PATOLOGÍA BASADA EN LA EVIDENCIA (PATOLOGÍA BASADA EN PRUEBAS),
GUÍAS DE CONSENSO Y SU APLICACIÓN A LA PRÁCTICA DIARIA
Marcial García Rojo. Complejo Hospitalario de Ciudad Real.
España.
D. REVISIÓN CRÍTICA Y ESTUDIOS DE
COSTE-EFECTIVIDAD
NHS Centre for Reviews
and dissemination (Eficiencia):
http://nhscrd.york.ac.uk/welcome.htm
El
Centro de Revisiones y Difusión (CRD), creado en 1994 por el NHS
y la Universidad de York, proporciona información de investigación
en salud, gracias a revisiones rigurosas y sistemáticas, con enlaces
a la literatura existente. Dispone de tres bases de datos: revisiones
sobre efectividad de tratamientos y algunas sobre procedimientos
diagnósticos (DARE), evaluación económica (NHSEED) y evaluación
tecnológica (HTA). Este centro, dedicado fundamentalmente a revisiones
de tratamientos, trabaja conjuntamente con otros similares, como
las Colaboraciones Cochrane y Campbell y participa en la evaluación
de guías clínicas.
También colabora con otras instituciones como el Instituto Nacional
para la Excelencia Clínica (NICE).
Para que las revisiones sean fiables, deben ser llevadas a cabo
de forma rigurosa y existen guías para asegurar esa calidad, como
las del CRD (CRD Report 4).
Si buscamos en todas las bases de datos, encontraremos 470 entradas
sobre cáncer de mama. Contiene revisiones sobre exactitud diagnóstica
en cáncer de mama, PCR en micrometástasis de cáncer de mama, coste-efectividad
en histopatología y de PAAF, PAAF en el manejo de adenopatías, etc.
Veamos algunos contenidos de cada una de las
bases de datos (no hay un resumen disponible en todos), que hemos
localizado con términos de búsqueda como “cytology, pathology,
histopathology, biopsy, immunohistochemistry, molecular o PCR”:
-
DARE (Database of Abstracts of
Reviews of Effects): Los resúmenes de DARE están
estructurados en metodología, resultados y conclusiones. En
ellos se valora la calidad de las revisiones que se
analizan.
Una aplicación esencial de esta base de datos para los patólogos
es aprender a valorar artículos científicos. Algunos ejemplos:
CITOLOGÍA:
- Collection
devices for obtaining cervical cytology samples.
Martin-Hirsch P, Jarvis G, Kitchener
H, Lilford R. Martin-Hirsch P, Jarvis G, Kitchener H, Lilford
R. Collection devices
for obtaining cervical cytology samples (Cochrane Review).
In: The Cochrane Library, Issue3, 2003. Oxford: Update
Software.
- El uso de espátula de punta extendida
con cepilllo (cytobrush) o es más efectiva que la espátula
sola para la toma de células endocervicales, para conseguir
un mayor número de frotis adecuados y mejorar la detección
de discariosis.
- Screening
for lung cancer.
Manser RL, Irving LB, Stone C,
Byrnes G, Abramson M, Campbell D. Manser RL, Irving LB, Stone
C, Byrnes G, Abramson M, Campbell D. Screening for lung cancer
(Cochrane Review). In: The Cochrane Library, Issue3,
2003. Oxford: Update Software.
- Las pruebas existentes no apoyan el
cribado de cáncer de pulmón mediante radiografía de tórax
o citología de esputo.
- Are
fluid-based cytologies superior to the conventional Papanicolaou
test: a systematic review.
Sulik S M, Kroeger K, Schultz J K, Brown J L, Becker L A, Grant
W D. Journal of Family Practice 2001; 50(12): 1040-1046.
- Para la mayoría de las mujeres no hay
motivos para reemplazar la triple toma por la citología
líquida. En las mujeres con alto riesgo de cáncer de cérvix
o en aquellas que rara vez son sometidas al cribado, el
posible incremento de sensibilidad de la citología líquida
puede superar los posibles riesgos de un mayor número de
falsos positivos. Antes de adoptar el uso rutinario de la
citología líquida es aconsejable disponer de más estudios
de referencia.
- Liquid-based
cytology in cervical screening: a rapid and systematic review.
Payne N, Chilcott J, McGoogan
E. Health Technology Assessment 2000; 4(18): 1-73.
- Detection
of false negative pap smears by rapid reviewing: a metaanalysis.
Arbyn M, Schenck U. Acta Cytologica 2000; 44(6): 949-957.
- Accuracy
of the Papanicolaou test in screening for and follow-up of cervical
cytologic abnormalities: a systematic review.
Nanda K, McCrory D C, Myers E R, Bastian L A, Hasselblad V,
Hickey J D, Matchar D B. Annals of Internal Medicine 2000; 132(10):
810-819.
- El cribado mediante triple toma en poblaciones
con prevalencia baja tiene una especificidad alta pero una
sensibilidad baja.
- Efficacy
of cervical-smear collection devices: a systematic review and
meta-analysis.
Martin-Hirsch P, Lilford R, Jarvis G, Kitchener H C. The Lancet
1999; 354: 1763-1770. In: The Cochrane Library, Issue 4, 2003.
Oxford: Update Software.
- Evaluation
of cervical cytology.
Duke University, McCrory D C, Matchar D B, Bastian L, Datta
S, Hasselblad V, Hickey J, Myers E, Nanda K. Rockville, MD,
USA: Agency for Health Care Policy and Research 1999: 1-274.
- Esta es una buena revisión del tema.
Concluyen que en la mayoría de los estudios, la estimación
de la sensibilidad de la triple toma está sesgada. En los
estudios menos sesgados, en la población con baja incidencia,
la sensibilidad ronda el 50%, aunque la especificidad es
alta. Las nuevas tecnologías (ThinPrep, Autopap) mejora
la sensibilidad respecto al cribado convencional con triple
toma, sin embargo no hay pruebas precisas de su efecto en
la especificidad.
- A
systematic review of the role of human papillomavirus testing
within a cervical screening programme.
Cuzick J, Sasieni P, Davies P, Adams J, Normand C, Frater A,
van Ballegooijen M, van den Akker E. Health Technology Assessment
1999; 3(14): 1-204.
- La detección del virus del papiloma
humano (VPH) por técnicas de biología molecular (PCR y captura
de híbridos) es más sensible que la citología para el CIN
de alto grado, pero tiene una especificidad menor, especialmente
en mujeres jóvenes. No se puede recomendar el uso rutinario
de la detección del VPH. Puede ser adecuado realizarlo en
el manejo de frotis de características poco definidas, o
en mujeres de más edad en las que se precise una mayor sensibilidad.
- Interactive
neural-network-assisted screening: a clinical assessment.
Mango L J, Radensky P W. Acta
Cytologica 1998; 42(1): 233-245.
- El sistema interactivo asistido por
red neuronal (INNA) tiene una sensibilidad para detectar
frotis anormales superior al 89% y es 8,2 veces mejor que
el re-cribado no asistido para en la identificación de falsos
negativos. Sin embargo, DARE avisa que el trabajo fue realizado
por empleados del sistema INNAy que sus conclusiones deben
tomarse con precaución pues no incluye una revisión de calidad
de los estudios incluidos y hay un posible sesgo en la selección
de la literatura revisada, en la extracción de datos y en
el metaanálisis.
- Meta-analysis
of Pap test accuracy.
Fahey M T, Irwig L, Macaskill P. American Journal of Epidemiology
1995; 141(7): 680-689.
- El estudio incluye estudios de poca
calidad por lo que sus conclusiones no son totalmente válidas,
siendo necesarios estudios primarios que sigan los estándares
metodológicos para la evaluación de pruebas diagnósticas.
Algunas debilidades de este estudio son: limitarse a una
sola base de datos bibliográfica, excluir datos no publicados,
y no describe el proceso de revisión.
PATOLOGÍA QUIRÚRGICA:
- Biopsy
versus resection for malignant glioma.
Grant R, Metcalfe SE.. Grant R, Metcalfe SE. Biopsy
versus resection for malignant glioma (Cochrane Review).
In: The Cochrane Library, Issue3, 2003. Oxford: Update Software.
- Sólo se encontró un ensayo controlado
y randomizado de 23 pacientes de una única institución y
éste mostraba desigualdades entre los dos grupos de tratamiento,
por lo que no es posible concluir qué modalidad de tratamiento
es mejor. El estudio destaca los frecuentes errores en el
diagnóstico radiológico (23%). Son necesarios pues, ensayos
controlados randomizados y multicéntricos.
- Accuracy
of outpatient endometrial biopsy in the diagnosis of endometrial
cancer: a systematic quantitative review.
Clark T J, Mann C H, Shah N, Khan K S, Song F, Gupta J K. BJOG
2002; 109(3): 313-21.
-
Diagnostic accuracy of dermoscopy.
Kittler H, Pehamberger H, Wolff K, Binder M. Lancet Oncology
2002; 3(3): 159-165.
- La dermoscopia mejora la exactitud diagnóstica
del melanoma respecto a la inspección ocular sin ayuda.
Sin embargo, la dermoscopia requiere un entrenamiento previo.
La mayor exactitud diagnóstica se consigue a través de un
diagnóstico de consenso que incluye dos o más expertos.
- The
natural history of acute histologic rejection without biochemical
graft dysfunction in orthotopic liver transplantation: a systematic
review.
Bartlett A S, Ramadas R, Furness S, Gane E, McCall J L. Liver
Transplantation 2002; 8(12): 1147-1153.
- Accuracy
of outpatient endometrial biopsy in the diagnosis of endometrial
hyperplasia.
Clark TJ, Mann CH, Shah N, Khan KS, Song F, Gupta JK. Acta
Obstetricia et Gynecologica Scandinavica 2001; 80(9): 784-793.
- Diagnostic
accuracy of large-core needle biopsy for nonpalpable breast
disease: a meta-analysis.
Verkooijen H M, Peeters P H, Buskens E, Koot V C, Borel Rinkes
I H, Mali W P, van Vroonhoven T J. British Journal of Cancer
2000; 82(5): 1017-1021.
-
Transthoracic needle aspiration biopsy for the diagnosis of
localised pulmonary lesions: a meta-analysis.
Lacasse Y, Wong E, Guyatt G H, Cook D J.. Thorax 1999;
54(10): 884-893.
-
The cost-effectiveness of fine-needle aspiration cytology and
14-gauge core needle biopsy compared with open surgical biopsy
in the diagnosis of breast carcinoma.
Logan-Young W, Dawson A E, Wilbur D C, Avila E E, Tomkiewicz
Z M, Sheils L A, Laczin J A, Taylor A S. The cost-effectiveness
of fine-needle aspiration cytology and 14-gauge core needle
biopsy compared with open surgical biopsy in the diagnosis of
breast carcinoma. Cancer, 1998;82(10):1867-1873.
- Coste-efectividad de la PAAF de mama
y la biopsia de mama con aguja 14-gauge frente a la biopsia
de mama abierta para el diagnóstico de cáncer de mama: Se
calcula un coste por cada PAAF de unos 100 Euros por cada
PAAF y 625 Euros por cada biopsia con aguja. Por cada biopsia
abierta que estas técnicas consiguen evitar, el ahorro es
de 1.150 Euros
- The
effect of interferon on the liver in chronic hepatitis C: a
quantitative evaluation of histology by meta-analysis.
Camma C, Giunta M, Linea C, Pagliaro
L. Journal of Hepatology 1997; 26(6): 1187-1199.
- Diagnosis,
management and screening of early localised prostate cancer.
Selley S, Donovan J, Faulkner A, Coast J, Gillatt D. Health
Technology Assessment 1997; 1(2): 1-96.
- Gastric
ulcers at endoscopy: brush, biopsy, or both.
Sadowski DC, Rabeneck L. American Journal of Gastroenterology
1997; 92(4): 608-613.
-
NHS EED (NHS Economic Evaluation
Database) Base de datos de estudios económicos de actuaciones
(alternativas de tratamiento o de diagnóstico) en salud. Incluye
análisis de coste-beneficio, coste-efectividad y coste-utilidad.
CITOLOGÍA
-
Potential
health and economic impact of adding a human papillomavirus
vaccine to screening programs.
Kulasingam S L, Myers E R. JAMA 2003; 290(6): 781-789.
-
Una estrategia basada sólo en la vacunación no es coste-efectiva.
La estrategia más atractiva es la vacunación más el cribado
bienal empezando a los 24 años. La vacuna que reduce la
incidencia de los tipos oncogénicos de VPH durante la
edad de mayor incidencia de infección (a finales de la
segunda década y comienzo de la tercera, ej. 16-24 años)
puede ser rentable económicamente, sobre todo si permite
retrasar el comienzo del cribado.
-
Fine
needle aspiration cytology versus percutaneous biopsy of nonpalpable
breast lesions.
Meunier M, Clough K. European Journal of Radiology
2002; 42(1): 10-16. (No es un estudio económico y no dispone
de resumen)
-
The
value of frozen section examinations in determining the extent
of thyroid surgery in patients with indeterminate fine-needle
aspiration cytology.
Roach J C, Heller K S, Dubner S, Sznyter L A. Archives of
Otolaryngology -- Head & Neck Surgery 2002; 128(3): 263-267.
-
Costs
and effectiveness of alternative strategies for cervical cancer
screening in military beneficiaries.
Maxwell G L, Carlson J W, Ochoa M, Krivak T, Rose G S, Myers
E R. Obstetrics & Gynecology 2002; 100(4): 740-748.
-
En la población militar femenina, la citología líquida
con despistaje del virus del papiloma humano (VPH) es
la opción de cribado más coste-efectiva para el cáncer
de cérvix, por encima de la citología líquida aislada
o la triple toma convencional. Es posible aumentar el
intervalo de cribado para reducir los costes directos
sin comprometer la efectividad de la estrategia.
-
Clinical
and economic implications of adding HPV tests to the routine
cytology follow-up and management of patients with histologically
defined cervical intraepithelial neoplasia grade 1.
Gamzu R, Almog B, Levin I, Fainaru O, Niv J, Lessing J B,
Bar-Am A. Gynecologic Oncology 2002; 86(2): 129-133.
-
Willingness
to pay for new Papanicolaou test technologies.
Raab S S, Grzybicki D M, Hart A R, Kiely S, Andrew-Jaja C,
Scioscia E. American Journal of Clinical Pathology 2002; 117(4):
524-533.
-
Human
papillomavirus testing for triage of women referred because
of abnormal smears: a decision analysis considering outcomes
and costs.
Meerding W J, van Ballegooijen M, Burger M P, Marle M E, Quint
W G, Habbema J D. Journal of Clinical Epidemiology 2002; 55(10):
1025-1032.
-
Role
of fine needle aspiration in diagnosing breast lesions.
Mansoor I, Jamal A A. Saudi Medical Journal 2002;
23(8): 915-920.
-
Immediate
on-site interpretation of fine-needle aspiration smears: a
cost and compensation analysis.
Layfield L J, Bentz J S, Gopez E V. Cancer Cytopathology 2001;
93(5): 319-322.
-
Repeat
cervical cytology at the time of colposcopy: is there an added
benefit?.
Simsir A, Ioffe O B, Bourquin P,
Brooks S E, Henry M. Acta Cytologica 2001; 45(1): 23-27.
-
Clinical
usefulness and cost-effectiveness of the transbronchial needle
aspiration for the diagnosis of mediastinal lymph node enlargement.
Villar J A, Rio F I, Barreiro J
M, Anon M M, Pombo C V, Duran ML, Varela J O, Amigo L P. Revista
Clinica Espanola 2001; 201(4): 169-173.
-
Policy
analysis of cervical cancer screening strategies in low-resource
settings: clinical benefits and cost-effectiveness.
Goldie S J, Kuhn L, Denny L, Pollack A, Wright T C. JAMA 2001;
285(24): 3107-3115.
-
Low-cost
technology for screening uterine cervical cancer.
Parashari A, Singh V, Satyanarayana L, Sodhani P, Gupta M
M. Bulletin of the World Health Organization 2000; 78(8):
964-967.
-
Cost-effectiveness
of screening for anal squamous intraepithelial lesions and
anal cancer in human immunodeficiency virus-negative homosexual
and bisexual men.
Goldie S J, Kuntz K M, Weinstein M C, Freedberg K A, Palefsky
J M. American Journal of Medicine 2000; 108(8): 634-641.
-
Economic
evaluation of NMP22 in the management of bladder cancer.
Lachaine J, Valiquette L, Crott R. Canadian Journal of Urology
2000; 7(2): 974-980.
-
Ward W G, Kilpatrick S. Clinical Orthopaedics
& Related Research 2000; (373): 80-87.
-
The
clinical application and cost analysis of fine-needle aspiration
biopsy in the diagnosis of mass lesions in sarcoidosis.
Tambouret R, Geisinger K R, Powers C N, Khurana K K, Silverman
J F, Bardales R, Pitman M B. Chest 2000; 117(4): 1004-1011.
-
Prediction
of cervical intraepithelial neoplasia grade 2-3 using risk
assessment and human papillomavirus testing in women with
atypia on Papanicolaou smears.
Shlay J C, Dunn T, Byers T, Baron A E, Douglas J M. Obstetrics
& Gynecology 2000; 96(3): 410-416.
-
Cost
effectiveness of rescreening cervicovaginal smears.
Raab S S, Bishop N S, Zaleski M S. American Journal of Clinical
Pathology 1999; 111(5): 601-609.
-
The
clinical effectiveness and cost-effectiveness of screening
for anal squamous intraepithelial lesions in homosexual and
bisexual HIV-positive men.
Goldie S J, Kuntz K M, Weinstein M C, Freedberg K A, Welton
M L, Palefsky J M. JAMA 1999; 281(19): 1822-1829.
-
Determining
the cost-effectiveness of mass screening for cervical cancer
using common analytic models.
Sato S, Matunaga G, Tsuji I, Yajima A, Sasaki H. Acta
Cytologica 1999; 43(6): 1006-1014.
-
Cost-efficacy
of endoscopic ultrasonography with fine-needle aspiration
vs. mediastinotomy in patients with lung cancer and suspected
mediastinal adenopathy.
Aabakken L, Silvestri G A, Hawes R, Reed C E, Marsi
V, Hoffman B. Endoscopy 1999; 31(9): 707-711.
-
Peritoneal
washing cytology is unnecessary in gynecologic surgery for
benign diseases.
Sharifi S, Ducatman B S, Wang H H, Fraser J L. Cancer Cytopathology
1999; 87(5): 259-262.
-
The
role of urine cytology in the assessment of lower urinary
tract symptoms.
Potter J M, Quigley M, Pengelly A W, Fawcett D P, Malone P
R. BJU International 1999; 84(1): 30-31.
-
Cost-effectiveness
of 3 methods to enhance the sensitivity of Papanicolau testing.
Brown A D, Garber A M. JAMA 1999; 281(4): 347-353.
-
Cost
effectiveness of transbronchial needle aspiration.
Crocket J A, Wong E Y, Lien D C, Nguyen K G, Chaput M R, McNamee
C. Canadian Respiratory Journal 1999; 6(4): 332-335.
-
NMP22
is a sensitive, cost-effective test in patients at risk for
bladder cancer.
Zippe C, Pandrangi L, Agarwal A. Journal of Urology
1999; 161(1): 62-65.
-
The
cost-effectiveness of the cytology laboratory and new cytology
technologies in cervical cancer prevention.
Raab S S, Zaleski M S, Silverman J F. American Journal of
Clinical Pathology 1999; 111(2): 259-266.
-
Fine-needle
aspiration in the management of peripheral lymphadenopathy
in a developing country.
Thomas J O, Adeyi D, Amanguno H. Diagnostic Cytopathology
1999; 21(3): 159-162.
-
Impact
of automated technology on the cervical cytologic smear:a
comparison of cost.
Grohs D H. Acta Cytologica 1998; 42(1): 165-170.
-
Relative
value and cost-effectiveness of culture and special stains
in fine needle aspirates of the lung.
Krane J F, Renshaw A A. Acta Cytologica 1998; 42(2):
305-311.
-
Outpatient
management of pneumothorax after fine-needle aspiration: economic
advantages for the hospital and patient.
Gurley M B, Richli W R, Waugh K A. Radiology 1998; 209(3):
717-722.
-
Interactive
neural network-assisted screening:an economic assessment.
Radensky P W, Mango L J. Acta Cytologica 1998; 42(1): 246-252.
-
Fine-needle
aspiration:comparison of smear, cytospin, and cell block preparations
in diagnostic and cost effectiveness.
Liu K, Dodge R, Glasgow B J, Layfield L J. Diagnostic Cytopathology
1998; 19(1): 70-74.
-
The
cost-effectiveness of fine-needle aspiration cytology and
14-gauge core needle biopsy compared with open surgical biopsy
in the diagnosis of breast carcinoma.
Logan-Young W, Dawson A E, Wilbur D C, Avila E E, Tomkiewicz
Z M, Sheils L A, Laczin J A, Taylor A S. Cancer 1998; 82(10):
1867-1873.
-
PAPNET-assisted
rescreening of cervical smears: cost and accuracy compared
with a 100% manual rescreening strategy.
O'Leary T J, Tellado M, Buckner S-B, Ali I S, Stevens
A, Ollayos C W. JAMA 1998; 279(3): 235-237.
-
Comparison
of the costs of fine-needle aspiration and open surgical biopsy
as methods for obtaining a pathologic diagnosis.
Rimm D L, Stastny J F, Rimm E B, Ayer S, Frable W J. Cancer
Cytopathology 1997; 81(1): 51-56.
-
The
cost-effectiveness of treating women with a cervical vaginal
smear diagnosis of atypical squamous cells of undetermined
significance.
Raab S S, Steiner A L, Hornberger J. American Journal of Obstetrics
& Gynecology 1998; 179(2): 411-420.
-
Sensitivity
and cost-effectiveness of fine-needle aspiration with immunocytochemistry
in the evaluation of patients with a pulmonary malignancy
and a history of cancer.
Raab S S, Slagel D D, Hughes J H, Thomas P A, Silverman J
F. Archives of Pathology & Laboratory Medicine 1997; 121(7):
695-700.
-
Use
of fine needle aspiration for solid breast lesions is accurate
and cost effective.
Rubin M, Horiuchi K, Joy N, Haun W, Read R, Ratzer E, Fenoglio
M. American Journal of Surgery 1997; 174(6): 694-698.
-
The
cost of production in cervical cytology: comparison of conventional
and automated primary screening systems.
Bishop J W. American Journal of Clinical Pathology 1997; 107(4):
445-450.
-
An
evaluation of educational outreach to general practitioners
as part of a statewide cervical screening program.
Stevens S A, Cockburn J, Hirst S, Jolley D. American Journal
of Public Health 1997; 87(7): 1177-1181.
-
The
cost of diagnosis: a comparison of four different strategies
in the workup of solitary radiographic lung lesions.
Goldberg-Kahn B, Healy J C, Bishop J W. Chest 1997; 111(4):
870-876.
-
Cost-effectiveness
of routine cytological cervical surveillance following treatment
for carcinoma of cervix.
Bliss P, Trott P A, Blake P R. Journal of Clinical Effectiveness
1997; 2(3): 87-90.
-
The
value of repeat Pap smear at the time of initial colposcopy.
Spitzer M, Ryskin M, Chernys A E, Shifrin A. Gynecologic
Oncology 1997; 67(1): 3-7.
-
Touch
cytology:a reliable and cost-effective method for diagnosis
of helicobacter pylori infection.
Trevisani L, Sartori S, Runia M, Caselli
M, Abbasciano V, Grandi E, Forini E. Digestive Diseases &
Sciences 1997; 42(11): 2299-2303.
-
The
importance of sputum cytology in the diagnosis of lung cancer:
a cost-effectiveness analysis.
Raab S S, Hornberger J, Raffin T. Chest 1997; 112(4):
937-945.
-
Gastric
ulcers at endoscopy: brush, biopsy, or both.
Sadowski D C, Rabeneck L. American Journal of Gastroenterology
1997; 92(4): 608-613.
-
Efficacy
and cost-effectiveness of multihole fine-needle aspiration
of head and neck masses.
Mui S, Li T, Rasgon B M, Hilsinger R L, Rumore G, Puligandla
B, Sawicki J. Laryngoscope 1997; 107(6): 759-764.
-
Human
papillomavirus testing as triage for atypical squamous cells
of undetermined significance and low-grade squamous intraepithelial
lesions: sensitivity, specificity, and cost-effectiveness.
Kaufman R H, Adam E, Icenogle J, Reeves W C. American Journal
of Obstetrics & Gynecology 1997; 177(4): 930-936.
-
Cost-effectiveness
of collecting routine cytologic specimens during fiberoptic
bronchoscopy for endoscopically visible lung tumor.
Govert J A, Kopita J M, Matchar D, Kussin P S, Samuelson W
M. Chest 1996; 109(2): 451-456.
-
Cost-effectiveness
of collecting routine cytologic specimens during fiberoptic
bronchoscopy for endoscopically visible lung tumor.
Govert J A, Kopita J M, Matchar D, Kussin P S, Samuelson W
M. Chest 1996; 109(2): 451-456.
-
Positive
economic and diagnostic accuracy impacts of on-site evaluation
of fine needle aspiration biopsies by pathologists.
Saleh H A, Khatib G. Acta Cytologica 1996; 40(6):
1227-1230.
-
The
use and accuracy of cross-sectional imaging and fine needle
aspiration cytology for detection of pelvic lymph node metastases
before radical prostatectomy.
Wolf J S, Cher M, Dallera M, Presti J C, Hricak H, Carroll
P R. Journal of Urology 1995; 153(3 Part 2): 993-999.
-
Use
of the polymerase chain reaction technique on induced-sputum
samples for the diagnosis of pneumocystis carinii pneumonia
in HIV-infected patients: a clinical and cost-analysis study.
Chouaid C, Roux P, Lavard I, Poirot J L, Housset B. American
Journal of Clinical Pathology 1995; 104(1): 72-75.
-
A
decision analysis of practice patterns used in evaluating
and treating abnormal pap smears.
Roland P Y, Naumann R W, Alvarez
R D, Kilgore L C, Partridge E E. Gynecologic Oncology 1995;
59(1): 75-80.
-
The
triple test: a cost-effective diagnostic tool.
Schmidt W A, Wachtel M S, Jones M K, Thurmond A S, DuBois
P M, Pommier R F, Vetto J T. Laboratory Medicine 1994; 25(11):
715-719
-
Economic
aspects of screening for cervical cancer in New Zealand.
Bethwaite J,Rayner A,Bethwaite, P. New Zealand Medical Journal
1986; 99(811): 747-751.
PATOLOGÍA QUIRÚRGICA
-
Clinical
and economic benefit of HPV-load testing in follow-up and
management of women postcone biopsy for CIN2-3.
Almog B, Gamzu R, Bornstein J, Levin I, Fainaru O, Niv J,
Lessing J B, Bar-Am A. British Journal of Cancer 2003; 89(1):
109-112.
-
Biopsy
of focal liver lesions: Guidelines, comparison of techniques
and cost-analysis..
Francque S M, De Pauw F F, Van den Steen G H, Van Marck E
A, Pelckmans P A, Michielsen P P. Acta Gastroenterologica
Belgica 2003; 66(2): 160-165.
-
Frequency
of seborrheic keratosis biopsies in the united states: A benchmark
of skin lesion care quality and cost effectiveness.
Duque M I, Jordan J R, Fleischer A B, Williford P M, Feldman
S R, Teuschler H, Chen G J. Dermatologic Surgery 2003; 29(8):
796-801.
-
Ultrasoltnd-guided
percutaneous thoracoabdominal biopsy: efficacy, cost-effectiveness
and safety.
Ojalehto M, Tikkakoski T, Rissanen T, Apaja-Sarkkinen
M. Acta Radiologica 2002; 43(2): 152-158.
-
Telepathology:
current status and future prospects in diagnostic histopathology.
Cross S S, Dennis T, Start R D. Histopathology 2002;
41(2): 91-109.
-
The
utility and cost effectiveness of voice recognition technology
in surgical pathology.
Henricks W H, Roumina K, Skilton B E, Ozan D J, Goss G R.
Modern Pathology 2002; 15(5): 565-571.
-
Cost-benefit
analysis of the anatomo-pathological study of tonsillectomy
specimens in the pediatric population (Spanish).
Prim M P, de Diego J I, Hardisson D, Sastre N, Rabanal
I, Larrauri J. Acta Otorrinolaringologica Espanola 2002; 53(6):
407-10.
-
Tissue
micro-array: a cost and time-effective method for correlative
studies by regional and national cancer study groups.
Milanes-Yearsley M, Hammond M E H, Pajak T F, Cooper J S,
Chang C, Griffin T, Nelson D, Laramore G, Pilepich M. Modern
Pathology 2002; 15(12): 1366-1373.
-
Recurrent
obstetric complications: how placental pathology can contribute
to cost-effective clinical evaluation and a rational clinical
care plan.
Salafia C M. Current Women's Health Reports 2002;
2(1): 65-71.
-
The
advantages of frameless stereotactic biopsy over frame-based
biopsy.
Dorward N L, Paleologos T S, Alberti O, Thomas D G T. British
Journal of Neurosurgery 2002; 16(2): 110-118.
-
Review
article: diagnosis of Helicobacter pylori infection.
Vaira D, Gatta L, Ricci C, Miglioli
M. Alimentary Pharmacology & Therapeutics 2002; 16 Suppl
1: 16-23.
-
Excision
of head and neck basal cell carcinoma with a rapid, cross-sectional,
frozen-section technique.
Bentkover S H, Grande D M, Soto H, Kozlicak B A, Guillaume
D, Girouard S. Archives of Facial Plastic Surgery 2002; 4(2):
114-119.
-
Impact
of second opinion pathology in the definitive management of
patients with bladder carcinoma.
Coblentz T R, Mills S E, Theodorescu D. Cancer 2001;
91(7): 1284-1290.
-
Endometrial
brush biopsy for the diagnosis of endometrial cancer.
Del Priore G, Williams R, Harbatkin C B, Wan L S, Mittal K,
Yang G C. Journal of Reproductive Medicine 2001; 46(5): 439-443.
-
Cost
consequences of sentinel lymph node biopsy in the treatment
of breast cancer: a preliminary analysis.
Chirikos T N, Berman C G, Luther S L, Clark R A. International
Journal of Technology Assessment in Health Care 2001; 17(4):
626-631.
-
Activity
and cost analysis in surgical pathology. Experience of a French
university laboratory using the activity-based costing method.
(French).
Bellocq J P, Biron N, Kessler S, Penaud M, Faujour V, Ospel
J, Supper E, Barthel A, Roussel J F, Mechine-Neuville A, Marcellin
L, Lang-Averous G, Chenard M P. Annales de Pathologie 2001;
21(3): 215-232.
-
Practical
applications of Internet resources for cost-effective telepathology
practice.
Leong F J. Pathology 2001; 33(4): 498-503.
-
Sentinel
node biopsies in melanoma patients: a protocol for accurate,
efficient, and cost-effective analysis by preselection for
immunohistochemistry on the basis of Tyr-PCR.
van der Velde-Zimmermann D, Schipper M I, de Weger R A, Hennipman
A, Borel Rinkes I H M. Annals of Surgical Oncology 2000; 7(1):
51-54.
-
The
economic impact of the diagnosis of dysplasia in Barrett's
esophagus.
Ofman J J, Lewin K, Ramers C, Ippoliti A, Lieberman D, Weinstein
W. American Journal of Gastroenterology 2000; 95(10): 2946-2952.
-
Methylene
blue-directed biopsies improve detection of intestinal metaplasia
and dysplasia in Barrett's esophagus.
Canto M I F, Setrakian S, Willis J, Chak A, Petras R, Powe
N R, Sivak M V. Gastrointestinal Endoscopy 2000; 51(5): 560-568.
-
Screening
for high-grade dysplasia in gastroesophageal reflux disease:
is it cost-effective?.
Soni A, Sampliner R E, Sonnenberg A. American Journal
of Gastroenterology 2000; 95(8): 2086-2093.
-
Office
based wire-guided open breast biopsy under local anesthesia
is accurate and cost effective.
Morris K T, Pommier R F, Vetto J T. American Journal of Surgery
2000; 179(5): 422-425.
-
HER-2/neu
assessment in breast cancer by immunohistochemistry and fluorescence
in situ hybridization: comparison of results and correlation
with survival.
Kakar S, Puangsuvan N, Stevens J
M, Serenas R, Mangan G, Sahai S, Mihalov M L. Molecular Diagnosis
2000; 5(3): 199-207.
-
Noninvasive
tests as a substitute for histology in the diagnosis of Helicobacter
pylori infection.
Hahn M, Fennerty M B, Corless C L, Magaret N, Lieberman D
A, Faigel D O. Gastrointestinal Endoscopy 2000; 52(1): 20-26.
-
The
cost-effectiveness of immunohistochemistry.
Raab S S. Archives of Pathology & Laboratory Medicine
2000; 124(8): 1185-1191.
-
The
impact of molecular diagnostic tests on patient outcomes.
Ross J S. Clinics in Laboratory Medicine 1999; 19(4):
815-831.
-
Percutaneous
liver biopsy: a cost-benefit analysis comparing sonographic
and CT guidance.
Kliewer M A, Sheafor D H, Paulson E K, Helsper R S, Hertzberg
B S, Nelson R C. American Journal of Roentgenology 1999; 173(5):
1199-1202.
-
The
usefulness of pathologists' assistants.
Grzybicki D M, Galvis C O, Raab S S. American Journal of Clinical
Pathology 1999; 112(5): 619-626.
-
The
cost-effectiveness of nationwide breast carcinoma screening
in Finland, 1987-1992.
Leivo T, Sintonen H, Tuominen R,
Hakama M, Pukkala E, Heinonen O P. Cancer 1999; 86(4): 638-646.
-
Endoscopic
biopsy pathology of helicobacter pylori gastritis: comparison
of bacterial detection by immunohistochemistry and genta stain.
Toulaymat M, Marconi S, Garb J, Otis C, Nash S. Archives of
Pathology & Laboratory Medicine 1999; 123(9): 778-781.
-
Accuracy
and cost of intraoperative lymph node frozen sections at radical
prostatectomy.
Young M P A, Kirby R S, O'Donoghue E P N, Parkinson M C. Journal
of Clinical Pathology 1999; 52(12): 925-927.
-
Financial
determinants of outcomes in molecular testing.
Ross J S. Archives of Pathology & Laboratory Medicine
1999; 123(11): 1071-1075.
-
Use
of intervening unstained slides for immunohistochemical stains
for high molecular weight cytokeratin on prostate needle biopsies.
Green R, Epstein J I. American Journal of Surgical Pathology
1999; 23(5): 567-570.
-
The
relative economics of screening for colorectal cancer, breast
cancer and cervical cancer.
Gyrd-Hansen D. Critical Reviews in Oncology-Hematology
1999; 32(2): 133-144.
-
Cost
analysis of sentinel lymph node biopsy as an alternative to
elective lymph node dissection in patients with malignant
melanoma.
Brobeil A, Cruse C W, Messina J L, Glass L F, Haddad F F,
Berman C G, Marshburn J, Reintgen D S. Surgical Oncology Clinics
of North America 1999; 8(3): 435-45, viii.
-
Application
of the principle of marginal analysis to sampling practice
using prostatic chippings as a model.
Langlois N E I, Donaldson C. Journal of Clinical Pathology
1998; 51(2): 104-107.
-
Histopathologic
review of prostate biopsies from patients referred to a comprehensive
cancer center:correlation of pathologic findings, analysis
of cost, and impact on treatment.
Wurzer J C, Al Saleem T I, Hanlon AL, Freedman GM, Patchefsky
A, Hanks GE. Cancer 1998; 83(4): 753-759.
-
Nation-wide
breast cancer screening in The Netherlands: results of initial
and subsequent screening 1990-1995 National Evaluation Team
for Breast Cancer Screening.
Fracheboud J, de Koning H J, Beemsterboer P M, Boer R, Hendriks
J H, Verbeek A L, van Ineveld B M, de Bruyn A E, van der Maas
P J. International Journal of Cancer 1998; 75(5): 694-8.
-
Efficacy
of reverse transcriptase-polymerase chain reaction screening
for micrometastatic disease in axillary lymph nodes of breast
cancer patients.
Lockett M A, Metcalf J S, Baron P L, O'Brien P H, Elliott
B M, Robison J G, Cole D J. American Surgeon 1998; 64(6):
539-544.
-
A
novel alcian yellow-toluidine blue (Leung) stain for helicobacter
species:comparison with standard stains, a cost-effectiveness
analysis, and supplemental utilities.
Vartanian R K, Leung J K, Davis J E, Kim Y B, Owen D A. Modern
Pathology 1998; 11(1): 72-78.
-
Minimally
invasive staging of patients with melanoma: sentinel lymphadenectomy
and detection of the melanoma-specific proteins MART-1 and
tyrosinase by reverse transcriptase polymerase chain reaction.
Goydos J S, Ravikumar T S, Germino F J, Yudd A, Bancila E.
Journal of The American College of Surgeons 1998; 187(2):
182-188.
-
Excising
the reexcision: stereotactic core-needle biopsy decreases
need for reexcision of breast cancer.
Kaufman C S, Delbecq R, Jacobson L. World Journal of Surgery
1998; 22(10): 1023-1027.
-
Percutaneous
large core needle biopsy versus surgical biopsy in the diagnosis
of breast lesions.
Anania G, Bazzocchi M, Di Loreto C,
Risaliti A, Terrosu G, Donni A, Zuiani C, Puglisi F, Bresadola
F. International Surgery 1997; 82(1): 52-55.
-
Value-based
pathology: a cost-benefit analysis of the examination of routine
and nonroutine tonsil and adenoid specimens.
Netser J C, Robinson R A, Smith R J, Raab S S. American Journal
of Clinical Pathology 1997; 108(2): 158-165.
-
Costing
pathology services: a practical approach to a difficult problem.
Bailey P E. Pathology 1997; 29(2): 196-200.
-
Cost
effectiveness of image diagnosis.
Inamura K, Kimura M, Ito A, Umeda T, Kozuka T. Rinsho Byori
[Japanese Journal of Clinical Pathology] 1997; 45(4): 350-6.
-
Assessment
of computer-aided assistive technology:analysis of outcomes
and costs.
Hass U, Andersson A, Brodin H, Persson J. Augmentative &
Alternative Communication 1997; 13(2): 125-35.
-
A
model for estimation of productivity and costs at a deparment
of histopathology (Danish).
Bjerregaard B, Hannibal S. Ugeskrift for Laeger 1997;
159(13): 1935-40.
-
Cost-effectiveness
of breast cancer screening in Spain.
Plans P, Casademont L, Salleras L. International Journal of
Technology Assessment in Health Care 1996; 12(1): 146-150.
-
The
utility of routine frozen section examination for intraoperative
diagnosis of thyroid cancer.
McHenry C R, Raeburn C, Strickland T, Marty J J. American
Journal of Surgery 1996; 172(6): 658-661.
-
The
prostate:decreasing cost-effectiveness of biopsy with advancing
age.
Gottlieb R H, Mooney C, Mushlin A I, Rubens D J, Fultz P J.
Investigative Radiology 1996; 31(2): 84-90.
-
Diagnostic
accuracy and charge-savings of outpatient core needle biopsy
compared with open biopsy of musculoskeletal tumors.
Skrzynski M C, Biermann S, Montag A, Simon M A. Journal of
Bone & Joint Surgery - American Volume 1996; 78A(5): 644-649.
-
Electron
microscopic examination of skin biopsy as a cost-effective
tool in the diagnosis of lysosomal storage diseases.
Prasad A, Kaye E M, Alroy J. Journal of Child Neurology 1996;
11(4): 301-308.
-
Clinical
and cost impact of second-opinion pathology: review of prostate
biopsies prior to radical prostatectomy.
Epstein J I, Walsh PC, Sanfilippo F. American Journal of Surgical
Pathology 1996; 20(7): 851-857.
-
Determining
the processing cost of a skin biopsy specimen.
Penneys N S. Journal of Cutaneous Pathology 1994;
21(5): 472-475.
-
HTA (Health Technology Assessment
Database). Esta base
de datos recoge información de valoraciones de tecnologías en
salud procedentes de publicaciones y de proyectos realizados por
la Red Internacional de Agencias de evaluación de Tecnologías en
Salud (INAHTA). Algunos ejemplos de interés en Anatomía
Patológica:
CITOLOGÍA:
- Liquid-based
cervical cytology.
Institute for Clinical Systems Improvement (ICSI) 2003 (Technology
Assessment Report): 23.
-
Computer-assisted image analysis for cervical
screening.
Medical Services Advisory Committee. Medical Services Advisory
Committee (MSAC) 2003 (MSAC reference 12c): 49.
-
Guidance on the use of liquid-based cytology
for cervical screening.
National Institute for Clinical Excellence. National Institute
for Clinical Excellence (NICE) 2003 (Technology Appraisal Guidance
- No.69): 22.
-
Liquid-based cytology and human papillomavirus
testing in cervical cancer screening.
Noorani H Z, Brown A, Skidmore B, Stuart G C E. Canadian Coordinating
Office for Health Technology Assessment (CCOHTA) 2003 (Technology
Report Issue 40): 85.
-
Liquid based cytology for cervical screening.
Medical Services Advisory Committee. Medical Services Advisory
Committee (MSAC) 2002 (MSAC reference 12a): 97.
-
Screening for cervical cancer: recent advances.
Health Technology Advisory Committee. Health Technology
Advisory Committee (HTAC) 2002.
-
Use of epithelial cell cytology in breast
cancer risk assessment and high-risk patient management.
Blue Cross Blue Shield Association (BCBS) 2002 (TEC Assessment
17(1)): 33.
-
Screening for cervical cancer.
Hartmann K E, Hall S A, Nanda K, Boggess J F, Zolnoun D. Agency
for Healthcare Research and Quality (AHRQ) 2002 (Preventive
Services Task Force Systematic Evidence Review No. 25): 91.
-
Analyses of diagnostic protocols for the
prevention of cervical cancer.
Elizalde B, Ugalde F, Beguiristain J M, Gutierrez A, Rezola
R, Arbulu A. Basque Office for Health Technology Assessment,
Health Department Basque Government (OSTEBA) 2001 (D-01-05):
49.
-
Use of mammography and Papanicolaou's test
for the early detection of breast and uterine cervix cancer
in Spain. IPE-02/34.
Luengo S, Munoz A. Agencia de Evaluacion de Tecnologias Sanitarias
(AETS) 2001 (Informe de Evaluacion de Tecnologias Sanitarias
No. 34): 45.
-
Liquid-based cytology in cervical screening:
a rapid and systematic review.
Payne N, Chilcott J, McGoogan E. The National Coordinating Centre
for Health Technology Assessment (NCCHTA) on behalf of ScHARR,
Sheffield. 2000: 73.
-
Guidance on the use of liquid-based cytology
for cervical screening.
National Institute for Clinical Excellence. National Institute
for Clinical Excellence (NICE) 2000 (Technology Appraisal Guidance
- No.5).
-
A systematic review of the role of human
papillomavirus testing within a cervical screening programme.
Cuzick J, Sasieni P, Davies P, Adams J, Normand C, Frater A,
van Ballegooijen M, van den Akker E. The National Coordinating
Centre for Health Technology Assessment (NCCHTA) 1999: pp204.
-
Evaluation of cervical cytology.
Agency for Healthcare Research and Quality (AHRQ) 1999 (Evidence
Report/Technology Assessment 5).
-
Assessment of techniques for cervical cancer
screening. - nonsystematic review.
Noorani HZ, Arratoon C, Hall A. Canadian Coordinating Office
for Health Technology Assessment (CCOHTA) 1997 (CCOHTA Report
1997: 2E): 33.
-
The management of primary breast cancer.
NHS Centre for Reviews and Dissemination. Centre for Reviews
and Dissemination (CRD) 1996 (Effective Health Care 2(6)): 16.
-
Computer assisted analysis system for cervico-vaginal
smears (systematic review, primary research, expert panel).
Jouveshomme S, Baffert S, Charpentier E, Souag A. Comite d'Evaluation
et de Diffusion des Innovations Technologiques (CEDIT) 1998
(97.01): 42.
-
Efficacy of liquid-based and computer-assisted
cervical cytology - Medical efficacy (project).
German Agency of Health Technology Assessment at German Institute
for Medical Documentation and Information (DAHTA@DIMDI) (DAHTA).
PATOLOGÍA QUIÚRGICA:
- Molecular
diagnosis for hereditary cancer predisposing syndromes: genetic
testing and clinical impact.
Ho C, Banerjee S, Mensinkai S. Canadian Coordinating Office
for Health Technology Assessment (CCOHTA) 2003 (Technology Report
Issue 41): 82.
-
Sentinel node biopsy (SNB) in breast cancer
- progress report.
L'Agence Nationale d'Accreditation d'Evaluation en Sante
(ANAES) 2002: 87.
-
Lymphatic mapping with sentinel lymph node
biopsy for breast cancer.
Institute for Clinical Systems Improvement (ICSI) 2002
(Technology Assessment Report).
-
DNA chips.
Comite d' Evaluation et de Diffusion des Innovations Technologiques.
Comite d'Evaluation et de Diffusion des Innovations Technologiques
(CEDIT) 2001 (01.08).
-
HPV DNA testing for cervical cancer.
Institute for Clinical Systems Improvement (ICSI) 2001
(Technology Assessment Report).
-
Predictive genetic testing for breast and
prostate cancer.
Noorani H Z, McGahan L. Canadian Coordinating Office for Health
Technology Assessment (CCOHTA) 1999 (Technology Report Issue
4): 85.
-
Duchenne and Becker muscular dystrophies:
family screening and molecular diagnosis - nonsystematic review.
Conseil d'Evaluation des Technologies de la Sante du Quebec.
Conseil d'Evaluation des Technologies de la Sante du Quebec
(CETS) 1997 (CETS 97-1 RE): 56.
-
Laboratory medicine and pathology services
under fixed funding arrangements.
Cowley D E. Alberta Heritage Foundation for Medical Research
(AHFMR) 1998 (Information Paper IP 1): 17.
-
Polymerase chain reaction.
University HealthSystem Consortium. University HealthSystem
Consortium (UHC) 1995 (Technology Report): 48.
-
Genetic diagnosis by PCR.
Homstrom s, Abens J, Boman J, Grankvist O, Johansson B, Landegren
U, Levi R, Marke LA, Lerup O. Swedish Council on Technology
Assessment in Health Care (SBU) 1993: pp. 54.
Instituto de Ciencias
de Evaluación Clínica de Ontario
El Instituto de Ciencias de
Evaluación Clínica de Ontario (ICES,
Institute for Clinical Evaluative Sciences) investiga la efectividad,
calidad y eficiencia de la atención sanitaria en esa provincia canadiense.
Publica revisiones sobre el Sistema de Salud (Research Atlases),
informes detallados sobre cribado, tecnología, etc. (Investigative
Reports), resúmenes de artículos, un boletín mensual (At a Glance)
y una revista para atención primaria (informed). En Research
Atlases podemos encontrar, por ejemplo, un
extenso artículo dedicado a la variabilidad en el diagnóstico patológico
de apéndices normales, publicado en 1996 (http://www.ices.on.ca/webbuild/site/ices-internet-upload/file_collection/Practice2-ch5.pdf)
Corporación
RAND
Esta institución
estadounidense se dedica a la investigación de calidad sobre
problemas de cuidados de salud y publican numerosos informes sobre
tecnología. Existen un índice completo de sus publicaciones en:
http://www.rand.org/scitech/pubs/index.html:
Consejo Sueco de Evaluación de
Tecnología en Cuidados de Salud (SBU)
Su misión es evaluar métodos utilizados en la atención sanitaria y
evaluar sus costes. Apenas hay documentos de interés para
patólogos:
En el Reino Unido, el Comité
de Desarrollo y Evaluación (DEC) confeccionó, entre 1991
y 2000, algunos informes bajo las instrucciones del “R&Development
Directorate South and West”, con el fin de ofrecer información breve,
exacta y útil sobre tecnología en salud, dirigida a compradores,
clínicos, gestores e investigadores. Muy pocos informes de este
sitio son de interés, en general para patólogos:
Cervical screening interval (1995), Screening for prostate cancer
(1994). Esta web (http://www.hta.nhsweb.nhs.uk/rapidhta/)
ya no es actualizada y los expertos trabajan ahora en colaboración
con el
Instituto Nacional para la Excelencia Clínica (NICE, National Institute
for Clinical Excellence).
Canadian
Task Force on Preventive Health Care
http://www.ctfphc.org/
Ejemplo:
Screening for Breast Cancer:
http://www.ctfphc.org/Full_Text/Ch65full.htm
U.S.
Preventive Services Task Force
http://www.ahcpr.gov/clinic/uspstfix.htm
Otras iniciativas en la
Comunidad Europea
-
Comisión Europea: Guías para el control de calidad (p. Ej.: para
en el cribado mamográfico incluye capítulos de control de calidad
para anatomía patológica).
http://home.hetnet.nl/~martinth/
-
La Organización Europea para la Investigación y Tratamiento del
Cáncer (EORTC), nacida en Bélgica en 1962, ha editado esquemas
de control de calidad para radioterapia, cirugía, etc. (ensayos
clínicos) (http://www.eortc.be/)
-
Plan Integral de Atención a la mujer. DETECCIÓN PRECOZ DEL CÁNCER
DE MAMA (INSALUD, colaboración de la SEAP): (http://www.msc.es/insalud/docpub/internet/mujer/plan_mujer.pdf)
-
Agencia de Evaluación de Tecnologías Sanitarias http://www.isciii.es/aets/
-
Uso de la Mamografía
y de la Citología de Papanicolaou para la Detección Precoz del
Cáncer de Mama y de Cérvix Uterino en España
-
Diagnóstico de
lesiones mamarias detectadas en cribado poblacional de cáncer
de mama mediante mamografía
-
Cribado poblacional
de cáncer de mama mediante mamografía
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