Abstract Objective To report the prevalence of malignant transformation of vulvar lichen sclerosus (VLS) and possible risk factors. Methods This is a cohort study with data analysis from medical records of 138 patients with histological diagnosis of VLS registered at the Vulvar Pathology Outpatient Clinic of the University Hospital, between 2007 and 2017. Predominance of risk factors was performed using logistic regression analysis. The variables studied were the length of follow-up, age, regular or irregular follow up; presence of symptoms (dyspareunia, pruritus and/or vulvar burning); histology characteristics, the presence of epithelial hyperplasia; and the presence of autoimmune diseases. Results There were 138 patients included in the study, and among them five progressed to malignant transformation. The patients had a median age of 59 years and 83% were symptomatic. The most frequent symptom was itching with 72%. Autoimmune diseases were present in 11.6%, the most prevalent being thyroid disease. All five case of malignant transformation (0.6%) had an irregular follow up. The logistic regression analysis was used among the studied variables, and no statistical significance was found among them (p ≥ 0.05). The relationship between hyperplasia and the clinical outcome of malignant transformation, in which non-significant but acceptable p value close to 0.05 was observed. Conclusion The prevalence of malignant transformation in patients with VLS was 0.6%, and common factors were the lack of adherence to medical treatments and the loss of follow-up. (VLS 13 Hospital 200 2017 followup, followup up, up follow-up dyspareunia, dyspareunia (dyspareunia andor burning burning) characteristics 5 83 symptomatic 72 72% 116 11 6 11.6% disease 0.6% 06 0 (0.6% 0.05. 005 . 05 0.05) nonsignificant non significant 0.0 observed followup. 1 20 201 8 7 11.6 0.6 (0.6 00 0. 2 11. (0. (0 (

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. Objective Methods 42 care n=411. n411 n n=411 . 411 (n=411) n=345. n345 n=345 345 (n=345) following 21 <21 2124 24 21–24 2535 25 35 25–35 >3 also ≤2 ≥2 zone p005 p 0 05 p<0.05 Results colposcopy (≤2 p=0.037 p0037 037 (≥2 p=0.003 p0003 003 Conclusion 4 n41 n=41 41 (n=411 n34 n=34 34 (n=345 2 <2 212 21–2 253 3 25–3 > ≤ ≥ p00 p<0.0 (≤ p=0.03 p003 03 (≥ p=0.00 p000 00 n4 n=4 (n=41 n3 n=3 (n=34 < 21– 25– p0 p<0. ( p=0.0 n= (n=4 (n=3 p<0 p=0. (n= p< p=0 (n p=

RESUMO Objetivos: avaliar se o status das margens, idade, tamanho da lesão colposcópica, tipo de cirurgia e expressão dos marcadores p16/Ki-67 são fatores de risco na persistência ou recidiva da LIEAG. Métodos: um estudo de corte transversal, observacional com coleta de dados retrospectivos de pacientes submetidas a conização a frio (CF) ou exérese da zona de transformação por cirurgia de alta frequência EZT por NIC2/3. Foram analisados os seguintes fatores em relação a persistência ou recidiva: comprometimento das margens, idade, tamanho da lesão, tipo de cirurgia e coexpressão dos imunomarcadores p16 e Ki-67. Resultados: 271 mulheres tratadas com CF (71) e EZT (200), onde 95 apresentavam NIC 2 e 173 NIC 3, 183 apresentaram margens cirúrgicas livres, 76 comprometidas e 12 prejudicadas por artefatos ou fragmentação. Das 76 pacientes com margens comprometidas, 55 foram endocervical, 11 ectocervical e 10 ambas as margens. Das 264 pacientes que tiveram seguimento, 38 persistiram ou recidivaram a doença. A regressão logística múltipla indicou ser a margem endocervical comprometida o único fator independente de risco de persistência/recorrência da NIC (p<0,001). Não houve associação significativa entre a idade, o tamanho da lesão colposcópica, o tipo de cirurgia e a expressão dos imunomarcadores p16/Ki-67 e a persistência ou recorrência da doença. Conclusão: entre os fatores estudados associados com persistência ou recorrência, somente a margem endocervical comprometida provou ser significativamente um fator risco para persistência ou recorrência da lesão. Objetivos idade colposcópica p16/Ki67 p16Ki67 pKi p16/Ki 67 Ki p p16/Ki-6 LIEAG Métodos transversal (CF NIC23 NIC2 3 NIC2/3 p1 Ki67. Ki67 67. Ki-67 Resultados 27 71 (71 200, 200 , (200) 9 17 18 livres 7 1 fragmentação 5 26 seguimento doença persistênciarecorrência p<0,001. p0001 p<0,001 . 0 001 (p<0,001) Conclusão p16/Ki6 p16Ki6 p16Ki 6 p16/Ki- NIC2/ Ki6 Ki-6 (7 20 (200 p000 p<0,00 00 (p<0,001 Ki- ( (20 p00 p<0,0 (p<0,00 (2 p0 p<0, (p<0,0 p<0 (p<0, p< (p<0 (p< (p

ABSTRACT Objectives: to evaluate whether the colposcopic lesion size , age, kind of surgery, the status of the surgical margins and the expression of the p16 and Ki-67 immunomarkers are risk factors for persistence or recurrence of the lesion. Methods: a cross-sectional, observational, retrospective study of patients submitted to cold knife conization (CKC) or the loop electrosurgical excision procedure for cervical intraepithelial neoplasia 2 or 3. The colposcopic lesion size, age, surgical method, involvement of the surgical margins, and p16/Ki-67 immunomarker expression were analyzed in relation to lesion persistence and recurrence. Results: seventy-one women were treated with cold knife conization and 200 were treated with loop electrosurgical excision. Of these, 95 had cervical intraepithelial neoplasia 2, 173 had cervical intraepithelial neoplasia 3, 183 had free surgical margins, 76 had compromised margins, and 12 showed damage by processing artifact or fragments. Among the 76 cases with positive margins, 55, 11, and 10 showed endocervical margin involvement, ectocervical margin involvement, and both endocervial and ectocervical margin involvement, respectively. Of the 264 followed-up patients, 38 had persistent or recurrent disease. A multiple logistic regression indicated that positive endocervical margins are the only independent risk factor for the persistence/recurrence of cervical intraepithelial neoplasia. No significant association was identified between the colposcopic lesion size, age, surgery type, or p16/Ki-67 immunomarker expression and lesion persistence or recurrence. Objectives age p p1 Ki67 Ki 67 Ki-6 Methods crosssectional, crosssectional cross sectional, sectional cross-sectional observational CKC (CKC 3 method p16/Ki67 p16Ki67 pKi p16/Ki p16/Ki-6 Results seventyone seventy one 20 these 9 17 18 7 1 fragments 55 11 respectively 26 followedup followed up disease persistencerecurrence type Ki6 6 Ki- p16/Ki6 p16Ki6 p16Ki p16/Ki- 5

Background: Even when pre-neoplastic lesions are treated, there is a risk that the disease will persist or recur. Objectives: Assess whether the status of the surgical margins, the age, the colposcopic lesion size,type of surgery and the expression of the P16 and KI67 markers are risk factors for the persistence or recurrence of high-grade squamous intraepithelial lesion after CIN 2 and CIN 3 treatment. Methods: A cross-sectional, observational study with retrospective data collection of patients undergoing cold knife( CKC) or Loop electrosurgical excision procedure (LEEP) for CIN 2 or CIN 3. The following factors were analyzed in relation to recurrence: compromised margins, age, lesion size, type of surgery and staining of immunomarkers P16 and KI67. Results: Among the 271 women, aged between 17 and 67 years, 71 had CKC and 200 LEEP, 95 had CIN 2 and 173 CIN 3, regarding the status of the margins, 183 patients had free surgical margins, 76 compromised and 12 damaged by artifacts or fragmentation. Of the 76 with compromised margins, 55 were endocervical, 11 ectocervical and 10 both margins. Of the 264 who completed followup, 38 persisted or relapsed the disease. A hundred-five reactions with the P16 marker were performed. As for the analysis of the P16 color intensity, 8 cases were mild, 32 moderate and 65 were strong. Regarding the analysis of immunostained epithelial thickness, 7 had 1/3 of the epithelium stained, 36 stained 2/3 and 62 stained the entire epithelium. A total of 113 reactions with the 67 KI marker were performed. As for the analysis of staining intensity, 3 cases were mild, 24 moderate and 86 strong. Regarding the analysis of immunostained epithelial thickness, 6 occurred in 1/3 of the epithelium, 48 in 2/3 and 59 in the entire epithelium. Conclusion: Only the status of the endocervical margins was associated with the persistence or recurrence of the lesion. Age, colposcopic lesion size, type of surgery and expression of P16/KI67 markers were not associated with recurrence or persistence of the lesion.

Introdução: Mesmo quando as dificuldades pré-neoplásicas são tratadas, existem os riscos de persistência ou recorrência da doença. Objetivos: Avaliar se o status das margens, idade, tamanho da lesão colposcópica, tipo de operação e expressão dos marcadores p16/ki67 são fatores de risco na persistência ou recidiva da lesão intraescamosa de alto3. Estudos: Estudos de transformação de dados transversais, observacionais de pacientes de dados de processamento de alta frequência (EZT) ou exercícios de análise de dados de alta frequência (EZT) ou NIC com 2 ou 3. Método NIC com 2 ou 3. relação a recidiva: comprometimento das margens, idade da lesão colpo, tipo de operação e tamanho com imunomarcadores P16 e KI67. 2 Resultados: Dentre as 271 mulheres, de 17 a 67 anos, 71 outros CF e 200EZT;95 apresentaram NIC 2 e 173 NIC 3; em relação ao status das margens,183 tiveram como margens, 76 prejudicadas por ameaças ou fragmentação. Das 76 com margens esquerdas, 55 foram endovicais, 11 e 10 as margens. Das 64 que a continuação ou 38 persistiram da persistência da doença completa. Foram realizadas 105 reações com o marcador P16. Quantos casos à análise da intensidade da identificação do P16, 8 foram leves, 32 moderados e 65 fortes. Referente a análise da espessura epitelial imunocorada, 7 tiveram 1/3 do epitélio, 36 coraram 2/3 e 62 todo o epitélio. Foram realizadas 113 reações com o marcador KI67. Quanto à análise da identificação da identificação, 3 casos foram moderados e 86 fortes.Em relação a análise da espessura epitelial imunocorada, 48 e pitélio em 1/3, 59 em todo o epitélio. Apenas conclusão: Apenas conclusão endovicais se associam com persistência ou a recidiva da recidiva. A idade, o tamanho da lesão colposcópica, o tipo de procedimento cirúrgico e a expressão dos marcadores P16/KI67 não tiveram associação com a recidiva ou persistência da lesão

Resumo Objetivo Avaliar se a biópsia colpodirigida é necessária para aumentar a acurácia diagnóstica nas lesões intraepiteliais de colo uterino em relaçãoà colposcopia. Métodos Estudo retrospectivo, observacional, incluindo pacientes submetidas a colposcopia, biópsia colpodirigida, e procedimento cirúrgico (cirurgia de alta frequência ou conização a frio), no período de fevereiro de 2008 a fevereiro de 2018, no Hospital de Clínicas da Universidade Federal do Paraná. Dados como número de quadrantes da lesão presentes na colposcopia, número de fragmentos retirados nas biópsias e diferenças por idade também foram analisados. Resultados Um total de 299 mulheres foram incluídas. Foi encontrada uma acurácia de 76,25% (intervalo de confiança [IC] 95% 71,4-81,1) entre a colposcopia e a conização, sendo 80,5% % (IC 95% 75.7-85.3) nas lesões de maior grau. A acurácia da biópsia foi de 79,6% (IC 95% 75-84,2), sendo 84,6% (IC 95% 80-89,1) nas lesões de maior grau. Pacientes com 1 quadrante acometido tiveram confirmação de 76,9% nas lesões de maior grau, enquanto as com 2 quadrantes acometidos apresentaram o mesmo resultado em 85% dos casos. A acurácia com a biópsia de 1 fragmento foi de 78% e com2 ou mais fragmentos 80%. Paramulheres com menos de 40 anos, a acurácia foi de 77,6% e 80,8% para colposcopia e biópsia, respectivamente. Para mulheres com 40 anos ou mais, a acurácia foi de 72,5% e 76,3% para colposcopia e biópsia, respectivamente. Conclusão Não há diferença entre a acurácia da colposcopia e a da biópsia colpodirigida no diagnóstico de lesões intraepiteliais cervicais em relação ao resultado da conização. As pacientes que tiveram o maior benefício quando a biópsia não foi realizada foram as que apresentaram lesão de alto grau na colposcopia e aquelas com menos de 40 anos, não existindo benefício emrealizar biópsia previamente a conização neste grupo de pacientes.

Abstract Objective To evaluate whether colposcopy-directed biopsy is necessary to increase the accuracy of diagnosing cervical intraepithelial lesions in relation to colposcopy. Methods We performed a retrospective, observational study by analyzing medical records obtained fromHospital de Clínicas do Paraná fromFebruary 2008 to February 2018. Patients with results of Pap tests, colposcopy, colposcopy-directed biopsy, and surgical procedures (high-frequency surgery or cold conization) were included. Data such as quadrants involved during colposcopy and age differences were also analyzed. Results A total of 299 women were included. Colposcopy was found to have an accuracy rate of 76.25% (95% confidence interval [CI], 71.4-81.1). Among the highest-grade lesions, the accuracy rate was 80.5% (95% CI, 75.7-85.3). The accuracy rates for biopsy were 79.6% (95% CI, 75-84.2) and 84.6% (95% CI, 80-89.1) for the highest-grade lesions. High-grade lesions were accurately confirmed in 76.9% and 85% of patients with 1 and 2 or more affected quadrants, respectively. For women younger than 40 years, the accuracy rates were 77.6% and 80.8% for colposcopy and biopsy, respectively. For women 40 years or older, the accuracy rates were 72.5% and 76.3% for colposcopy and biopsy, respectively. Conclusion There is no difference between the accuracy of colposcopy and that of biopsy in diagnosing cervical intraepithelial lesions in relation with the result of conization. The patients who received the greatest benefit when biopsy was not performed were those with high-grade lesions at colposcopy, a lesion involving 2 or more quadrants, and those younger than 40 years.

Resumo Objetivo Determinar a acurácia dos achados colposcópicos no diagnóstico das neoplasias intraepiteliais cervicais (NIC) em mulheres com resultado de exame citopatológico de células escamosas atípicas de significado indeterminado não podendo excluir lesão intraepitelial de alto grau (ASC-H) e analisar a correlação entre a prevalência de HSIL ou câncer com fatores de risco sociodemográficos e achados colposcópicos específicos. Métodos Os achados colposcópicos, e os fatores de risco sociodemográficos foram analisados como possíveis preditores de diagnóstico NIC 2 ou mais grave em mulheres com resultado de exame citopatológico ASC-H. Resultados A acurácia da impressão colposcópica foi de 92%, sensibilidade foi 91,6%, e a especificidade foi de 93,1%, com um valor preditivo de 96,4% e valor preditivo negativo de 84,3%. O diagnóstico de NIC 2 ou mais grave foi mais frequente em pacientes com história pregressa de displasia cervical e nas que não estavam na pós menopausa. A identificação de achados colposcópicos maiores, epitélio acetobranco denso, mosaico e pontilhados grosseiros se correlacionaram positivamente com o diagnóstico NIC 2 ou mais grave. Conclusão A colposcopia realizada por um examinador experiente pode diferenciar com acurácia pacientes com NIC 1 ou menos grave de pacientes com NIC 2 ou mais grave. O diagnóstico de NIC 2 ou mais grave foi mais frequente em pacientes com história pregressa de displasia cervical e pacientes que estavam na pré menopausa. A densidade da acetorreação foi o melhor preditor colposcópico para NIC 2 ou mais grave.

Abstract Objective To determine the accuracy of colposcopy findings in diagnosing cervical intraepithelial neoplasia (CIN) in women with an atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) pap smear result and analyze whether the prevalence of HSIL and cancer correlates with sociodemographic risk factors and specific colposcopic findings. Methods Colposcopic findings and sociodemographic risk factors were analyzed as possible predictors of a CIN 2 or worse diagnosis in women with an ASC-H pap smear result. Results Accuracy of the colposcopic impression was 92%, sensitivity was 91.6%, and specificity was 93.1%, with a positive predictive value of 96.4% and negative predictive value of 84.3%. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. Identification of major colposcopic findings, dense acetowhite epithelium, coarse mosaicism, and punctuation correlated significantly with CIN 2 or worse. Conclusion Colposcopy performed by an experienced examiner can accurately differentiate patients with CIN 1 or less from patients with CIN 2 or worse. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. The degree of acetowhite changes was the best colposcopic feature to predict CIN2 or worse.

CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp). MÉTODOS: Foram revisados prontuários e laudos histopatológicos de 118 mulheres que foram submetidas a conização por cirurgia de alta frequência no período de 1999 a 2007. Idade, número de fragmentos, grau da lesão, grau de artefatos térmicos e qualidade das margens foram avaliados. RESULTADOS: A idade média das pacientes foi de 27,14 anos; 63,6% tinham diagnóstico de NIC II e 36,4% de NIC III. A lesão foi retirada com um fragmento em 79,6%. As margens estavam livres de neoplasia em 85,6% e comprometidas na margem endocervical em 6,8%. Fragmentos prejudicados por artefatos ocorreram em 2,5%. Artefatos de grau severo ocorreram em 22,8%. Mulheres com idade igual ou superior a 30 anos apresentaram mais casos de NIC III (P < 0,0004). O comprometimento neoplásico de margens cirúrgicas e artefatos de grau severo ocorreram mais vezes nos casos em que foram retirados dois ou mais fragmentos e em pacientes com idade igual ou superior a 30 anos. CONCLUSÃO: NIC III em mulheres com idade superior a 30 anos, quando retiradas em dois ou mais fragmentos na CAF, apresentaram maior número de margens comprometidas e grau severo de artefatos térmicos.

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.