The COVID-19 pandemic threatens the impact of cervical cancer screening and global cervical cancer elimination goals. As cervical cancer screening programmes were adjusting to the new situation, we ...evaluated the intensity, quality, and outcomes of cervical cancer screening in Slovenia in the first seven months of the pandemic.
Historical observational study on data from a population-based cervical cancer screening registry. Number of cervical cytopathology (screening and follow-up), histopathology (diagnostic procedures, invasive procedures and number of newly diagnosed CIN2+ cases) and HPV test results from the entire Slovenian women population between January 1st and September 30th 2020 were compared to a three-year average of the years 2017–19.
A two-month screening lock-down between March 12th and May 8th 2020 resulted in an epidemic deficit of screening (-92%), follow-up (-70%), and HPV triage tests (-68%), as well as invasive diagnostic (-47%) and treatment (-15%) of cervical lesions. Time to diagnosis and treatment did not increase; times to laboratory results fluctuated but stayed within standards. Slovenia has entered the second epidemic intending to add as little as possible to the pandemic deficit of screening smears (-23%) and yearly CIN2+ cases (-10%). Women aged 30–39 were most affected, with the highest pandemic deficit of screening smears (-26%) and yearly CIN2+ cases (-19%).
The pandemic has deeply affected all levels of our lives. New vulnerable groups and inequalities have emerged that require recognition and action. To prevent long-term increases in the cervical cancer burden due to the COVID-19 pandemic, it is crucial that organised screening is maintained and monitored in settings where it can be safely and comprehensively provided.
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Glavni namen snovalcev klasifikacije po Bethesdi je bil ustvariti tako terminologijo sprememb na materničnem vratu, da bi bil citološki izvid Pap testa jasen in bi jasno odražal nadaljnjo obravnavo ...žensk. V Sloveniji smo leta 2006 spremenili klasifikacijo in se zelo približali Bethesdini, sedaj pa smo se odločili, da jo v celoti prevzamemo. Glavne spremembe so naslednje: v novem izvidu je bris uporaben ali neuporaben. Negativni bris delimo na normalen bris in neneoplastične spremembe, ki poleg reaktivnih sprememb iz stare klasifikacije vsebujejo še tubarno metaplazijo, žlezne celice po histerektomiji, endometrijske celice po 40. letu starosti in folikularni cervicitis. Med patološkimi spremembami je na ploščatem epiteliju najpomembnejša razlika ta, da je namesto atipičnih metaplastičnih celic dodana zelo pomembna kategorija atipičnih ploščatih celic, ne moremo pa izključiti ploščatocelične lezije visoke stopnje. Patološke spremembe žleznih celic so razdeljene v 4 skupine. Priporočila v novi klasifikaciji niso več obvezna, saj je odločitev o nadaljnji obravnavi žensk z nekaterimi spremembami odvisna tudi od HPV-testiranja. Obvezni postopki so zapisani v Smernicah za celostno obravnavo žensk s predrakavimi spremembami materničnega vratu.
Information on the in vivo antitumor efficiency of the combination of Vinca alkaloids in animal tumor models, especially vinblastine (VLB) with cisplatin cis-diamminedichloroplatinum(II); CDDP is ...very limited. Therefore, the aim of our study was to explore whether antitumor schedule dependence exists for the combination of CDDP and VLB on i.p. Ehrlich ascites tumors in mice. Animals were treated 3 days after tumor transplantation with VLB (0.006 mg/kg) or CDDP (0.05 mg/kg) alone, VLB followed by CDDP, and CDDP followed by VLB. The time interval between i.p. injections of the drugs was 24 h. Cell number was measured by counting viable cells using the trypan blue exclusion assay, cell platinum content by electrothermal atomic absorption spectrometry, DNA distribution pattern using flow cytometry, apoptosis by flow-cytometric terminal deoxynucleotidyl transferase dUTP nick-end labeling assay, and cell morphology. Combination of CDDP and VLB resulted in additive interaction when VLB preceded CDDP as determined from cell survival data 24 h after completion of the therapy and in increased platinum content (two times) compared with the same combination in a reverse schedule (CDDP given before VLB), which resulted in antagonism. None of the treatment combinations induced apoptosis. We propose that the observed increase in antitumor effectiveness is mainly due to higher platinum accumulation in tumor cells, which we unambiguously demonstrated by measurement of platinum content in the tumor cells, leading to increased cytotoxicity as well as to cell cycle-dependent effects of VLB and CDDP.
Multivariate studies concerning the prognosis of patients with anaplastic carcinoma of the thyroid gland are scarce. The aim of our study was to determine the prognostic factors associated with ...survival of patients with anaplastic carcinoma in Slovenia, an iodine-deficient region.
This retrospective study was carried out on a group of 188 patients (130 female, 58 male; median age 68 years) with anaplastic carcinoma of the thyroid who had been treated at a tertiary care centre from 1972 to 2003. For each patient, data on gender, age, disease history, extent of disease, morphological characteristics, mode of therapy, and survival were collected. Statistical correlation between possible prognostic factors and survival was analysed by univariate and Cox's multivariate analysis. Treatment modality was not included in the analysis to avoid selection bias.
The median survival of all the patients was 3 (+/-0.36) months. Overall 1-year survival of our patients was 13%, and 2-year survival was 6%. Multivariate analysis showed that the patients' age, performance status, tumour growth, tumour extension and distant metastases were independent prognostic factors for the survival.
Patients younger than 71 years, with a good performance status and slowly growing tumours confined to the thyroid, and without distant metastases, had the best prognosis.
Fine needle aspiration biopsies (FNA) of 47 Warthin's tumours confirmed by histology were re‐evaluated for cytomorphological findings. The majority of aspirates (37/47) contained a typical background ...with proteinaceous substance and cell debris, along with cellular elements represented by oncocytic, lymphoid, and mast cells with degranulated cytoplasm. Uncommon cellular findings were true squamous cells (1/47), atypical cells with vacuoles (1/47), osteoclastic giant cells (1/47), epithelioid cells (1/47), mast cells with preserved granules in cytoplasm (3/47), and siderophages (4/47). Uncommon findings in the background were corpora amylacea‐like structures and homogeneous bright red droplets. Squamous cells and atypical cells with vacuoles caused diagnostic difficulties in distinguishing a Warthin's tumour from a squamous cell or mucoepidermoid carcinoma. However, other unusual cellular and background findings were not worrying; therefore, they are merely regarded as a curiosity in the cytomorphological appearance of the tumour.
V dobro organiziranih presejalnih programih za odkrivanje predrakavih sprememb na vratu maternice je nujna dobra kontrola kakovosti. Pri odkrivanju patoloških sprememb visoke stopnje laboratoriji ...uporabljajo različne načine ponovnega pregleda brisov materničnega vratu (BMV). Na Oddelku za citopatologijo Onkološkega inštituta v Ljubljani izvajamo notranjo kontrolo kakovosti od leta 2006 dalje v okviru šole za presejalce. V triletnem obdobju od 2006 do 2008 smo od januarja do julija pregledali 54.000 BMV, kandidati šole pa so znova pregledali 6813 (12,6 %) BMV. Napačno negativno stopnjo (NNS) smo računali po formuli: napačno negativni primeri / (napačno negativni primeri + PIL VS) krat 100. Ob ponovnem pregledu smo 302 od 6813 (4,4 %) BMV razvrstili v višjo kategorijo. Iz skupine negativnih, tj. normalnih brisov (A), smo v negativne, tj. reaktivne (B), prerazporedili 221 (3,2 %) BMV. V 73 primerih (1,1 %) smo oceno iz negativnega spremenili v patološke spremembe nizke stopnje, v 7 primerih (0,1 %) pa smo ploščatocelične intraepitelijske lezije nizke stopnje (PIL NS) prerazporedili v ploščatocelične intraepitelijske lezije visoke stopnje (PIL VS). V 1 primeru (0,015 %) smo negativen BMV prekvalificirali v PIL VS (pravi napačno negativni BMV). Histopatološka preiskava je v 7 primerih potrdila CIN 2 in CIN 3, v 1 primeru pa je bila diagnoza CIN 1. NNS je v naši študiji za PIL NS 2,4 %, za PIL VS 1,3 %. Menimo, da bi morali tudi v Sloveniji uvesti obvezen ponovni pregled BMV v okviru notranje kontrole kakovosti dela. Kontrola kakovosti, ki smo jo uvedli v našem laboratoriju v okviru Šole za presejalce, je primerna in jo lahko zaradi pomanjkanja presejalcev še naprej uporabljamo.
Program ZORA po petih letih delovanja na državni ravni že kaže javnozdravstvene rezultate. Prvi je velika pregledanost žensk, torej odstotni delež žensk, starih 20–64 let, ki so v treh letih, kolikor ...je priporočeni interval med presejalnimi pregledi, opravile vsaj en pregled brisa materničnega vratu. V zadnjem obdobju (2006–2008) je stopnja pregledanosti pri nas 71,2-odstotna. Če preračunamo pregledanost na pet let, kot je presejalni interval na Finskem in v Veliki Britaniji, torej v državah, ki so drugim v Evropi zgled, je pri nas ta stopnja 82,1-odstotna. V Veliki Britaniji je bila v istem obdobju 78,6- odstotna, na Finskem pa že dolga leta ne presega 70 %. Drugi je manjše število novih primerov raka materničnega vratu (incidenca raka materničnega vratu). Incidenca raka materničnega vratu se je v petih letih delovanja presejalnega programa zmanjšala za dobro četrtino (28 %), z 209 novih primerov leta 2003 na 151 novih primerov leta 2007. Podatki Registra ZORA kažejo, da je bilo v letu 2007 pri 235.713 ženskah odvzetih in pregledanih 260.684 brisov. Na presejalnem pregledu je bilo 194.163 žensk (82 %), druge so prišle na kontrolni pregled ali pa so imele klinične težave. V registru histoloških izvidov je bilo registriranih 8.569 izvidov, skoraj dve tretjini (nekaj več kot polovico) je rezultat diagnostičnih posegov. Dobrih rezultatov zagotovo ne bi bilo mogoče doseči brez prizadevanja številnih ginekologov v primarnem zdravstvenem varstvu žensk, presejalcev in citopatologov v laboratorijih in vseh drugih strokovnjakov, ki sodelujejo v multidisciplinarnem postopku presejanja in zdravljenja predrakavih in rakavih sprememb materničnega vratu. Želimo si, da bi skupna prizadevanja dajala podobne, če ne še boljše rezultate tudi v prihodnje.
Objective: Sentinel lymph node (SLN) biopsy is a new component of the surgical treatment of breast cancer that accurately predicts axillary status. In this study the authors evaluated the accuracy ...of intraoperative imprint cytology (IC) in comparison with definitive histologic evaluation of SLN in breast cancer patients.
Methods: A total 413 women with breast carcinoma and clinically negative axillary nodes underwent breast surgery and SLN biopsy. Mapping of SLN involved injection of 99mTechnecium labelled human albumin nanocolloid particles and Patent Blue dye. At the Department of Pathology, SLNs were bisected along its major axis. Both halves were imprinted 2–4 times on the slides and immediate staining with Hemacolor (Merck Germany) was performed for intraoperative examination. Imprint node negative women underwent no further surgery, while node positive women proceeded to full axillary clearance. Histological analysis of the SLN involved serial sectioning of the whole node with H&E and immunostaining for cytokeratin.
Results: Definitive histology revealed metastases (pN+) in 159/413 patients (38.5%): 69 (16.7%) macro metastases, 57 (13.8%) micro metastases, and 33 (8%) women with only isolated IHC positive cells or positive cell groups smaller than 0.2 mm (pNO sn+). The other 254 women had negative SLN biopsy. Imprint cytology detected 54/69 macro metastases, and 4/57 micro metastases. In the group with negative SLN (254), 2 cases were ‘‘false positives’’.
Conclusions: Imprint of SLN biopsy can identify a negative axilla with high accuracy (specificity 99.2%). Overall sensitivity is only 36.5%, but macrometastases are detected in 77% which is important for performing ALDN in one session with operation of primary tumour.
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