younger than 25 years, the most commonly recommended approach. Equipoise remains, so high-quality randomized trials of multiple rounds of screening with biological outcome measures are still needed to determine the balance of benefits and harms of chlamydia screening.
Topics: Adolescent; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Humans; Male; Mass Screening; Pelvic Inflammatory Disease; Program Evaluation; Research Design; Young Adult
PubMed: 19060033
DOI: 10.1093/ije/dyn222 -
Annals of Internal Medicine Jul 2007Chlamydial infection is the most common sexually transmitted bacterial infection in the United States, with an estimated 3 million new cases annually. In 2001, the U.S.... (Review)
Review
BACKGROUND
Chlamydial infection is the most common sexually transmitted bacterial infection in the United States, with an estimated 3 million new cases annually. In 2001, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians screen all sexually active women at increased risk for infection for Chlamydia trachomatis.
PURPOSE
To summarize a systematic evidence review commissioned by the USPSTF in preparation for an update of its 2001 recommendation.
DATA SOURCES
English-language articles identified in PubMed between July 2000 and July 2005. Additional articles were identified by bibliographic reviews and discussions with experts. A total of 452 articles were identified.
STUDY SELECTION
Explicit inclusion and exclusion criteria were used for each of 3 key questions. For studies of screening in nonpregnant women at increased risk, review was limited to randomized, controlled trials. For other groups, both randomized, controlled studies and nonrandomized, prospective, controlled studies were included.
DATA ABSTRACTION
Using standardized forms, staff of the Agency for Healthcare Research and Quality abstracted data on study design, setting, sample, randomization, blinding, results, and harms.
DATA SYNTHESIS
Only 1 new study met inclusion criteria. This poor-quality study of the effectiveness of screening for chlamydial infection among nonpregnant women at increased risk found that screening was associated with a lower prevalence of chlamydial infection and fewer reported cases of pelvic inflammatory disease at 1-year follow-up.
LIMITATIONS
No new evidence was found on screening in pregnant women, nonpregnant women not at increased risk, or men.
CONCLUSIONS
A systematic review found a small amount of new evidence to inform the USPSTF as it updates its recommendations regarding screening for chlamydial infection. There are large gaps in the evidence about screening men to improve health outcomes in women.
Topics: Adolescent; Chlamydia Infections; Cost of Illness; Evidence-Based Medicine; Female; Health Services Needs and Demand; Health Services Research; Humans; Male; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Risk Factors; United States
PubMed: 17576995
DOI: 10.7326/0003-4819-147-2-200707170-00173 -
Sexually Transmitted Infections Jun 2006To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. (Review)
Review
OBJECTIVE
To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening.
METHODS
Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used.
RESULTS
Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult.
CONCLUSION
The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area.
Topics: Adolescent; Adult; Aged; Bacteriological Techniques; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Cost-Benefit Analysis; Female; Humans; Male; Mass Screening; Middle Aged
PubMed: 16731666
DOI: 10.1136/sti.2005.017517 -
BMJ (Clinical Research Ed.) Apr 2006To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate factors predisposing women to chronic and recurrent pelvic pain. DESIGN, DATA SOURCES, AND METHODS: Systematic review of relevant studies without language restrictions identified through Medline, Embase, PsycINFO, Cochrane Library. SCISEARCH, conference papers, and bibliographies of retrieved primary and review articles. Two reviewers independently extracted data on study characteristics, quality, and results. Exposure to risk factors was compared between women with and without pelvic pain. Results were pooled within subgroups defined by type of pain and risk factors.
RESULTS
There were 122 studies (in 111 articles) of which 63 (in 64,286 women) evaluated 54 risk factors for dysmenorrhoea, 19 (in 18,601 women) evaluated 14 risk factors for dyspareunia, and 40 (in 12,040 women) evaluated 48 factors for non-cyclical pelvic pain. Age < 30 years, low body mass index, smoking, earlier menarche (< 12 years), longer cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilisation, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhoea. Younger age at first childbirth, exercise, and oral contraceptives were negatively associated with dysmenorrhoea. Menopause, pelvic inflammatory disease, sexual abuse, anxiety, and depression were associated with dyspareunia. Drug or alcohol abuse, miscarriage, heavy menstrual flow, pelvic inflammatory disease, previous caesarean section, pelvic pathology, abuse, and psychological comorbidity were associated with an increased risk of non-cyclical pelvic pain.
CONCLUSION
Several gynaecological and psychosocial factors are strongly associated with chronic pelvic pain. Randomised controlled trials of interventions targeting these potentially modifiable factors are needed to assess their clinical relevance in chronic pelvic pain.
Topics: Chronic Disease; Dysmenorrhea; Dyspareunia; Female; Humans; Pelvic Pain; Regression Analysis; Risk Factors
PubMed: 16484239
DOI: 10.1136/bmj.38748.697465.55 -
Nederlands Tijdschrift Voor Geneeskunde Apr 2005To determine the rate of PID in women with genital Chlamydia trachomatis infection. (Review)
Review
OBJECTIVE
To determine the rate of PID in women with genital Chlamydia trachomatis infection.
DESIGN
Systematic literature review.
METHOD
MEDLINE and EMBASE were searched over the years 1975-2003 using the keywords 'Chlamydia trachomatis', 'complication', 'pelvic (inflammatory disease)', 'PID', 'endometritis', 'adnexitis', and 'salpingitis'. The reference lists ofthe articles retrieved were checked for other relevant publications. The PID complication rate was determined, as were the characteristics of the study populations and the validity of the diagnostic methods and outcome measures used.
RESULTS
9 prospective studies were identified. The rate of PID in women with a genital C. trachomatis infection varied between o and 72%. Asymptomatic women who were diagnosed with C. trachomatis infection in general screening had the lowest rate of PID: 0-4%. PID occurred in 12-30% of symptomatic women or women with a higher risk of having an STD (e.g. visitor of an STD clinic, double-infection with gonorrhoea, high risk assessed by questionnaire, having a partner with symptomatic C. trachomatis infection). Women who underwent legal abortion had the highest rate of PID (27-72%).
CONCLUSION
The PID rate in women with C. trachomatis varied considerably. Risk depended on whether the infection was symptomatic and the prior probability of having an STD.
Topics: Adult; Chlamydia Infections; Chlamydia trachomatis; Female; Genital Diseases, Female; Humans; Mass Screening; Meta-Analysis as Topic; Netherlands; Pelvic Inflammatory Disease; Risk Factors
PubMed: 15868993
DOI: No ID Found -
Gynecologic Oncology Jan 2005Frozen section diagnosis is a diagnostic procedure for the assessment of the adnexal mass during surgery. The purpose of the present study was to perform a systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Frozen section diagnosis is a diagnostic procedure for the assessment of the adnexal mass during surgery. The purpose of the present study was to perform a systematic review of the literature on the accuracy of frozen section diagnosis in the assessment of the adnexal mass.
METHODS
We performed a computerized Medline and EMBASE search to identify all registered articles published between January 1966 and June 2003, comparing frozen section diagnosis of ovarian pathology to the final histopathological diagnosis. For each study, we calculated the prevalence of malignant and borderline tumors, and the sensitivity and specificity of the frozen section diagnosis using the final histopathological diagnosis as reference. We performed the calculations in two ways. In the first analysis, tumors that were found to be borderline were considered as malignant in the 2 x 2 table. In the second analysis, tumors that were found to be borderline were considered as benign in the 2 x 2 table.
RESULTS
Eighteen studies were included for analysis. When the diagnosis borderline was classified as malignant, the sensitivity of frozen section diagnosis varied between 65% and 97%, and the specificity between 97% and 100%. When the diagnosis borderline was considered to be benign, the sensitivity varied between 71% and 100%, for a specificity varying between 98.3% and 100%.
CONCLUSION
The accuracy of frozen section diagnosis for the assessment of the ovarian mass is good, with acceptable sensitivities for almost perfect specificities. Future studies on patient preferences for the different outcomes as well as economic analysis are needed for definite position of this diagnostic technique.
Topics: Adnexa Uteri; Adnexal Diseases; Female; Frozen Sections; Humans; Ovarian Neoplasms; Ovariectomy; Reproducibility of Results
PubMed: 15589572
DOI: 10.1016/j.ygyno.2004.09.042 -
Journal of Medical Microbiology Dec 2002Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and... (Meta-Analysis)
Meta-Analysis Review
Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and infertility. This systematic review aims to state clearly which of the available diagnostic tests for the detection of C. trachomatis would be most effective in terms of clinical effectiveness. The review included all studies published from 1990 onward that evaluated diagnostic tests in asymptomatic, young, sexually active populations. Medline and Embase were searched electronically and key journals were hand-searched. Further studies were identified through the Internet and contact with experts in the field. All studies were reviewed by two reviewers and were scored by Irwig's assessment criteria. Additional quality assessment criteria included a documented sexual history and recording of previous chlamydial infection. The reviews were subjected to meta-analysis and meta-regression. The 30 studies that were included examined three types of DNA-based test--ligase chain reaction (LCR), PCR and gene probe--as well as enzyme immuno-assay (EIA). The results showed that while specificities were high, sensitivities varied widely across the tests and were also dependent on the specimen tested. Pooled sensitivities for LCR, PCR, gene probe and EIA on urine were 96.5%, 85.6%, 92% and 38%, respectively, while on cervical swabs the corresponding sensitivities of PCR, gene probe and EIA were 88.6%, 84% and 65%. Meta-analysis demonstrated that DNA amplification techniques performed best for both urine and swabs in low prevalence populations. We conclude that nucleic acid amplification tests used on non-invasive samples such as urine are more effective at detecting asymptomatic chlamydial infection than conventional tests, but there are few data to relate a positive result with clinical outcome.
Topics: Cervix Uteri; Chlamydia Infections; Chlamydia trachomatis; DNA Probes; Diagnostic Techniques and Procedures; Enzyme-Linked Immunosorbent Assay; Female; Gene Amplification; Humans; Ligase Chain Reaction; MEDLINE; Mass Screening; Nucleic Acid Amplification Techniques; Polymerase Chain Reaction; Sensitivity and Specificity; Urine
PubMed: 12466399
DOI: 10.1099/0022-1317-51-12-1021