Submitted by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-04-23T13:30:28Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Naíza ABRAHIM dissertação.pdf: 2379113 bytes, checksum: 03d17ed0d8926251d43bd117d3a16c14 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2018-04-23T13:32:23Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Naíza ABRAHIM dissertação.pdf: 2379113 bytes, checksum: 03d17ed0d8926251d43bd117d3a16c14 (MD5) / Made available in DSpace on 2018-04-23T13:32:24Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Naíza ABRAHIM dissertação.pdf: 2379113 bytes, checksum: 03d17ed0d8926251d43bd117d3a16c14 (MD5) Previous issue date: 2017-09-19 / . / JUSTIFICATION: Oral cancer is considered worldwide as a major public health problem, more common in developing countries. The evolution can be insidious, and often diagnosed only in advanced stages with mutilating surgeries, associated or not with adjuvant treatment. As in other cancers, early diagnosis is a priority activity to perform less aggressive treatments and improving survival. An activity that can contribute to the early diagnosis of lesions with or without evident clinical repercussion is exfoliative cytology; technique is not yet implemented for the diagnosis of oral lesions in the Amazonas´s state. OBJECTIVES: The aim of this study is to evaluate the efficacy of the use of exfoliative cytology for the diagnosis of oral cavity and oropharyngeal lesions, prior to its surgical removal. MATERIAL AND METHODS: Patients with an incisional or excisional biopsy of oral cavity lesions attended at the Dental North Specialty Center and the Oncology Control Center Foundation of the State of Amazonas, both in Manaus-AM, were selected. Before completing the biopsy, and after patient's consent, a form was filled out to obtain clinical data, followed by photodocumentation of the lesion and collection of cytological material for the preparation of conventional smears and in a liquid medium. These were fixed and then stained by the Papanicolaou technique. The results of the cytology techniques were compared with each other and with those obtained in the histopathological evaluation. RESULTS: The study sample was composed of 50 patients, 30 females and 20 males. In 70% of the cases, the lesions were histological interpreted as benign and 30% as malignant. Squamous cell carcinoma was the most prevalent lesions, with 15 cases, the benign lesions preferential site was lip and the malignant lesions were tongue, the profile´s patients diagnosed with malignancy was of male patients, smoker and alcohol use. When comparing the two methods of cytology we obtained 100% sensitivity, specificity 97%, accuracy 97%, Kappa 0.91. Regarding the accuracy of the cytological and histopathological diagnosis, sensitivity was 86.6%, specificity 100%, PPV 100%, NPV 94.5%, Kappa 0.958 and accuracy 96%. CONCLUSIONS Traditional and liquid based cytology methods were able to identify and classify cell changes with characteristics of malignancy and have high sensitivity and specificity, without significant differences between the two techniques tested. Cytology techniques have proven reproducible and, if well indicated, can be routinely used for the early detection of malignant lesions. / JUSTIFICATIVA: O câncer de boca é considerado em todo o mundo como um grave problema de saúde pública, sendo mais incidente em países em desenvolvimento. Sua evolução pode ser insidiosa, sendo na maioria das vezes diagnosticado apenas em estágios avançados, em que cirurgias mutiladoras são realizadas, associadas ou não a tratamento adjuvante. Como em outras neoplasias, a precocidade do diagnóstico é atividade prioritária para a realização de tratamentos menos agressivos e na melhoria da sobrevida. Uma atividade que pode contribuir para o diagnóstico precoce de lesões orais e de orofaringe, com ou sem repercussão clínica mais evidente, é a citologia esfoliativa, técnica ainda não implementada para avaliação das referidas lesões no Estado do Amazonas. OBJETIVOS: Avaliar a eficácia do uso da citopatologia esfoliativa para diagnóstico de lesões de cavidade oral antes de sua remoção cirúrgica. MÉTODOS: Foram selecionados pacientes com indicação de biópsia incisional ou excisional de lesões de cavidade oral e orofaringe, atendidos no Centro de Especialidade Odontológica Norte e na Fundação Centro de Controle de Oncologia do Estado do Amazonas, ambos em Manaus-AM. Antes da realização da biópsia, e após anuência do paciente, foi realizado preenchimento de formulário para obtenção de dados clínicos, seguido de fotodocumentação da lesão e de coleta de material citológico para confecção de esfregaços convencional e em meio líquido. Estes foram fixados e então corados pela técnica de Papanicolau. Os resultados das técnicas de citologia foram comparados entre si e com aqueles obtidos na avaliação histopatológica. RESULTADOS: A amostra foi constituída de 50 pacientes, na qual 30 eram do sexo feminino e 20 do sexo masculino. E em 70% dos casos a lesão foi interpretada à histopatologia como de natureza benigna e em 30%, como maligna. A localização preferencial das lesões benignas foi em lábio e das lesões malignas, em língua, sendo que destas, a mais prevalente foi o carcinoma escamocelular, com 15 casos. O perfil dos pacientes com diagnóstico de malignidade foi de pacientes do sexo masculino, tabagistas e etilistas. Quando os dois métodos de citologia foram comparados entre si foram obtidos os seguintes resultados: sensibilidade 100%, especificidade 97%, acurácia 97%, Kappa 0,91. Com relação à acuidade do diagnóstico citológico com o histopatológico, a sensibilidade foi de 86,6%, a especificidade de 100%, o VPP 100%, o VPN 94,5%, Kappa 0,958 e acurácia 96%. CONCLUSÕES: Os métodos de citologia tradicional e em meio líquido foi capaz de identificar e classificar as alterações celulares características de malignidade e possuem alta sensibilidade e especificidade, sem que houvesse diferenças significativas entre as duas técnicas testadas. As técnicas de citologia se mostraram reprodutíveis e se bem indicadas podem ser utilizadas rotineiramente para detecção precoce de lesões malignas.

Das orale Plattenepithelkarzinom ist der weltweit häufigste Tumor der Mundhöhle und des Rachens. Das Ziel dieser retrospektiven Studie war die Evaluation der Treffsicherheit der flüssigkeitsbasierten oralen Bürstenbiopsie als Screening-Methode für das orale Plattenepithelkarzinom. Bei der Bürstenbiopsie handelt es sich um ein Verfahren, das ursprünglich aus der Gynäkologie kommt und dort schon seit Jahrzehnten erfolgreich als Abstrich-Methode eingesetzt wird. Die orale Bürstenbiopsie dient der Gewinnung von Zellen aus klinisch suspekten Läsionen der Mundhöhle, in dieser Studie unter Verwendung des Zellkollektors 'Orcellex'. Die Bürste wird mit Druck etwa zehn Mal auf der zu untersuchenden Läsion rotiert, um eine ausreichende Menge an Zellen zu gewinnen. Bei der Verwendung des flüssigkeitsbasierten Verfahrens wird der Bürstenkopf anschließend in ein Gefäß mit alkoholbasierter Flüssigkeit transferiert und die Probe in ein Labor versandt. Nach der Verarbeitung der Probe wird sie von einem erfahrenen Zythopathologen untersucht und in Wertungsgruppen eingeteilt. Lautet die Diagnose 'Positiv', so können Tumorzellen in der Probe nachgewiesen werden, 'Mit dringendem Verdacht' bedeutet, dass das Vorliegen von bösartigen Zellen sehr wahrscheinlich ist, 'Zweifelhaft', dass das Vorliegen von bösartigen Zellen nicht sicher ausgeschlossen werden kann und 'Negativ' bedeutet, dass keine Tumorzellen vorliegen. Anhand der Einteilung kann dann über das weitere Vorgehen entschieden werden. Die Ergebnisse der Studie zeigen das Vorliegen einer hohen Sensitivität und Spezifität der flüssigkeitsbasierten oralen Bürstenbiopsie. Sie ist nicht-invasiv und schnell und einfach durchzuführen und eignet sich daher optimal als Screening-Methode für das orale Plattenepithelkarzinom.:1. Einführung 1.1 Tumorentstehung 1.2 Risikofaktoren 1.3 Orale Bürstenbiopsie 1.4 Adjuvante Untersuchungsmethoden 1.4.1 DNA-Zytometrie 1.4.2 Intraorale Skalpellbiopsie mit histopathologischer Untersuchung 1.5 TNM-System 1.6 Zielsetzung und Fragestellung 2. Publikationsmanuskript 3. Zusammenfassung der Arbeit 4. Literatur 5. Darstellung des eigenen Beitrags 6. Erklärung über die eigenständige Abfassung der Arbeit 7. Lebenslauf 8. Danksagung

År 2020 stod lungcancer för högst andel cancer-relaterade dödsfall. Cellblockstekniken används inom diagnostik av vätskebaserad cytologi för att morfologiskt undersöka cellernas utseende och tumörcellers ursprung. I dagsläget upplever personal på Avdelningen för Klinisk patologi och cytologi Jönköping problematik vid klotformering av cellerna, vilket kan resultera i cellförlust. Syftet var att testa en ny metod för preparering av cellblock för lungcytologi samt utvärdera immunohistokemisk färgning med metoden. Studien behandlade 20 prover av pleuravätska och 20 lungcytologiprover som bearbetades till cellblock. Proteinglycerol och formaldehyd ersatte nuvarande agglutineringslösning bestående av koncentrerad formaldehyd och ättiksyra. Cellmängd beräknades på 39 snitt av två cytodiagnostiker, och graderades i tre nivåer från sparsam till riklig (1–3). Åtta cellblock selekterades för immunohistokemisk färgning. Det totala medelvärdet för cellularitet på snitten var måttlig (2,04). För pleuraproverna var medelvärdet 1,775 och för lungcytologiprover 2,315. Inga celler hittades på n=4 prover. Samtliga (n=8) immunohistokemiska färgningar med tillhörande kontroller godkändes av metodspecialist. Metoden ger snitt med tillräcklig cellularitet som fungerar väl med immunohistokemisk färgning. Metoden kan optimeras i relation till proteinförhållande och provtagning för att vid implementering bidra till en effektiviserad och individualiserad diagnostik. / In 2020, lung cancer accounted for the highest proportion of cancer-related mortalities. The cell-block technique is used in liquid-based cytology to morphologically examine the appearance of cells and the origin of tumour-cells.  Staff at the Department of Clinical pathology and cytology in Jönköping are experiencing problems with clot-formation of cells, which can result in cell-loss. The aim was to test a new method for preparing cell-blocks for lung cytology, and evaluate immunohistochemical staining with the method. The study treated 20 pleural fluids and 20 fine needle aspirations that were processed into cell-blocks. Protein-glycerol and formaldehyde replaced the current agglutination solution consisting of concentrated formaldehyde and acetic acid. The cell-count on 39 sections were graded by two Cytotechnologists in three levels from sparse to abundant (1-3). Eight cell-blocks were selected for immunohistochemical staining. The mean cellularity was moderate (2,04). For the pleural and lung cytology samples the mean values were 1,775 and 2.315. No cells were found on n=4 sections. Every (n=8) immunohistochemical staining with associated controls was approved by method specialist. The method provides sufficient cellularity and works with immunohistochemical staining. It can be optimized in relation to protein-ratio and sampling to contribute to streamlined and individualized diagnosis if implemented.

Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą] / The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text]

The study comparing the effectiveness of a novel liquid-based Pap test (the PapSpin) with the conventional Pap smear. The impetus behind the study is meritorious: although the conventional Pap smear has been highly effective in diminishing mortality from cervical cancer, it is not perfect. It suffers from inconsistency in cell thickness and occasional obscuring blood, which hinder accurate evaluation. An alternative preparation method, one that would reduce the amount of blood and provide for a more consistent, thin layer of cells would make screening easiser and more accurate. The several performance characteristics examined in the study: Rate of unsatisfactory smears, rate of "atypical" smears (smears with an interpretation of "atypical squamous cells of undetermined significance"), sensitivity, specificity, positive predicitve value (PPV), and negative predictive value (NPV), based on histologic correlation and suitability for human papillomavirus (HPV) testing. The study consists of two principal parts. In the first part, the cervical sample collected was split into two preparations ("split sample"): a conventional smear was prepared first, then the residue left on the collection device was used to prepare a PapSpin slides. In the second part ("direct to vial"), the entire cervical sample was used to prepare a PapSpin slide. In the "split sample" study a significant reduction in the proportion of unsatisfactory and "atypical" cases was found when slides were prepared... [to full text] / Disertacijos objektas naujas citologinio gimdos kaklelio tyrimo panaudojus Shandon PapSpin skystąsias terpes efektyvumo įvertinimas. Žinoma, kad citologinis gimdos kaklelio tepinėlio tyrimas-efektyvus gimdos kaklelio vėžio kontrolės būdas, tačiau jis pasižymi nepakankamu jautrumu sąlygotu nepakankamos tyrimo kokybės. Skystųjų terpių citologinis tyrimas buvo įvertintas dviem etapais: tiriant dalytą gimdos kaklelio medžiagą ( angl.split-sample) fazėje ir nedalytą gimdos kaklelio medžiagą (angl. direct to vial). 2950 moterims buvo atlikti citologiniai tyrimai. Gauti citologinių tyrimų rezultatai buvo palyginti su atitinkamai konizuotosios gimdos kaklelio dalies histologinio tyrimo rezultatais apskaičiuojant citologinių metodų diagnostines vertes, sutarimą tarp citologinio tepinėlio tyrimų ir skystųjų terpių tyrimų. Disertacijoje keliamas klausimas ar citologiniai gimdos kaklelio tyrimai panaudojus skystąsiais terpes yra patikimas ikinavikinės gimdos kaklelio patologijos diagnostikos metodas. Disertacijoje konstatuojama, kad citologiniai gimdos kaklelio tyrimai panaudojus skystąsias terpes yra efektyvus diagnostikos metodas diagnozuojant ikinavikinius gimdos kaklelio pakitimus. Pagrindiniai metodo privalumai –statistiškai reikšmingas netinkamų ir ASC ( atipinių plokščiojo epitelio ląstelių) tyrimų kiekio sumažėjimas. Disertacijoje taip pat daug dėmesio skiriama Žmogaus papilomos viruso nustatymui iš skystosios likusios po citologinio tyrimo terpės ir konizuotosios gimdos... [toliau žr. visą tekstą]