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      Neoplasias intraepiteliales cervicales en adolescentes


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          Objetivo: Determinar la frecuencia y evolución clínico patológica de las neoplasias intraepiteliales cervicales en adolescentes, que acudieron al Servicio de Ginecología del Hospital Universitario de Los Andes. Mérida. Métodos: Se realizó un estudio descriptivo y longitudinal, donde se evalúan 74 pacientes adolescentes con patología cervical, captadas durante un período de 6 años (Los datos fueron organizados en cuadros y figuras. Se realizaron las correlaciones estadísticas, mediante el método de Chi cuadrado). Se analizó la evolución clínica de las lesiones presentes en el grupo estudiado, y se determinó su persistencia, regresión o progresión. Resultados: La mayor frecuencia de patología cervical, está en el grupo entre los 18 y 19 años. En las citologías de ingreso, 43,24 % de los casos reportaron lesión intraepitelial de bajo grado y 5,41 % lesión intraepitelial de alto grado. En la primera biopsia, 60,81 % presenta neoplasia intraepitelial cervical 1/por virus papiloma humano. 9,46 % reporta neoplasia intraepitelial cervical 2, y 8,11 % presenta neoplasia intraepitelial cervical 3/por cáncer in situ. Un 90,54 % de las pacientes presentaron signos histológicos sugestivos de infección por virus papiloma humano. En cuanto al uso de electrocirugía, el procedimiento fue omitido en el 77,03 %. A 14,86 % se les realizó cono por radiocirugía. Los informes de conos, muestran que 54,55 % reportaron neoplasia intraepitelial cervical 1/ virus papiloma humano, y 27,27 % reportaron neoplasia intraepitelial cervical 3. Al analizar la evolución de la patología, se observa que 82,60 % presentó regresión de sus lesiones. Conclusiones: Por la edad y competencia inmunológica, el manejo de las lesiones cervicales debe ser conservador en adolescentes. En un alto porcentaje del grupo estudiado, se mantuvo una conducta conservadora y se determinó una alta tasa de regresión.

          Translated abstract

          Objective: To determine the frequency and pathologic evolution of cervical intraepithelial neoplasia in adolescents who attended in the Gynecology Service of the University Hospital of the Andes in Merida, Venezuela. Methods: We conducted a longitudinal study, which evaluated 74 adolescent patients with cervical pathology, collected over a period of six years. The data were organized in tables and figures. Statistical correlations were made by Chi square method. Subsequently, we analyzed the clinical course of the lesions present in the group studied, determining their persistence, regression or progression. Results: The increased frequency of cervical pathology is in the group between 18 and 19 years. In smears of income, 43.24 % of the cases reported low grade squamous intraepitheliel lesion and 5.41 % high grade squamous intraepitheliel lesion. In the first biopsy, 60.81 % presents cervical intraepithelial neoplasia 1/ human papillomavirus. 9.46 % reported cervical intraepithelial neoplasia 2 and 8.11 % present cervical intraepithelial neoplasia 3/cancer in situ. 90.54 % of the patients had histological signs suggestive of human papillomavirus infection. Regarding the use of electrosurgery, the procedure was omitted from the 77.03 %. 14.86 % underwent radiosurgery cone. Cones reports show that 54.55 % reported cervical intraepithelial neoplasia 1/human papillomavirus, and 27.27 % reported cervical intraepithelial neoplasia 3. When analyzing the evolution of the disease, it is observed that 82.60 % had regression of their lesions. Conclusions: By age and immune competence, management of cervical lesions in adolescents should be conservative. In a high percentage of the study group, remained a conservative therapy and found a high rate of regression.

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          Most cited references20

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          Natural history of cervical intraepithelial neoplasia: a critical review.

          A G Ostör (1993)
          The literature dealing with the natural history of cervical intraepithelial neoplasia (CIN) since 1950 is reviewed, in particular from the viewpoint of regression, persistence, and progression. When stratified into the various grades of severity, the composite data indicate the approximate likelihood of regression of CIN 1 is 60%, persistence 30%, progression to CIN 3 10%, and progression to invasion 1%. The corresponding approximations for CIN 2 are 40%, 40%, 20%, and 5%, respectively. The likelihood of CIN 3 regressing is 33% and progressing to invasion greater than 12%. It is obvious from the above figures that the probability of an atypical epithelium becoming invasive increases with the severity of the atypia, but does not occur in every case. Even the higher degrees of atypia may regress in a significant proportion of cases. As morphology by itself does not predict which lesion will progress or regress, future efforts should seek factors other than morphological to determine the prognosis in individual patients.
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            Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study.

            High parity has long been suspected of being associated with an increased risk of cervical cancer, but previous analyses of this association have not taken the strong effect of human papillomavirus (HPV) into account. To assess the role of reproductive factors in the progression from HPV infection to cancer, we did a pooled analysis including only HPV-positive women. We pooled data from eight case-control studies on invasive cervical carcinoma (ICC) and two on in-situ carcinoma (ISC) from four continents. 1465 patients with squamous-cell ICCs, 211 with ISCs, 124 with adenocarcinomas or adenosquamous ICCs, and 255 control women, all positive for HPV DNA by PCR-based assays, were analysed. We calculated pooled odds ratios by means of unconditional multiple logistic regression models, and adjusted them for sexual and non-sexual confounding factors. The 95% CI were estimated by treating the odds ratio as floating absolute risk. We found a direct association between the number of full-term pregnancies and squamous-cell cancer risk: the odds ratio for seven full-term pregnancies or more was 3.8 (95% CI 2.7-5.5) compared with nulliparous women, and 2.3 (1.6-3.2) compared with women who had one or two full-term pregnancies. There was no significant association between risk of adenocarcinoma or adenosquamous carcinoma and number of full-term pregnancies. High parity increases the risk of squamous-cell carcinoma of the cervix among HPV-positive women. A general decline in parity might therefore partly explain the reduction in cervical cancer recently seen in most countries.
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              Natural history of cervical human papillomavirus infection in young women: a longitudinal cohort study.

              Laboratory and epidemiological research suggests an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). We studied the natural history of incident cervical HPV infection and its relation to the development of CIN. We recruited 2011 women aged 15-19 years who had recently become sexually active. We took a cervical smear every 6 months and stored samples for virological analysis. We immediately referred all women with any cytological abnormality for colposcopic assessment, but postponed treatment until there was histological evidence of progression to high-grade CIN. In 1075 women who were cytologically normal and HPV negative at recruitment, the cumulative risk at 3 years of any HPV infection was 44% (95% CI 40-48): HPV 16 was the most common type. The cumulative risk at 3 years of detecting an HPV type not present in the first positive sample was 26% (20-32). 246 women had an abnormal smear during follow-up, of whom 28 progressed to high-grade CIN. The risk of high-grade CIN was greatest in women who tested positive for HPV 16 (risk ratio 8.5 [3.7-19.2]); this risk was maximum 6-12 months after first detection of HPV 16. All HPV types under consideration were associated with cytologically abnormal smears. Although abnormality was significantly less likely to be associated with low-viral-load samples, the cumulative risk at 3 years of a high-viral-load sample after a low-viral-load sample was 45% (95% CI 35-56). Five women who progressed to high-grade CIN consistently tested negative for HPV. Our findings suggest that attempts to exploit the association between cervical neoplasia and HPV infection to improve effectiveness of cervical screening programmes might be undermined by the limited inferences that can be drawn from the characterisation of a woman's HPV status at a single point in time, and the short lead time gained by its detection.

                Author and article information

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                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                March 2014
                : 74
                : 1
                : 24-29
                [1 ] Universidad de Los Andes Venezuela
                [2 ] Hospital Universitario de Los Andes Venezuela
                [3 ] Universidad de Los Andes Venezuela



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en

                Obstetrics & Gynecology
                Adolescents,Human papillomavirus,Squamous intraepitheliel lesion,Cervical intraepithelial neoplasia,Electrosurgery,Adolescentes,Virus papiloma humano,Lesión intraepitelial,Neoplasia intraepitelial cervical,Electrocirugía


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