Edição 20
Edição Saúde Feminina Câncer de colo de útero: Citologia em meio líquido e testes reflexos moleculares de infecções como HPV, clamidia e neisseria
Editorial Presidente do Conselho: Dr. Romeu Cortes Domingues Presidente Dasa: Pedro Bueno
Prezados colegas,
E
stima-se, para o Brasil, no biênio 2018-2019, a ocorrência de 600 mil casos novos de câncer para cada ano. Excetuando-se o câncer de pele não melanoma (cerca de 170 mil casos novos), ocorrerão 420 mil casos novos de câncer. Nas mulheres, os cânceres de mama (29,5%), intestino (9,4%), colo do útero (8,1%), pulmão (6,2%) e tireoide (4,0%) figurarão entre os principais.
Conselho Editorial: Dr. Emerson Gasparetto – Vice-Presidente Médico Dr. Gustavo Aguiar Campana – Diretor Médico de Análises Clínicas Dr. Leonardo Vedolin – Diretor Médico de Imagem Dra. Mônica Freire – Diretora Médica de Análises Clínicas RJ Dr. Roberto Cury – Diretor Médico de RDI SP Marcelo Luiz Mearim – Diretor de Marketing
Há diversos fatores envolvidos na etiologia do câncer do colo do útero, mas as infecções persistentes pelo papilomavírus humano (HPV) são o principal deles. Entre seus tipos oncogênicos, o HPV16 e HPV18 são os mais comumente relacionados com o aparecimento da doença. No Brasil, o controle de câncer do colo do útero constitui uma das prioridades da agenda de saúde do país e integra o Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis (DCNT). A Dasa, por sua vez, vem dedicando toda a atenção e os esforços em novas tecnologias e exames preventivos para os cuidados com a saúde feminina. Exemplo disso é o lançamento de um serviço especial para a retirada de amostras de exames ginecológicos em várias cidades do Brasil, coletados no próprio consultório médico, isto é, a citologia em meio líquido, associada a testes reflexos moleculares. Tratam-se de kits de coleta de amostras que permitem que o material de análise seja retirado no próprio consultório por um profissional treinado do laboratório e o laudo de análise seja entregue no consultório, sem a necessidade de transportar esse material. Nesta edição, convidamos você a conhecer um pouco mais sobre a tecnologia, e trouxemos artigos relevantes sobre o universo feminino envolvendo síndromes, cânceres de mama e de colo do útero, tomossíntese e oncofertilidade, na certeza de colaborar cada vez mais para a evolução da área da medicina diagnóstica.
Helaine Zanzini Cury Hohendorff – Gerente de Marketing Marco Antônio de Castro – Gerente de Produto Adriana Marçalo – Especialista de Marketing Beatriz Anselmo Ferreira dos Santos – Especialista de Marketing Shirley Carolina Costa – Analista de Marketing Participaram desta edição: Dr. Alberto Chebabo Prof. Dr. Antonio Luiz Almada Horta Prof. Dr. Carlos Eduardo Suaide Silva Dr. Cristovam Scapulatempo Neto Dra. Danieli Andrade Dr. Eduardo Perrone Dra. Glaucy Lane Neme Dr. Gustavo Guida Dr. Heron Werner Jr. Dra. Ilana Zalcberg Dr. José Eduardo Levi Dr. Leandro Accardo de Mattos Dr. Luiz Fernando Dale Dra. Maria Fernanda Milanezi Dra. Paula de Camargo Moraes Dr. Rodrigo Ambrosio Fock Dra. Suemi Marui www.dasa.com.br Grappa Marketing Editorial Diretoria: Adriano De Luca
Juliano Guarany De Luca
Editor: Adriano De Luca (MTB: 49.539) Arte: Paula Cristina d'Andréa
Dr. Emerson Gasparetto Vice-Presidente Médico da Dasa
Redação: Suênia Cardoso Revisão: Jaqueline Kanashiro contato@grappa.com.br www.grappa.com.br Fotos: Alessandro Mendes e Sergio Zacchi Responsável técnico: Dr. Gustavo Aguiar Campana (Cremesp: 112.181)
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1 - Sarcoma x mioma uterino: É possível diferenciá-los?
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Tirumani, S. H., Ojili, V., Shanbhogue, A. K. P., Fasih, N., Ryan, J. G., & Reinhold, C. Current concepts in the imaging of uterine sarcoma. Abdominal Imaging, 2012; 38(2), 397–411.
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Bazot M., et al. How to differentiate benign from malignant myometrial tumours using MR imaging. European Radiology, 2013; 23(8), 2306–2314.
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Kim TH, Kim JW, Kim SY, Kim SH, Cho JY. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration?. J Gynecol Oncol. 2018 May; 29(3):e26.
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Lakhman Y., et al. Differentiation of uterine leiomyosarcoma from atypical leiomyoma: Diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol. 2017 Jul; 27(7):2903-2915.
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Tasaki A., et al. Differential diagnosis of uterine smooth muscle tumors using DWI. Abdom Imaging (2015) 40:1742–1752.
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Li HM., et al. Diffusion-weighted imaging for differentiating uterine leiomyosarcoma from degenerated leiomyoma. J Comput Assist Tomogr. 2017; 41:599–606.
2 - Síndrome antifosfolípide como causa de abortamento de repetição
Referências Bibliográficas: 1.
Myiakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, DE Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SAR et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).J Thromb and Haemos 2006;4:295-306.
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De Jesus GR, Gibbins KJ, Silver RB and Branch WD. Prevention and Treatment of Obstetric APS in APS- Current Research Highlights and Insights, Springer 2017.
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Bouvier S, Cochery-Nouvellon E, Lavigne-Lissalde G, Mercier E, Marchetti T, Balducchi JP, Marès P, Gris JC. Comparative incidence of pregnancy outcomes in treated obstetric antiphospholipid syndrome: the NOH-APS observational study.Blood 2014;123:404-13.
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Yelnik CM, Porter TF, Branch DW, Laskin CA, Merrill JT, Guerra MM, Lockshin MD, Buyon JP, Petri M, Sammaritano LR, Stephenson MD, Kim MY, Salmon JE. Brief Report: Changes in Antiphospholipid Antibody Titers During Pregnancy: Effects on Pregnancy Outcomes. Arthritis Rheumatol 2016;68:1964-9.
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Lockshin MD, Kim M, Laskin CA, Guerra M, Branch DW, Merrill J, Petri M, Porter TF, Sammaritano L, Stephenson MD, Buyon J, Salmon JE. Prediction of adverse pregnancy outcome by the presence of lupus anticoagulant, but not anticardiolipin antibody, in patients with antiphospholipid antibodies. Arthritis Rheum 2012;64:2311-8.
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de Jesus GR, Agmon-Levin N, Andrade CA, Andreoli L, Chighizola CB, Porter TF, Salmon J, Silver RM, Tincani A, Branch DW.Branch W.. 14th International Congress on Antiphospholipid Antibodies Task Force report on obstetric antiphospholipid syndrome. Autoimmun Rev 2014;13:795-813.
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10. Triolo G, Ferrante A, Ciccia F, Accardo-Palumbo A, Perino A, Castelli A, Giarratano A, Licata G. Randomized study of subcutaneous low molecular weight heparin plus aspirin versus intravenous immunoglobulin in the treatment of recurrent fetal loss associated with antiphospholipid antibodies. Arthritis Rheum 2003;58:728-31. 11. Dendrinos S, Sakkas E, Makrakis E. Low-molecular-weight heparin versus intravenous immunoglobulin for recurrent abortion associated with antiphospholipid antibody syndrome.Int J Gynaecol Obstet 2009;104:223-5. 12. Rand JH, Wu XX, Quinn AS, Taatjes DJ The annexin A5-mediated pathogenic mechanism in the antiphospholipid syndrome: role in pregnancy losses and thrombosis. Lupus 2010;19:460-9. 13. Schreiber K et al. HYPATIA Protocol. HYdroxychloroquine to Improve Pregnancy Outcome in Women with AnTIphospholipid Antibodies (HYPATIA) Protocol: A Multinational Randomized Controlled Trial of Hydroxychloroquine versus Placebo in Addition to Standard Treatment in Pregnant Women with Antiphospholipid Syndrome or Antibodies. Seminars in Thormbosis and Haemosthasis 2017;43:562-571. 14. Marmor MF, Kellner U, Lai TY, Melles RB, Mieler WF;American Academy of Ophthalmology. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology 2016; 123:1386-94.
EDIÇÃO 20 | Saúde Feminina 15. Lefkou E, Mamopoulos A, Dagklis T, Vasnakis C, Rousso D amd Girardi G. Pravastatin improves pregnancy outcomes in obstetric antiphospholipid syndrome refractory to antithrombotic therapy. J Clin Invest 2016;126:2933-40. 16. Andrade D, Cervera R, Cohen H, Crowther M, Cuadrado M J, Canaud G, Garcia DA, Gerosa M, Ortel TL, Pengo V, Rahman A, Salmon JE, Willis R, Scott C. Woller S, Erkan D, Lockshin MD,Tektonidou M. Antiphopholipid Syndrome. Erkan D, Lockshin MD. Springer. Current Research Highlights and Clinical Insights. Pg 317-40, 2017. 17. Unlu O, Erkan D, Barbhaiya M, Andrade D, Nascimento I, Rosa R, Banzato A, Pengo V, Ugarte A, Gerosa M, Ji L, Efthymiou M, Branch DW, de Jesus GR, Tincani A, Belmont HM, Fortin PR, Petri M, Rodriguez E, Pons-Estel GJ, Knight JS, Atsumi T, Willis R, Zuily S, Tektonidou MG; TheBehalf of APS ACTION.The Impact of Systemic Lupus Erythematosus on the Clinical Phenotype of Antiphospholipid Antibody Positive Patients: Results from AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository. Arthritis Care Res 2018 Apr 18 doi: 10.1002/acr.23584. [Epub ahead of print] 18. Arachchillage DR, Machin SJ, Mackie IJ, Cohen H.Diagnosis and management of non-criteria obstetric antiphospholipid syndrome. Thromb Haemost 2015;113:13-9.
3 - Câncer de mama: Fluxogramas e diretrizes de utilização de testes genéticos no câncer de mama hereditário
Referências Bibliográficas: 1.
Rol de procedimentos e eventos em saúde 2018 (Anexo II): Diretrizes de Utilização para Cobertura de Procedimentos na Saúde Suplementar.
4 - Determinação dos níveis séricos de HER-2/neu Referências Bibliográficas: 1.
Ali SM, Carney WP, Esteva FJ et al. Serum HER-2/neu and relative resistance to trastuzumab-based therapy in patients with metastatic breast cancer. Cancer 2008 September 15;113(6):1294-301.
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Kostler WJ, Steger GG, Soleiman A et al. Monitoring of serum Her-2/neu predicts histopathological response to neoadjuvant trastuzumab-based therapy for breast cancer. Anticancer Res 2004 March;24(2C):1127-30.
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Kostler WJ, Schwab B, Singer CF et al. Monitoring of serum Her-2/neu predicts response and progression-free survival to trastuzumab-based treatment in patients with metastatic breast cancer. Clin Cancer Res 2004 March 1;10(5):1618-24.
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Lipton A, Ali SM, Leitzel K et al. Elevated serum Her-2/neu level predicts decreased response to hormone therapy in metastatic breast cancer. J Clin Oncol 2002 March 15;20(6):1467-72.
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Carney WP, Leitzel K, Ali S, Neumann R, Lipton A. HER-2/neu diagnostics in breast cancer. Breast Cancer Res 2007;9(3):207.
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10. Sandri MT, Johansson H, Colleoni M et al. Serum levels of HER2 ECD can determine the response rate to low dose oral cyclophosphamide and methotrexate in patients with advanced stage breast carcinoma. Anticancer Res 2004 March;24(2C):1261-6. 11. Sorenson PD, Jakobsen EH, Langkjer ST, Bokmand S, Ostergarrd B, Olsen DA, et al. Serum HER-2 concentrations for monitoring women with breast cancer in a routine oncology setting. Clin Chem Lab Med 2009;47(9):1117-23. 12. Molina R, Augé JM, Escudero JM, Filella X, Zanon G, Pahisa J, Farrus B, Muñoz M, Velasco M. Evaluation of tumor markers (HER-2/neu oncoprotein, CEA, and CA 15.3) in patients with locoregional breast cancer: prognostic value. Tumour Biol. 2010 Jun;31(3):171-80. doi: 10.1007/s13277-010-0025-9.
5 - Câncer de colo de útero: Citologia em meio líquido e testes reflexos moleculares de infecções como HPV, clamidia e neisseria
Referências Bibliográficas: 1.
Ministério da Saúde (BR). Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Estimativa 2018: Incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2017. Disponível em: http://www1.inca.gov.br/inca/Arquivos/estimativa-2018.pdf . (Acessado em 28 ago. 2018).
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The impact of liquid-based cytology in decreasing the incidence of cervical cancer. Gibb RK, Martens MG. Rev Obstet Gynecol. 2011;4(Suppl 1):S2-S11.
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Kitchener HC, et al. Automation-assisted versus manual reading of cervical cytology (MAVARIC): a randomized controlled trial. Lancet Oncol. 2011;12 (1):56-64.
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Ronco G, Rossi PG. Role of HPV DNA testing in modern gynaecological practice. Best Practice & Research Clinical Obstetrics and Gynaecology. 2018; 47:107e118.
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Acetta G, et al. Is human papillomavirus screening preferable to current policies in vaccinated and unvaccinated women? A cost-effectiveness analysis. J Med Screen. 2010;17:181–189.
10. Gervais et al. Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend. BMC Public Health. 2017; 17:283. 11. Cuschieri K, et al. Eurogin roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programs. Int J Cancer. 2018;143(4):735-745. 12. Wentzensen N, et al. Triage of HPV positive women in cervical cancer screening. J Clin Virol. 2016;76(Suppl 1): S49–S55. 13. Poljak M, et al. Commercially available molecular tests for human papillomaviruses (HPV): 2015 update. J Clin Virol. 2016; Suppl 1:S3-S13. 14. Arbyn M, et al. Which high-risk HPV assays fulfil criteria for use in primary cervical cancer screening? Clin Microbiol Infect. 2015;21(9):817-26. 15. Heard I, et al. Clinical and analytical performance of the PapilloCheckHPV-Screening assay using the VALGENT framework. Journal of Clinical Virology. 2016; 81 6–11. 16. Stoler MH, et al. The Onclarity Human Papillomavirus Trial: design, methods, and baseline results Gynecologic Oncology. 2018; 149:498–505. 17. Martins T, et al. Influence of prior knowledge of Human Papillomavirus status on the performance of cytology screening. Am J Clin Pathol. 2018;149(4):316-323.
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6 - Manejo clínico e laboratorial da infecção urinária em mulheres
Referências Bibliográficas: 1.
Cunha MA, Assunção GLM, Medeiros IM, Freitas MR. Antibiotic resistance patterns of urinary tract infections in a northeastern brazilian capital. Rev. Inst. Med. Trop. Sao Paulo. 2016;58:E2.
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Trautner B, Grygorian B. Approach to a positive urine culture in a patient without urinary symptoms. Infect Dis Clin N Am. 2014;28:15-31.
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Grabe M, Bjerklund-Johansen TE, Botto H, Çek M, Naber KG et al. Guidelines on urological infections. European Association of Urology. 2013.
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Rodrigues WF, Miguel CB, Nogueira APO, Ueira-Vieira C, Paulino TP et al. Antibiotic Resistance of Bacteria Involved in Urinary Infections in Brazil: A Cross-Sectional and Retrospective Study. Int J Envirom Res Public Health. 2016;13:E918.
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Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-54.
7 - O rastreio do câncer de mama por imagem: Quando indicar a tomossíntese?
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8 - Oncofertilidade
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10. Fetility preservation with the use of GHRH analogue in women undergoing chemotherapy for Lymphoma, RL Tavares, H Repro, 106,3, e133 set 2016 11. GNRH Agonist for gonadal protection during Chemotherapy,Tommaso Falcone, H Repro, T30,12,2711 , december 2015.