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OBJECTIVE: We sought to evaluate the oncologic outcomes of simple hysterectomy in patients with low-risk early-stage cervical cancer (tumors ≤2 cm with limited stromal invasion). METHODS: This study was registered in PROSPERO (registration number CRD42023433840) following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. MEDLINE (through Ovid), EmMBASEbase, and Cochrane Central Register of Controlled Trials were searched from inception until June 2023. Randomized controlled trials and observational studies with two arms of comparison (simple hysterectomy with lymph node assessment vs radical hysterectomy with lymph node assessment) in patients with low-risk early-stage cervical cancer were considered. RESULTS: The search identified 1270 articles; eighteen studies were considered potentially eligible after removing duplicates, and four met the selection criteria. Three studies were randomized controlled trials, and the other was a retrospective cohort study. In total, 981 patients were included. There were 485 (49.4%) and 496 (50.6%) patients in the simple hysterectomy and radical hysterectomy groups, respectively. Simple hysterectomy with lymph node assessment was not associated with a higher risk of death at 5 years (RR 0.98, 95% CI: 0.31 to 3.10; I2=0%, two randomized controlled trials, 141 patients, for an absolute risk reduction of zero percentage points [95% CI -9.0 to 9.0]), pelvic recurrence at 3 years (97.5% and 97.8% for simple hysterectomy and radical hysterectomy, respectively, p=0.79), and overall recurrence at 3 years (95 %% and 100% for simple hysterectomy and radical hysterectomy, respectively, p=0.30). CONCLUSION: Simple hysterectomy with lymph node evaluation for low-risk early-stage cervical cancer is not associated with a detrimental effect on oncologic outcomes and has a better morbidity profile.

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Resumen OBJETIVO: Determinar la prevalencia de alteraciones en la citología anal, infección anal por virus del papiloma humano y en la neoplasia intraepitelial anal; además, explorar los factores de riesgo y los serotipos asociados en pacientes con lesión intraepitelial cervical de alto grado, a partir de la hipótesis de que esta población tiene mayor riesgo de lesiones precursoras o cáncer anal. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo y transversal, con componente analítico, efectuado en pacientes con diagnóstico de lesión intraepitelial cervical de alto grado (LIEAG) en dos instituciones de salud: una privada y otra pública de Bogotá, atendidas entre enero de 2017 y febrero de 2018. Se efectuó un muestreo no probabilístico, por conveniencia. RESULTADOS: Se incluyeron 119 participantes, en 4 de ellas se evidenció, en la citología anal, el hallazgo de células anormales en el tejido que reviste la parte exterior del cuello uterino. Se encontraron 14 anoscopias anormales que dieron una prevalencia de neoplasia intraepitelial anal del 6.7%. Siete eran neoplasia intraepitelial anal de bajo grado y una de alto grado. Se encontró infección por VPH anal en 45 participantes (37.8%) y se detectaron genotipos de VPH-AR en 29 participantes (24.4%). Más de 3 compañeros sexuales, más de 3 hijos y tener menos de 21 años antes del primer embarazo tuvieron un valor de p < 0.05 que confiere mayor riesgo de infección por VPH anal. CONCLUSIÓN: Es importante establecer en Colombia protocolos para la detección de la neoplasia intraepitelial anal en grupos de alto riesgo, como las pacientes con neoplasia intraepitelial cervical o cáncer de cuello uterino, e incentivar el adiestramiento en la anoscopia de alta resolución en especialistas relacionados con el diagnóstico de patología anogenital.

Abstract OBJECTIVE: To determine the prevalence of alterations in anal cytology, anal human papillomavirus infection, and anal intraepithelial neoplasia, and to explore the risk factors and associated serotypes in patients with high-grade cervical intraepithelial lesion, based on the hypothesis that this population is at higher risk for precancerous lesions or anal cancer. MATERIALS AND METHODS: Observational, descriptive, cross-sectional study, with analytical component, performed in patients diagnosed with high-grade cervical intraepithelial lesion (HG-CIL) in two health institutions: one private and one public in Bogota, visited between January 2017 and February 2018. A non-probabilistic sampling was performed, by convenience, with a sample calculated in 124 patients. RESULTS: 119 participants were included, in 4 of them it was evidenced in the anal cytology, the finding of abnormal cells in the tissue lining the outside of the cervix. Fourteen abnormal anoscopies were found, giving a prevalence of anal intraepithelial neoplasia of 6.7%. Seven were low-grade anal intraepithelial neoplasia and one was high-grade. Anal HPV infection was detected in 45 participants (37.8%) and HR-HPV genotypes were detected in 29 participants (24.4%). More than 3 sexual partners, more than 3 children and being younger than 21 years before first pregnancy had a p-value < 0.05 conferring an increased risk of anal HPV infection. CONCLUSION: It is important to establish protocols in Colombia for the detection of anal intraepithelial neoplasia in high-risk groups, such as patients with cervical intraepithelial neoplasia or cervical cancer, and to promote training in high-resolution anoscopy in specialties related to the diagnosis of anogenital pathology.

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Abstract Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. Conclusion: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.

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Objetivo: comprobar la tasa de evaluación correcta mediante la comparación visual directa de las medidas de dilatación cervical en modelos de cuello uterino de consistencia dura. Método: estudio aleatorizado abierto con 63 estudiantes de obstetricia a los que se les asignó usar o no la comparación visual directa con una guía de dilatación. Los estudiantes estimaron de forma ciega la dilatación cervical en simuladores con diferentes dilataciones. El resultado primario fue la tasa de evaluación correcta. Resultados: los estudiantes realizaron 441 pruebas. Se observó una mayor tasa de evaluación correcta en el grupo experimental que en el grupo control (47,3% versus 27,2%; p < 0,001; Odds Ratio = 2,41; intervalo de confianza del 95% = 1,62-3, 58). Conclusión: la comparación visual directa aumentó la precisión de la evaluación de la dilatación cervical en modelos de simulación de cuello, lo que podría ser beneficioso en el entrenamiento de laboratorio. Registro Brasileño de Ensayos Clínicos n.º U1111-1210-2389.

Objective: to verify the correct assessment rate when using direct visual comparison in the cervical dilation measures in hard-consistency cervix simulation models. Method: an open-label and randomized study conducted with 63 Obstetrics students that were designated either to use direct visual comparison in a dilation guide or not. The students estimated cervical dilation blindly in simulators with different dilations. The primary outcome was the correct assessment rate. Results: the students performed 141 tests. A higher correct assessment rate was found in the Experimental Group than in the Control Group (47.3% versus 27.2%; p<0.001; Odds Ratio = 2.41; 95% Confidence Interval = 1.62-3.58). Conclusion: the direct visual comparison increased precision of the cervical dilation assessment in cervix simulation models, with the possibility of being beneficial in laboratory training. Brazilian Registry of Clinical Trials No. U1111-1210-2389.

Objetivo: verificar a taxa de avaliação correta com o uso da comparação visual direta nas medidas de dilatação cervical em modelos de simulação de colo com consistência dura. Método: estudo randomizado aberto com 63 estudantes de obstetrícia que foram designados para usar comparação visual direta em um guia de dilatação ou não. Os estudantes estimaram cegamente a dilatação cervical em simuladores com diferentes dilatações. O desfecho primário foi a taxa de avaliação correta. Resultados: os estudantes realizaram 441 testes. Foi encontrada maior taxa de avaliação correta no grupo experimental do que no grupo controle (47,3% versus 27,2%; p <0,001; Odds Ratio = 2,41; intervalo de confiança de 95% = 1,62-3,58). Conclusão: a comparação visual direta aumentou a precisão da avaliação da dilatação cervical em modelos de simulação de colo, podendo ser benéfica no treinamento em laboratório. Registro Brasileiro de Ensaios Clínicos nº U1111-1210-2389.

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Objetivo : Determinar la relación entre la ausencia de células endocervicales y resultados citológicos Papanicolaou falsos negativos. Material y métodos : Estudio observacional, de enfoque cuantitativo, transversal, relacional y retrospectivo realizado en el Servicio de Anatomía Patológica del Hospital General de Huacho. Se realizó la búsqueda de resultados de biopsias de cuello uterino positivos para lesiones intraepiteliales escamosas y sus respectivos resultados citológicos Papanicolaou previos durante los años 2016 al 2018. Se seleccionó los resultados negativos con ausencia de células endocervicales. Resultados : De los 158 resultados citológicos, 23 mostraron ausencia de células endocervicales y de éstos, sólo dos (8,7%) fueron reportados como negativos. En total 11 (7%) citologías fueron negativas. Conclusiones : No se encontró relación entre la ausencia de células endocervicales y resultados citológicos falsos negativos; por tanto, no influyó de manera significativa en la detección de lesiones escamosas premalignas de cuello uterino.

SUMMARY Objective : To determine the relationship between absence of endocervical cells and false negative Pap smears in patients with squamous premalignant cervix lesions. Methods : A cross sectional study was carried out at Servicio de Anatomía Patológica del Hospital General de Huacho. A search for positive cervix biopsies for squamous intraepithelial lesions and their Pap smears from 2016 to 2018 was done. Negative Pap smears with absence of endocervical cells were investigated. Results : 23 out of 158 cytology results showed absence of endocervical cells, only two (8.7%) were reported negative. Eleven cytologies were negative (7%). Conclusions : No relationship was found between absence of endocervical cells and false negative results at Pap smears. Therefore, no influence in the detection of squamous pre-malignant cells was found.

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In 2020, approximately 604 127 patients were newly diagnosed with cervical cancer and 341 831 died of the disease worldwide. Unfortunately, 85-90% of new cases and deaths occur in less developed countries. It is well known that persistent human papillomavirus (HPV) infection is the main risk factor for developing the disease. There are more than 200 HPV genotypes identified, but the most important in public health are the high-risk HPV genotypes including HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 due to their strong association with cervical cancer. Among these, genotypes 16 and 18 are responsible for about 70% of cervical cancer cases worldwide. Implementing systematic cytology-based screening, HPV screening, and HPV vaccination programs have successfully decreased the cervical cancer burden, particularly in developed countries. Although the etiological agent has been identified, we have seen the impact of well-conducted screening programs in developed countries, and we have available vaccines, the fight against this preventable disease has shown poor results globally. In November 2020 the World Health Organization launched its strategy to eliminate cervical cancer from the earth by 2130 (the goal is to achieve a global incidence lower than 4 per 100 000 women/year). The strategy aims to vaccinate 90% of girls before 15 years of age, to screen with a highly sensitive test (HPV-based) 70% of women at 35 and 45 years of age, and to provide proper treatment by trained personnel to 90% of women diagnosed with either cervical dysplasia or invasive cervical cancer. The objective of this review is to update the state of the art on primary and secondary prevention of cervical cancer.

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Introdução: O câncer do colo uterino é um sério problema de saúde pública, mas pode ser prevenido por vacinação, rastreamento e tratamento das lesões precursoras. Objetivo: Verificar o conhecimento e o comportamento das mulheres de Governador Valadares, no que diz respeito ao câncer do colo do útero e às ações relacionadas com a sua prevenção. Material e Métodos: Foi realizado um estudo descritivo, transversal de setembro de 2019 a fevereiro de 2020, quando 202 mulheres maiores de 18 anos, foram convidadas, de forma aleatória, em locais públicos, a responder um questionário estruturado. Resultados: A idade média das mulheres que participaram do estudo foi de 31,2 anos, sendo a maioria delas solteiras e com ensino médio completo. Algumas delas (7,9%) não souberam responder o que é o câncer do colo uterino, que ele pode ser evitado (10,9%) e nem de sua relação com a infecção pelo papilomavírus humano (38,1%). Além disso, 6,4% delas nunca ouviram falar do exame preventivo e 25,7% nunca o realizaram, sendo descuido (17,3%), vergonha (12,9%) e falta de tempo (7,9%) os principais motivos. A maioria (48,4%) das mulheres que já realizaram o exame o fizeram a menos de um ano e 49,5% disseram sentir-se mais confortáveis quando o profissional coletor é mulher. Para 49% um sistema de auto-coleta aumentaria a possibilidade de realizar o exame regularmente. Aproximadamente um quarto das participantes desconhecem a existência de uma vacina contra o Papilomavírus Humano e mais da metade delas não sabem que ela protege apenas contra os quatro tipos mais frequentes. Conclusão: Um número significativo de mulheres apresentou conhecimento insatisfatório sobre o câncer do colo uterino e sua prevenção, o que impacta na adesão às práticas de rastreamento e justifica o investimento em ações de educação em saúde.

Introduction: Cervical cancer is a serious public health problem, but it can be prevented by vaccination, screening and treatment of precursor lesions. Objective: To verify the knowledge and behavior of women in Governador Valadares, with regard to cervical cancer and actions related to its prevention. Material and Methods: A descriptive, cross-sectional study was carried out from September 2019 to February 2020, when 202 women over 18 years old were invited, randomly, in public places, to answer a structured questionnaire. Results: The average age of the women who paticipated in the study was 31.2 years, most of whom was single and had completed high school. Some of them (7,9%) were unable to answer what cervical cancer is, that it can be avoided (10,9%) or its relationship with Human Papillomavirus infection (38,1%). In addition, 6,4% of them had never heard of the preventive exam and 25,7% had never taken it, with carelessness (17,3%), shame (12,9%) and lack of time (7,9%) main reasons. The majority (48,4%) of the women who had already taken the test had done so less than a year ago and 49,5% said they felt more comfortable when the collector was a woman. For 49% a self collection system would increase the possibility of performing the exam regularty. Approximately a quarter of the participants are unware of the existence of a vaccine against Human Papillomavirus and more than half of them are unaware that it only protects agains the four most common types. Conclusion: A significant number of women had unsatisfactory knowledge about cervical cancer and its prevention, which impacts on their adherence to screening practices and justifies the investiment in health education actions.

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The phase angle, an indicator of muscle mass status and membrane cell integrity, has been associated with low survival, poorer clinical outcomes, and worse quality of life among cancer patients, but information on women with uterine cervical cancer (UCCa) is scarce. In this prospective study, we used a bioelectrical impedance analyzer to obtain the PA of 65 women with UCCa. We compared the health-related quality of life and inflammatory and nutritional indicators between low PA and normal PA. The mean age was 52 ± 13. The low PA and normal PA groups differed in terms of the C-reactive protein (15.8 ± 19.6 versus 6.82 ± 5.02, p = 0.022), glucose (125.39 ± 88.19 versus 88.78 ± 23.08, p = 0.021), albumin (3.9 ± 0.39 versus 4.37 ± 0.30, p = 0.000), EORTC QLQ-C30 loss of appetite symptom scale score (33.33 (0.0-100.00) versus 0.0 (0.0-0.0), p = 0.005), and EORTC QLQ-CX24 menopausal symptoms scale score (0.0 (0.0-33.33) versus 0.0 (0.0-100.0), p = 0.03). The main finding of the present study is the interaction between PA and obesity as critical cofactors in the UCCa adeno and adenosquamous histologic variants, to a greater extent than cervical squamous cell carcinoma.

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OBJECTIVE: To evaluate the non-inferiority and safety of simple hysterectomy in early stage (<2 cm) cervical cancer. METHODS: This proof-of-concept randomized phase II non-inferiority trial was performed between May 2015 and April 2018 in three oncological centers in Northeast Brazil. Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stages IA2-IB1 cervical cancer and tumors ≤2 cm were treated with either simple or modified radical hysterectomy (Querleu-Morrow type B2). Intention-to-treat analysis was carried out. The primary endpoint was 3-year disease-free survival and secondary endpoints were overall survival, operative outcomes, adjuvant therapy, and patient's health-related quality of life (QoL). RESULTS: A total of 40 patients underwent either simple hysterectomy (n=20) or modified radical hysterectomy (n=20). All patients except three underwent open procedures (n=37/40, 92.5%). At a median follow-up of 52.1 months (IQR 43.9-60.1), 3-year disease-free survival was 95% (95% CI 68% to 99%) after simple hysterectomy and 100% (95% CI 100% to 100%) after modified radical hysterectomy (log-rank p=0.30). The corresponding 5-year overall survival rates were 90% (95% CI 64% to 97%) and 91% (95% CI 50% to 98%), respectively (log-rank p=0.46). The operative time was shorter after simple hysterectomy than after modified radical hysterectomy (150 min (IQR 137.5-180) vs 199.5 min (IQR 140-230); p=0.003), with a trend towards a longer time for vesical catheterization removal (1 day (IQR 1-1) vs 1 day (IQR 1-2); p=0.043). There was no post-operative mortality and the rates of post-operative complications were not statistically different between arms (15% and 25%; p=0.69). QoL questionnaires were received from only 17 patients (42.5%), with no major differences observed over time between the surgical arms. CONCLUSIONS: Simple hysterectomy is safe and potentially non-inferior to the radical surgery in patients with early-stage cervical cancer ≤2 cm. TRIAL REGISTRATION NUMBER: NCT02613286.

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