Search

evaluation of a centralised collection of clinical data (Service) within cancer screening programmes in Piedmont based on a hubspoke model and its impact on process indicators.assessment of an organisational intervention, through a non-controlled pre-post design.organised screening programmes within the Piedmont Region, divided into 9 departments.clinical data (extracted from medical charts for mammography screening and from excision histology reports for cervical screening) obtained through the Service were quantified and their completeness was assessed. The Service impact on the detection rate (DR) was evaluated, comparing the DR pre- (2005-2008) and post-Service (2009- 2012) within breast screening; the DR was computed through histological diagnosis made during colposcopy (pre-Service method) or through the worst diagnosis between the latter and that reported from excision histology (post-Service method) within cervical screening (data available for department 1, year 2013). Some hints on human resources employed in pre- and post-Service periods were reported.within mammography screening, the Service obtained 53.1% of extra-department medical charts and 45.8% of extra-region ones; the percentage of missing diagnoses changed from 5.5% (pre- Service) to 3.7% (post-Service). The age standardised DR for malignant tumours in the post-Service period is 1.3 times the DR of the pre-Service period per 1,000 screening tests. Within cervical screening, 51.7% of histological reports was recorded. Crude DR for high-grade lesions changed from 3.9 (pre-Service) to 4.7 (post-Service) per 1,000 screened women. The system centralisation did not imply an increase in the dedicated personnel.the Service is an operational core which coordinates the collection of clinical data, impacting on process indicators without an increase in human resources at departmental level.

OBJECTIVE: To investigate epidemiologic, clinical and pathologic aspects of various grades of vulvar intraepithelial neoplasia (VIN). STUDY DESIGN: A retrospective, multicenter study of 370 cases of vulvar intraepithelial neoplasia (VIN) wits performed by the Italian Study Group on Vulvar Disease. RESULTS: Of the 370 cases, 148 were VIN 1 (40.0%), 53 were VIN 2 (14.3%), and 169 were VIN 3 (45.7%). The mean age of the patients was 52.6 years. During the study period an increase in the rate of human papillomavirus-associated VIN was observed. In addition, while VIN 1 and 2 were associated mostly with squamous cell hyperplasia, VIN 3 was almost equally associated with lichen sclerosus and squamous cell hyperplasia; the difference was statistically significant. Intraepithelial or invasive squamous neoplasia of the lower genital tract was associated in 22% of the cases (82/370). CONCLUSION The results of the investigation, although not allowing firm conclusions due to the retrospective and multicentered nature of the study, demonstrate the extreme heterogeneity of VIN lesions.

In 1986 the International Society For the Study of Vulvar Disease classified vulvar Paget's disease (VPD) as a non-squamous intraepithelial lesion of the vulva. The clinical multiform aspect of VPD, similar to other dermatological lesions, often delays the execution of a biopsy. Paget's cells could be instead easily identified at histological examination and with histochemical reactions. Underlying adenocarcinomas or stromal invasion are present in about 10% of intraepithelial VPD. Patients with VPD are at risk for a second synchronous or metachronous neoplasia: colo-rectal adenocarcinoma (more frequent in perianal localization of VPD), cervical adenocarcinoma, carcinoma of the transitional epithelium from the renal pelvis to urethra and mammary carcinoma. A wide spectrum of frequency of these associations is reported in the literature (0-45%). Therapy for intraepithelial VPD is wide and deep surgical resection comprising all the skin appendages. However VPD has a high frequency of recurrences (15-62%), often irrespective for radicality of surgical excision. When association with underlying invasive adenocarcinoma or stromal invasion is histologically confirmed, vulvar surgical approach must be integrated with inguino-femoral lymphadenectomy. The role of chemotherapy and radiotherapy in the multimodal approach to extensive or recurring VPD is still controversial. Recurrences or progression of intraepithelal VPD are reported more than 10 years from first surgical resection so that long term follow-up is mandatory.

Forty-two patients with primary invasive vulvar carcinoma were treated with radical vulvectomy and deep femoral lymphadenectomy with preservation of the fascia lata and cribriform fascia. The rationale for using this technique was based on anatomic knowledge of the topographic distribution of groin lymph nodes, which was confirmed by the study of 50 cadavers. The preliminary data show that the number of superficial and deep femoral lymph nodes removed from the 42 patients (mean number of nodes, 20; range, 8-32) was similar to the number reported in anatomy books. In addition, the five-year actuarial survival rate, 70%, was comparable to that in the literature. These preliminary results suggest that the surgical technique used in this study is as radical an oncologic procedure as Way's classic groin lymphadenectomy, which consists of removing the fascia lata and cribriform fascia.

A study of 80 cases of dysplasia of the uterine cervix showed the coexistence of HPV infections in 52 cases. This association (65%) shows the important role played by the human papilloma virus in the genesis of cancer of the cervix.

Papillomavirus common internal capsid antigen (PV-Ag) was demonstrated using an immunoperoxidase technique in 74 out of 239 (31.0%) cases of cervical condylomata diagnosed histologically. All the positive cases but 2 (72/74) had nuclear changes compatible with dysplasia or cervical intraepithelial neoplasia (CIN). Immunocytochemically determined PV-Ag positivity was found in 54 out of 92 CIN I (58.7%), in 14 out of 32 CIN II (43.8%) and in 4 out of 18 CIN III (22.2%). The extent of koilocytosis in the epithelium had a direct correlation with the PV-Ag positivity: when koilocytosis extended to more than two thirds of the epithelium thickness, 24/41 cases (63.4%) were positive; when between one third and two thirds, 32/105 cases (30.5%) were positive; when present in less than one third 16/93 cases (17.2%) were positive. The positivity was 41.8% under 30 years of age and 20.5% over 30. Out of 16 positive cases followed with multiple biopsies for 6-20 months, 9 remained positive without change in CIN degree and 7 became negative, with CIN regression in 4 cases and progression to CIN III with disappearance of koilocytosis in 3 cases. More specific methods than histocytopathology alone are needed for epidemiologic and follow-up studies, especially in the cases in which the disappearance of antigenic and morphological expression of PV infection is not followed by dysplasia regression.