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Meaning of the experience of breast cancer patients in a university clinic in Bogotá, Colombia: A qualitative study [哥伦比亚波哥大一家大学诊所乳腺癌患者的体验感:一项定性研究]。
Pub Date : 2024-09-09 DOI: 10.18597/rcog.4167
Jhonatan Daniel Olivero Luna, María Claudia Ramírez Flórez, Nicolás Rozo Agudelo, Juliana Vanessa Rincón López, John Alexander Castro Muñoz, María Fernanda Luna

Objectives: To understand the meaning of the experiences of breast cancer patients undergoing diagnostic and treatment processes.

Material and methods: A descriptive qualitative study based on the hermeneutic-interpretative scientific paradigm and grounded in a phenomenological epistemological framework. The study included women aged 18 years or older diagnosed with breast cancer and treated at a university clinic in Bogotá, who were given a semi-structured interview. Procedure: Semi-structured interviews were conducted based on pre-established categories. Aspects evaluated: Knowledge about current breast cancer screening and detection patterns, current utilization patterns of healthcare services, and perceived healthcare needs.

Results: Regarding Current knowledge patterns on breast cancer screening and detection, patients demonstrated limited awareness. Concerning Current utilization patterns of healthcare services, there were noted dissatisfactions with the administrative process. Regarding Perceived healthcare needs, a feeling of abandonment was identified, stemming from a lack of continuity in the care process. Additionally, two emergent categories were identified: trust in the healthcare system and predisposition to feelings of guilt due to a lack of knowledge about the disease.

Conclusions: A comprehensive care process is needed that addresses the real medical needs of patients, beyond administrative concerns, and is focused on the quality of the doctor-patient relationship across the entire multidisciplinary team.

目的:了解乳腺癌患者在诊断和治疗过程中的经历的意义。材料与方法:从现象学的认识论基础出发,采用诠释-解释科学范式进行定性描述研究。研究对象包括在波哥大一所大学诊所就诊的、被诊断患有乳腺癌的 18 岁或 18 岁以上女性,对她们进行了半结构化访谈。程序:根据预先确定的类别进行半结构化访谈。评估内容:对当前乳腺癌筛查和检测模式的了解、当前医疗保健利用模式和感知的健康需求。 结果:关于当前乳腺癌筛查和检测的知识模式,患者知之甚少。关于目前使用医疗服务的模式,有证据表明患者对行政程序不满意。在认为的健康需求方面,由于护理过程缺乏连续性,病人有一种被遗弃的感觉。此外,还发现以下新类别:结论:除了行政管理方面的问题外,还需要有一个能满足病人真正医疗需求的全 面护理过程,重点是整个多学科团队的医患关系质量。
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引用次数: 0
Prevalence of unexpected malignant disease in the histopathology of hysterectomy indicated for benign condition [良性子宫切除术组织病理学中未预期的恶性疾病的发生率]。
Pub Date : 2024-09-02 DOI: 10.18597/rcog.4174
Isabela Sanchez Mayorca, Angela María Gómez Forero, Roberto Gallo Roa, Camilo Alberto Garzón Sarmiento

Objective: To describe the prevalence of incidental malignant pathology following a hysterectomy performed for benign reasons.

Method: A descriptive cross-sectional study based on hospital records. Women who underwent hysterectomy for benign reasons at a general referral hospital between 2013 and 2021 were included. Women with obstetric hysterectomy were excluded. Measured variables: age, route of hysterectomy, type of hysterectomy, histopathological diagnosis of premalignant lesion or invasive cancer, type of cancer. Analysis: Descriptive, the prevalence of preneoplastic and neoplastic conditions was estimated for the overall period.

Results: Of 816 clinical records, 674 cases (87 %) met the inclusion criteria and were analyzed. The premenopausal population predominated. Twentysix cases of unexpected malignant disease were identified, yielding a prevalence of 3.8 %, and 13 cases of premalignant pathology (1.9 %). The most common origin was the cervix (40 %), followed by the ovary (33 %).

Conclusions: Patients undergoing hysterectomy for benign conditions should be informed about the risk of unexpected injury. The importance of performing, in our context an adequate preoperative approach to rule out cervix uteri and ovarian cancer is emphasized. Follow-up studies of patients with unanticipated cancer are required to determine their treatment and prognosis in the region.

目的:描述良性子宫切除术后偶发恶性病变的发生率。方法:基于医院记录的描述性横断面研究。研究对象包括 2013 年至 2021 年期间在一家综合转诊医院因良性原因接受子宫切除术的女性。不包括产科子宫切除术的妇女。测量变量:年龄、子宫切除术的途径、子宫切除术的类型、组织病理学诊断为恶性前病变或浸润性癌症、癌症类型。结果:从 816 份临床记录中分析了符合纳入标准的 674 个病例(87%)。绝经前人群占多数。共发现 26 例未预见到的恶性疾病,发病率为 3.8%,13 例恶性肿瘤前病变(1.9%)。结论:因良性疾病接受子宫切除术的患者应考虑报告意外病变的风险。结论:因良性疾病而接受子宫切除术的患者应考虑到报告意外病变的风险,强调充分的术前处理的重要性,尤其是在我们的环境中排除卵巢癌和宫颈癌的可能性。需要对意外癌症患者进行随访研究,以确定该地区的治疗方法和预后。
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引用次数: 0
Gastric signet ring cell adenocarcinoma metastatic to the breast. Systematic review of the literature, regarding a case [胃印戒细胞腺癌转移至乳房。文献的系统回顾,一个病例的启示]。
Pub Date : 2024-09-02 DOI: 10.18597/rcog.4187
José Ismael Guío-Ávila, Adriana Yulieth Soler-Perilla, Ximena Briceño-Morales, Clara Briceño-Morales

Objectives: To determine the general state of scientific evidence published in the last 20 years on gastric signet ring cell (SRC) adenocarcinoma metastatic to the breast, and present a case.

Material and methods: The case of a patient who attended a high-complexity reference institution in Bogotá for a breast metastasis from a gastric SRC adenocarcinoma is reported. A Systematic Review of the literature was carried out, including cohort studies, reports and case series of patients with gastric SRC adenocarcinoma metastatic to the breast, which will present information on the epidemiology, clinical, radiological and histopathological characteristics, and the treatment and prognostic of this disease.

Results: There were identified 363 references, twenty-six of which met the eligibility criteria. Gastric SRC adenocarcinoma metastatic to the breast predominated in the Asian continent (75.9%). The mean age at presentation was 42.5 years. In 62% (n=18) of cases this condition manifested clinically as a breast mass. From a radiological point of view, the majority of breast lesions presented as one or several nodules with suspicious characteristics (55.2%; n=16). In the biopsy of breast lesions, positivity for cytokeratin 7 and cytokeratin 20 occurred in 41.4% (n=12) and 37.9% (n=11) of cases, respectively. Only nine patients (31%) underwent any type of breast surgery. There is a lack of information on the treatment and prognosis of gastric SRC adenocarcinoma metastatic to the breast.

Conclusions: The frequency of cases of gastric SRC adenocarcinoma metastatic to the breast published in the last 20 years is low. The general practitioner and the gynecologist could be the first medical professionals to face this rare condition, so knowing it and suspecting it is essential, especially if we take into account that the median overall survival of these patients is low.

目的:介绍一例由胃标志环细胞腺癌(AGCES)转移而来的乳腺病变,并对有关此类乳腺病变患者的流行病学、诊断、治疗和预后的文献进行系统综述(SR)。材料和方法:我们报告了一例因右侧乳房结节而到波哥大一家高难度转诊机构就诊的患者。患者曾在三年前接受过 SCFA 手术、化疗和辅助放疗。双侧腋窝淋巴结均已确定。结节活检报告为标志环细胞型腺癌。随后,正电子发射断层扫描发现了其他部位的转移。患者在 10 个月后死亡。研究人员对相关文献进行了检索,其中包括关于转移至乳腺的 SCAN 患者的队列研究、报告和系列病例,介绍了该疾病的流行病学、临床、放射学和组织病理学特征、接受治疗的类型以及预后。转移至乳房的 SCLCFA 患者主要为亚洲人(75.9%)。发病年龄中位数为 42.5 岁。62%的病例临床表现为乳腺结节。从放射学角度看,大多数乳腺病变表现为一个或多个可疑结节(55.2%)。对乳腺病变进行活检时,细胞角蛋白 7 和细胞角蛋白 20 呈阳性的病例分别占 41.4% 和 37.9%。只有 31% 的患者接受了某种形式的乳腺手术。结论:任何有癌症病史并伴有乳房肿块或临床变化的患者都应转诊进行乳房活检,以排除继发性乳腺癌。对这种类型的SCLC表现进行进一步的前瞻性研究,对于明确该亚组患者的治疗效果和预后非常重要。
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引用次数: 0
Treatment of ectopic pregnancy implanted in cesarean scar: other therapeutic approaches [剖腹产疤痕植入性异位妊娠的治疗:其他治疗方法]。
Pub Date : 2024-08-23 DOI: 10.18597/rcog.4186
Jorge Andrés Castrillón-Lozano, Mariean Kamila Caraballo-Martínez
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引用次数: 0
Letter to the Editor about “Preoperative neutrophil/ lymphocyte ratio as prognostic factor in epitelial ovarian cancer” [致编辑的信--"作为上皮性卵巢癌预后因素的术前中性粒细胞/淋巴细胞比率"]。
Pub Date : 2024-08-22 DOI: 10.18597/rcog.4278
Luis Ángel Cesar Huamanciza
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引用次数: 0
Letter to the Editor about the qualitative study on breastfeeding experiences: sociocultural limitations in the lives of breastfeeding women [致编辑关于母乳喂养经历定性研究的信:母乳喂养妇女经历的社会文化限制]。
Pub Date : 2024-08-13 DOI: 10.18597/rcog.4255
Samir Steve Cusipuma Pariapuma, Alexandra Barrios Carpio, Mery Milagros Maldonado Ochoa
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引用次数: 0
Reply to the letter to the Editor: qualitative study about breastfeeding experiences from the perspective of the breastfeeding woman [回应致编辑的信:母乳喂养经验定性研究:母乳喂养妇女的社会文化限制]。
Pub Date : 2024-08-13 DOI: 10.18597/rcog.4288
Diana C Londoño-Sierra, Sandra L Restrepo-Mesa

Reply to the letter to the Editor

回应致编辑的信。
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引用次数: 0
Reply to the letter to the Editor "Treatment of ectopic pregnancy implanted on cesarean scar: other therapeutic approaches". 回复致编辑的信 "剖宫产疤痕上异位妊娠的治疗:其他治疗方法"。
Pub Date : 2024-08-13 DOI: 10.18597/rcog.4260
Oswaldo Tipiani

Reply to the letter to the Editor.

回复致编辑的信。
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引用次数: 0
Reply to the letter to the Editor about “Preoperative neutrophil/lymphocyte ratio as prognostic factor in epitelial ovarian cancer” [对 "作为上皮性卵巢癌预后因素的术前中性粒细胞/淋巴细胞比值 "的致编辑信的回复].
Pub Date : 2024-08-13 DOI: 10.18597/rcog.4289
Julio Vázquez Rojo

Reply to the letter to the Editor

回应致编辑的信。
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引用次数: 0
Colombian consensus for the molecular diagnosis of endometrial cancer 哥伦比亚子宫内膜癌分子诊断共识
Pub Date : 2024-06-17 DOI: 10.18597/rcog.4060
Marc Edy Pierre, Angélica Viviana Fletcher Prieto, Juliana Rodríguez, Abraham Hernández Blanquisett, Ana Milena Gómez Camacho, Rafael Parra Medina, Lucrecia Mojica Silva, Robinson Fernández, Pedro Hernando Calderón Quiroz
<p><p>Objective: The Cancer Genome Atlas research program (TCGA) developed the molecular classification for endometrial cancer with prognostic and therapeutic utility, which was replaced by the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) classification by consensus and international guidelines due to its high cost. This article aims to present national recommendations from an expert consensus that allows unification and implementation of the molecular classification for women with endometrial cancer nationwide, with a rational use of resources and technology.Methods: Consensus of 36 experts in clinical oncology, oncological gynecology, pathology, and genetics, with clinical practice in the national territory. The leader group performed a literature review and structuring of questions rated 1 to 9 points. A modified nominal group technique was used. There was a face-to-face meeting with master presentations, deliberative dialogue, and Google Forms (Google LLC, Mountain View, CA, USA) questionnaire voting with analysis and discussion of responses. The non-consensual responses led to a second round of voting. The final manuscript was finally prepared and revised.Results: Seven recommendations were formulated integrating the panelist responses based on evidence, but adjusted to the Colombian context and reality.Recommendation 1. The molecular classification is recommended in all the endometrial cancers using the immunohistochemistry markers as subrogated results from the molecular profile initially proposed in the TCGA classification.Recommendation 2. The sequential test strategy is recommended, starting with the immunohistochemistry markers (p53, MLH1, MSH 2, MSH6, PMS2) simultaneously in all the patients, defining to request POLE (DNA polymerase epsilon) (if available) according to the risk classification based on the surgical piece.Recommendation 3. It is recommended, that the gynecologist oncologist should be the one to request the POLE (if available) according to the final pathology report. This test must be requested for all endometrial cancers stage I-II, except in low risk (stage IA low grade endometrioid histology without linfovascular invasion normal p53) and, stages III-IV without residual disease, without affecting the request of subrogated immunohistochemistry molecular markers upon histology.The consensus proposes that the POLE is requested after the immunohistochemistry and according to the categories in the risk classification established by the 2020 ESGO/ESTRO/ESP guidelines.Recommendation 4. It is recommended to perform immunohistochemistry for hormonal receptors for all women with endometrial cancer and the HER2 in patients with p53abn, simultaneously with the others immunohistochemistry markers.Recommendation 5. It is recommended to perform the immunohistochemistry markers (p53, MLH1, MSH2, MSH6 y PMS2) in an initial endometrial biopsy or curettage when the specimen is adequate and availabl
目的:癌症基因组图谱研究计划(TCGA)制定了具有预后和治疗作用的子宫内膜癌分子分类法,由于其成本高昂,该分类法被ProMisE(子宫内膜癌主动分子风险分类器)分类法所取代,并被国际指南达成共识。本文旨在通过专家共识提出国家建议,以便在全国范围内统一和实施子宫内膜癌妇女分子分类,合理利用资源和技术:由 36 位在全国范围内开展临床实践的临床肿瘤学、肿瘤妇科学、病理学和遗传学专家达成共识。领导小组进行了文献综述,并对 1 至 9 分的问题进行了结构化。采用了改良的名义小组技术。在面对面的会议上进行了主讲、商议对话和谷歌表格(Google LLC,美国加利福尼亚州山景城)问卷投票,并对答复进行了分析和讨论。未达成共识的答复导致了第二轮投票。最后编写并修改了最终稿件:综合专家小组成员的答复,根据证据提出了七项建议,但根据哥伦比亚的国情和实际情况进行了调整。建议 1:建议对所有子宫内膜癌进行分子分类,使用免疫组化标记物作为 TCGA 分类中最初提出的分子特征的替代结果。建议采用顺序检测策略,首先对所有患者同时进行免疫组化标记(p53、MLH1、MSH 2、MSH6、PMS2)检测,然后根据基于手术切片的风险分类要求进行 POLE(DNA 聚合酶ε)检测(如有)。建议 3:建议由妇科肿瘤专家根据最终病理报告申请 POLE(如有)。所有 I-II 期子宫内膜癌,除低危(IA 期低度子宫内膜样组织学,无血管内膜侵犯,p53 正常)和 III-IV 期无残留病灶外,都必须进行 POLE 检查,但不影响在组织学检查后申请代位免疫组化分子标记。建议 4:建议对所有子宫内膜癌妇女进行激素受体免疫组化,对 p53abn 患者进行 HER2 免疫组化,同时进行其他免疫组化标记。建议 5:如果标本充足且可用,建议在初次子宫内膜活检或刮宫术中进行免疫组化标记(p53、MLH1、MSH2、MSH6 y PMS2)。如果初次免疫组化检查结果不确定,或初次病理检查结果与最终病理检查结果存在组织学差异,建议在手术病理检查中重复分子图谱检查。免疫组化标记物必须根据 CAP(美国病理学家学会)的建议在病理报告中报告,与样本类型无关。建议 6:对于免疫组化显示 MLH1 表达缺失的患者,无论是否伴有 PMS2 表达缺失,都应进行 MLH1 启动子甲基化检测。建议 7:所有存在 MMR(错配修复)缺陷的患者都应接受遗传咨询,以排除林奇综合征。建议在进行辅助判断时,除了考虑经典的组织病理学标准外,还应考虑分子分类,2020 年 ESGO/ESTRO/ESP 指南中的预后组别分类也纳入了这一标准:根据哥伦比亚的国情,有必要在临床实践中实施子宫内膜癌分子分类,因为它具有预后和可能的预测价值。这将有助于确定哥伦比亚人口的特征,从而提供个性化的指导治疗。本文件为学术性、非法规性文件。
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Revista colombiana de obstetricia y ginecologia
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