Asociación entre el inicio de la vida sexual y las lesiones intraepiteliales / Association between age at onset of active sexual life and intraepithelial lesion

Introducción: El cáncer cervicouterino inicia con una lesión precancerosa llamada displasia, pudiendo ser de bajo grado o alto grado; uno de los factores más importantes en este sentido es la edad de inicio de la vida sexual activa (IVSA). Objetivo: Conocer si existe asociación entre la edad de inicio de la vida sexual activa y la lesión intraepitelial escamosa de alto grado (LIEAG). Material y métodos: Estudio descriptivo, retrospectivo, observacional, en 52 expedientes de mujeres de 15 a 60 años, con Papanicolaou en el HGZ MF No. 1, previa autorización del CLIS 301 y el CEI 3018, con folio R-2022-301-021. Se recolectaron los datos de expedientes que cumplieron los criterios de inclusión; se realizó un análisis estadístico con frecuencias, porcentajes para variables cualitativas nominales, con medidas de tendencia central y dispersión en variables cuantitativas, con determinación de chi2 y prueba de Kruskal-Wallis, respetándose los principios de Belmont en consideración a la Justicia y Beneficencia, los principios éticos de la Declaración de Helsinki 1964 y la Ley General de Salud en México. Resultado: Al evaluar 52 expedientes de pacientes, la edad fue de 37.81 ± 9.949 años; se encontró asociación entre el IVSA y la LIEAG, sin significación estadística, de acuerdo con la prueba de chi2, con un valor de p = 0.538 (IC 95%: 0.403-0.674), y una asociación significativa por la prueba de Kruskal-Wallis entre la LIEAG y la edad de la paciente, con un valor de p = 0.019 (IC 95%: 0.000-0.057). Conclusión: El IVSA no se correlaciona con el tipo de LIEAG.

Introduction: Cervical cancer begins with a precancerous lesion called dysplasia, which can be low grade or high grade. One of the most important factors is the age at which an active sexual life begins. Objective: To know if there is an association between the age of beginning of active sexual life (BASL) and high-grade squamous intraepithelial lesions (HGSIEL). Material and methods: Descriptive, retrospective, observational study, in 52 files of women aged 15 to 60 years with Pap smear at HGZ MF No. 1, prior authorization from CLIS 301 and CEI 3018 with folio R-2022-301-021. Data were collected from files that met the inclusion criteria, a statistical analysis was carried out with frequencies, percentages for nominal qualitative variables, with measures of central tendency and dispersion in quantitative variables, with determination of chi2 and Kruskal-Wallis, respecting the principles of Belmont in consideration of Justice and Beneficence, the ethical principles of the Declaration of Helsinki 1964, the General Health Law in México. Result: When evaluating 52 patient records, the age was 37.81 ± 9.949 years, the association of BASL and HGSIEL was found without statistical significance according to the chi2 with a p = 0.538 (95% CI, 0.403-0.674) and a significant association by Kruskal-Wallis between HGSIEL and patient age, with p = 0.019 (95% CI, 0.000-0.057). Conclusion: The beginning of an active sexual life has no association with the type of high-grade squamous intraepithelial lesions.

Comparative HPV genotype distribution among women with normal and abnormal cervical cytology in Yaoundé, Cameroon

Background: The epidemiology of human papillomavirus (HPV) infection and the pattern of HPV genotype distribution are parameters needed to assess the risk of cervical cancer. Oncogenic HPV types are well-known pathogen for lower genital tract neoplasias, representing the primary cause of cancer death in Africa and the second in Cameroon. This study was conducted to identify the various genotypes particularly the high-risk HPV types in normal and abnormal cervical cytology from women in Yaoundé, Cameroon. Methodology: This was a hospital-based, analytical cross-sectional study carried out on 226 symptomatic women wherein cervico-vaginal samples were obtained during gynaecological examination for Pap smears, HPV-DNA and genotype detection with linear array HPV strip, conducted from November 2019 to January 2021. Results: From the 226 women whose cervical samples were collected for Pap smears, 71 (31.4%) had abnormal cytology results while 155 (68.6%) had normal results. The overall HPV prevalence in the study population was 34.1% (77/226). The HPV prevalence in women with abnormal Pap smears was 100% (71/71) and are distributed in following descending order; LSIL (21.1%, 15/71), HSIL (21.1%, 15/71), ASC-US (19.7%, 14/71), ICC (19.7%, 14/71) and others (18.4%, 13/71). HPV-DNA was positive in 6 (3.9%) of the 155 women with normal cytology results, 4 (2.6%) of whom were high-risk HPV. There is statistically significant difference in the HPV prevalence between women with abnormal and normal Pap smear results (OR=3289, 95% CI=182.62-59235, p<0.0001). The frequently identified oncogenic HPV types were type 16 (31.2%, 24/77), type 45 (14.3%, 11/77) and type 18 (10.4%, 8/77). Conclusion: It is evident from our study that symptomatic women with normal Pap smear can have HR-HPV infection and should therefore be screened for HPV and followed up with periodic Pap smears to detect any abnormal change in cervical cytology results, to prevent cervical cancer development. Women should be encouraged to take up cervical screening, through Pap smears, because it is a non-invasive and cost-effective method for early detection of preinvasive lesions

Cáncer de cérvix: una mirada práctica / Cervical cancer, a practical view

Resumen Introducción: El cáncer de cérvix (CC) es un problema de salud pública en países desarrollados y no desarrollados; esta patología tiene repercusiones socioeconómicas en mujeres en edad reproductiva. Objetivo: Describir las características sobre métodos de prevención, tamizaje, diagnóstico y tratamiento del cáncer de cérvix. Método: Se realizó una búsqueda bibliográfica exhaustiva en un período de seis años (2016-2021) en la base de datos de la Fundación Universitaria del Área Andina, utilizando motores de búsqueda como Dialnet, Science Direct, Medline, LIlacs, Scopus para revisar los conceptos generales sobre cáncer de cérvix. Resultados: El CC es el segundo cáncer más frecuente en Colombia, la principal etiología del cáncer de cérvix es el virus del papiloma humano (VPH), el cual es un virus prevenible mediante la adecuada educación e información y seguimiento a sus lesiones precancerosas. Conclusión: El CC es una patología con altas tasas de mortalidad, especialmente en países en vía de desarrollo y en las infecciones asociadas a VPH de alto riesgo, afectando principalmente a mujeres en edad reproductiva y estratos socioeconómicos bajos. Los principales pilares para el manejo de esta patología siguen siendo las estrategias de salud pública, como la vacunación y realización de las pruebas de tamizaje.

Abstract Introduction: Cervical cancer (CC) is a public health problem in both developed and undeveloped countries; besides it has socio-economic repercussions in women of reproductive age. Objective: To describe the characteristics of cervical cancer prevention, screening, diagnosis, and treatment methods. Method: An exhaustive bibliographic search was carried out within a period of 6 years (2016-2021) in the database of the Fundación Universitaria del Área Andina, using search engines such as Dialnet, Science Direct, Medline, Lilacs, and Scopus to review the concepts general information about cervical cancer. Results: The main etiology of cervical cancer is the human papillomavirus (HPV) which is a preventable virus through adequate education and information and follow-up of its precancerous lesions. It is the second most frequent cancer in Colombia. Conclusion: CC is a pathology that mainly affects women of reproductive age belonging to low socioeconomic strata. This type of cancer has high mortality rates, especially in developing countries and in high-risk HPV infections. Regarding the management of this pathology, public health strategies, such as vaccination and conducting screening tests continue being the fundamental pillars.

Células glandulares atípicas: abordagem ginecológica / Atypical glandular cells: gynecological approach

As células glandulares atípicas representam 0,2% a 2,1% dos resultados dos testes de Papanicolaou. Mesmo com essa baixa prevalência, tem um significado importante no diagnóstico do câncer cervical e endometrial, tendo em vista que tais células e subcategorias, associadas à idade da paciente, podem prenunciar um número expressivo de doença intraepitelial, doença invasiva do endocérvix, endométrio e até neoplasias anexiais. E não se pode esquecer do importante número de resultados histológicos benignos, identificados no seguimento dessas pacientes, muitas vezes assintomáticas.(AU)

Atypical glandular cells represent 0,2% to 2,1% of Pap test results even with this low prevalence has an important significance in the diagnosis of cervical and endometrial cancer, considering that such cells and subcategories associated with the patient's age can predict a significant number of intraepithelial disease, invasive disease of the endometrium, endocervix and even adnexial neoplasms; no forgetting the important number of benign histological results, identified in the follow up of these patients, often asymptomatic.(AU)

Prevalence of Cervical Cancer in Childbearing, Premenopausal and Postmenopausal Women in Kolhan Region, Jharkhand

Background: Cancer of uterine cervix is one of the commoncarcinoma among females. The global incidence of cervicalcancer varies (5 lakhs new cases/year), highest in developingcountries with >50% dying. In India, cervical cancer contributesto approximately 6–29% of all cancers in women. Prevention ofcervical cancer, whether primary or secondary requires activeparticipation of the community. This study is to assess thePrevalence, Pap screening, knowledge, attitude practice andprevention regarding cervical cancer. Identification of riskfactors is necessary to curb the disease.Methods: A cross-sectional study was conducted in differentCHC, PHC and MGM Medical college Jamshedpur area ofKolhan region of Jharkhand. A sample of 499 women aged 15-70 years was taken from January 2017- August 2019 and wasselected and subjected to Pap smear test of cervix andabnormal smears, Histopathological report of HSIL/invasivecarcinoma, Factors like menarche, coitarche, age at marriage,parity, contraception, smoking habit and socio-economic statuswere noted.Results: In our study, HSIL was 0.2% and invasive cancer was2.8%. Out of the 499 respondents most of them belonged tothe 15-39 years age group. About 81.96% were Hindu, morethan all the other religion respondents 79.75% of the womenwere educated in primary level. Around 85.17% of therespondents were housewives by occupation. Majority of thembelonged to the lower socio-economic strata. The awarenessabout Pap smear where p>0.05 not significant.Conclusions: Early menarche, early coitarche, early marriage,high parity, use of contraception other than barrier, lowsocioeconomic status, poor habitat and HPV infection, carrieda high risk of developing cervical cancer. HPV infection wasthe most important risk factor. Improvement of socioeconomicstatus, education and cervical cancer screening of the high-riskgroup can reduce cervical cancer mortality and morbiditysignificantly.

Frecuencia de alteraciones citológicas cervicales y virus papiloma humano en una muestra de estudiantes universitarias en Temuco, Chile / Frequency of cervical cytological alterations and human papilloma virus in a sample of university students in Temuco, Chile

Resumen Introducción: El inicio precoz de actividad sexual puede favorecer el desarrollo de alteraciones cervicales y de infecciones de transmisión sexual, en especial del virus papiloma humano (VPH) muy frecuente en adolescentes y jóvenes. Objetivo: Analizar el estado del cuello uterino, presencia del VPH y conductas sexuales en mujeres menores de 25 años. Material y Métodos: Participaron 182 estudiantes universitarias de 18-24 años, sanas, sexualmente activas y no vacunadas para VPH. Se realizó Papanicolaou (Pap) y clasificación del VPH en alto y bajo riesgo (AR y BR) mediante reacción de polimerasa en cadena en tiempo real. Las conductas sexuales fueron consultadas privadamente. Resultados: El 46,9% de los Pap presentaron alteraciones citológicas (inflamación inespecífica/hemorrágico: 29,4% y frotis atípicos (FA):10,2%). La frecuencia de los VPH-AR fue 24,3%; de éstos, 67,4% presentó un Pap alterado. Hubo asociación entre alteraciones citológicas y presencia de VPH (p < 0,0001) y años de actividad sexual y FA o neoplasia intraepitelial grado I (NIE I) (p = 0,009). El 11,9% de las jóvenes estudiadas (21/177) presentó FA o NIE I, con 66,7% de casos VPH-AR. Conclusiones: Estos hallazgos alertan la vulnerabilidad de estas jóvenes que tendrían un riesgo potencial de persistencia viral, NIE y eventualmente cáncer. Es importante enfatizar consejería y prevención previo a la edad normada de ingreso al programa de cribado para cáncer cérvico uterino en Chile.

Background: The early onset of sexual activity can promote the development of cervical alterations and sexually transmitted infections, especially the human papillomavirus (HPV) very common in adolescents and young people. Aim: The condition of the cervix, HPV and sexual behavior in young women under 25 years of age were analyzed. Methods: 182 university students, healthy, sexually active, 18-24 years old, without vaccine for HPV participated. Papanicolaou (Pap) test and classification of high and low risk HPV (HR and LR) were performed by real time polymerase chain reaction. The sexual behaviors were consulted in private. Results: The 46.9% of Pap presented cytological alterations, non-specific inflammation/hemorrhagic (29.4%) and atypical smear (10.2%) being de most frequent. The overall frequency of HPV-HR was 24.3%, of these 67.4% presented an altered Pap. There was an association between cytological alterations and HPV (p < 0.0001) and years of sexual activity and atypical smear or cervical intraepithelial neoplasia grade I (CIN I) (p = 0.009). 11.9% of young women (21/177) presented atypical smear or CIN I, with 66.7% of cases HPV-HR. Conclusions: These findings alert the vulnerability of these young women who would have a potential risk of viral persistence, CIN and eventually cancer. It is important to emphasize counseling and prevention prior to the regular age of admission to the screening program for cervical cancer. This study was financed by the Universidad de La Frontera through Projects DI15-0047 and DI17-0123.

Adequacy of PAP Smear in Females of Reproductive Age and Perimenopausal Age

Introduction: The purpose of the Papanicolou (Pap) smearin the early detection and prevention of cervical canceris well proved. However, due to lack of awareness stillmany women fail to undertake this test. To address theusefullness and awareness issue, we assessed the feasibilityand adequacy of Pap smears in females of reproductive ageand perimenopausal age. Cervical cancer is the second mostsevere cancer affecting women globally and mortality is notonly affecting India but also the other developing nations.This study aimed to study the cervical cytology and its patternin patients from reproductive age group and perimenopausalage group in Gynaec Outpatient Department of MGM medicalcollege and hospital in Jamshedpur.Material and methods: The procedure of clinical Pap smearincludes extraction of cells from squamocolumnar junctionby sweeping and then the smear was spread over glass slideand it was dipped in a small container with fixative (95%ethyl alcohol). Later on, the slides were stained (Pap stain)and observed for the cytological study according to Bethesdascoring system, 2001 for detection of cervical cancer inpatients.Results: Majority of the patients presented with single orcombination of symptoms like white discharge per vaginumand lower abdominal pain or both. The samples extractedand evaluated from the patients through the Pap smearswere put according to Bethesda scoring system, 2001;where it was found that Non-specific inflammation was76.417%, normal cervical cytology was 14.153%, LSIL((Lowgrade intraepithelial lesion) was 3.77% and inadequate/unsatisfactory was 5.660%.Conclusion: Pap smear testing related to cervical cancerpresence drastically reduces in morbidity and mortalitythrough early detection, diagnosis and management ofcervical cancer. This cytological testing is one of the meresttools available to find the occurrence of cervical cancer.

Role of obstetricians and gynecologists in cervical cancer screening / 中华预防医学杂志

Cervical cancer is the second leading cause of death due to gynecological malignancy in female patients. If obstetrician and gynecologists could master the mechanisms involved in the development of cell mutation and new tissue, the effectiveness of cervical cancer screening could be greatly increased. In the process of cervical cancer screening, if cervical tissue hyperplasia accompanied by bleeding could be identified by visual inspection and also in line with the conditions of abnormal cells and vascular proliferation, the cervical cancer would be highly suspicious at this time. Taking the tissue of the abnormal part of the cervix should be immediately conducted when conditions are available. If not, the colposcopy and following biopsy should be immediately performed. After these actions, if no cervical abnormalities are found, the visual inspection of cervix should be performed using cervical cytology (Pap smear test) or a human papillomavirus (HPV) test, or a combination of two tests. When the risk of cervical precancerous lesions predicted by screening results is greater than 5%, colposcopy should be required which is unconditional on the screening methods used before. In the area of abnormal cell proliferation and angiogenesis, 5% acetic acid should be applied to observe whether there is acetowhite epithelium. If yes, the cervical precancerous lesions is highly suspicious in the area of acetowhite epithelium and biopsy should be performed. Even if there is no acetowhite epithelium in the blood vessel-rich area, cervical precancerous lesion could not be excluded and the cervical detachment cell diagnosis results could be used. If the results prompt abnormalities, biopsy could be taken continuously in the red area, including the endocervical curettage in the red area of endocervical tissue. Following the above three-step process of cervical cancer screening, obstetricians and gynecologists could easily, accurately and quickly detect the cervical cancer and cervical precancerous lesions, and complete the goal of cervical cancer screening.

Prevalencia de lesiones intraepiteliales cervicales de bajo y alto grado en pacientes en edad fértil. Maracaibo. Estado Zulia / Prevalence of intrepelitelial, cervical low and high grade injuries in patients in the fertile age. Maracaibo. Zulia state

Determinar la prevalencia de las lesiones intraepiteliales cervicales de bajo y alto grado en pacientes de edad fértil en la consulta de ginecología del centro Materno pediatrico Zulia, en el período comprendido febrero 2016 -febrero 2018 Maracaibo, Estado Zulia. Métodos: Se realizó un estudio descriptivo retrospectivo en el que se incluyeron mujeres entre los 15 y 44 años, que acudieron a la consulta de Ginecología obstetricia del centro materno pediátrico Zulia para el periodo comprendido febrero 2016 ­ febrero 2018. Se evaluó la normalidad de las variables cuantitativas, empleándose la mediana o el promedio con sus varianzas según su distribución, y frecuencias y proporciones para las variables categóricas. Resultados: Se incluyeron 150 pacientes. La mediana de la edad fue 29 años con rango (R: 15-43 años), la mediana del número de partos 1 (R: 0-3). Uso de métodos anticonceptivos, la mayoría utilizaba ACO. El 60% de las citologías se reportaron como negativas, 20 % lesión de bajo grado (LSIL), 10% células escamosas atípicas de significado indeterminado (ASC-US), 2% lesiones de alto grado (HSIL), 2,3% células escamosas atípicas de significado indeterminado de alto grado ASC-H, 3,3% células glandulares atípicas de significado incierto (ASGUS) y 2% carcinoma invasor. Conclusión: La prevalencia de las anormalidades citológicas fue alta en todos los grupos analizados, sin embargo, existe un mayor número de LSIL hacia la tercera década de la vida y en aquellas que iniciaron su vida sexual después de los 40 años. De igual manera se encontró una relación inversa entre el número de partos, planificación familiar hormonal y aparición de lesiones pre neoplásicas(AU)

To determine the prevalence of cervical intraepithelial lesions of low and high grade in patients of fertile age in the gynecology clinic of the Zulia maternity center, in the period February 2016-February 2018 Maracaibo, Zulia State. Methods: A retrospective descriptive study was carried out that included women between 15 and 44 years old, who attended the obstetrics gynecology clinic of the Zulia pediatric maternity center for the period February 2016-February 2018. The normality of the quantitative variables, using the median or average with their variances according to their distribution, and frequencies and proportions for the categorical variables. Results: 150 patients were included. the median age was 29 years with range (R: 15-43 years), the median number of births 1 (R: 0-3). Using contraceptive methods, most used ACO. 60% of cytologies were reportedas negative, 20% low grade lesion (LSIL), 10% atypical squamous cells of undetermined significance (ASC-US), 2% high grade lesions (HSIL), 2.3% cells Atypical squamous of indeterminate significance of high grade ASC-H, 3.3% atypical glandular cells of uncertain significance (ASGUS) and 2% invasive carcinoma. Conclusion: The prevalence of cytological abnormalities was high in all the groups analyzed, however, there is a greater number of LSIL in the third decade of life and in those who began their sexual life their 40 years. Likewise, an inverse relationship was found between the number of births, hormonal family planning and the appearance of pre-neoplastic lesions(AU)

Detección de ARNm de oncoproteínas E6/E7 del Virus del Papiloma Humano en cáncer de cuello uterino / Detection of Human Papillomavirus E6/E7 mRNA in cervical cancer / Detecção de RNAm de oncoproteínas E6/E7 do Vírus do Papiloma Humano em câncer de colo de útero

La infección de transmisión sexual por el Virus del Papiloma Humano (VPH) es una de las más comunes en el mundo. Los VPH se clasifican en bajo riesgo y alto riesgo. Los VPH de bajo riesgo son los causantes de lesiones benignas como verrugas genitales y condilomas acuminados, mientras que los VPH de alto riesgo pueden originar la transformación maligna de las células del epitelio cervical por la acción de las oncoproteínas E6 y E7, lo que puede dar origen al cáncer de cuello uterino. La detección de los niveles de ARN mensajero (ARNm) de E6 y E7 de VPH en las células del epitelio cervical está siendo evaluada como un marcador predictivo del cáncer de cuello uterino como alternativa a las técnicas de detección del ADN de VPH. En este artículo se realizó una revisión crítica acerca de la relación existente entre la detección de la expresión de ARNm de E6 y E7 del virus del papiloma humano y el cáncer de cuello uterino. Además, se revisaron las técnicas aprobadas actualmente por la FDA (Food and Drug Administration) para la detección de ARNm de las oncoproteínas E6 y E7 de VPH y el estado del arte del VPH en Colombia.

The sexually transmitted infection by the Human Papillomavirus (HPV) is one of the most common in the world. Human papillomaviruses are classified as low risk and high risk. Low-risk HPVs are the cause of benign lesions such as genital warts and condylomata acuminata, while high-risk HPV types can cause malignant transformation of cervical epithelial cells by the action of oncoproteins E6 and E7, which could result in the development of cervical cancer. The detection of levels of HPV E6 and E7 mRNA (messenger RNA) in cervical epithelial cells is being evaluated as a predictive marker of cervical cancer as an alternative to HPV DNA detection techniques. In this article, a critical review was made about the relationship between the detection of E6 and E7 mRNA expression of human papillomavirus and cervical cancer. Furthermore, the techniques currently approved by the Food and Drug Administration (FDA) for the detection of mRNA from the HPV E6 and E7 oncoproteins and the state of the art of HPV in Colombia were reviewed.

A infecção sexualmente transmissível pelo Vírus do Papiloma Humano (HPV) é uma das mais comuns no mundo. Os HPV são classificados em tipos de baixo e de alto risco. Os HPV de baixo risco são a causa de lesões benignas, tais como verrugas genitais e condilomas acuminados, enquanto que os HPV de alto risco podem causar a transformação maligna das células do epitélio cervical pela ação das oncoproteínas E6 e E7, o que pode dar origem ao câncer de colo de útero. A detecção dos níveis de RNA Mensageiro (RNAm) E6 e E7 de HPV nas células do epitélio cervical está sendo avaliada como marcador preditivo do câncer de colo de útero como alternativa às técnicas de detecção de DNA do HPV. Neste artigo, foi realizada uma revisão crítica sobre a relação entre a detecção da expressão de RNAm E6 e E7 do vírus do papiloma humano e o câncer do colo de útero. Do mesmo modo, foram revisadas as técnicas aprovadas pela FDA (Food and Drug Administration) para detecção de ARNm das oncoproteínas E6 e E7 de HPV e o estado da arte do HPV na Colômbia.

Value of combined detection of cervical cytology and high-risk human papillomavirus in the diagnosis of cervical adenocarcinoma / 上海交通大学学报（医学版）

Objective • To investigate the diagnostic value of combined detection of cervical cytology and high-risk human papillomavirus (HPV) in cervical adenocarcinoma. Methods • The clinical data of patients diagnosed as cervical adenocarcinoma in the International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2006 to December 2017 were retrospectively collected and analyzed. A comparison among cytology detection, high-risk HPV test, and combined detection of both methods was performed. Results • A total of 2 291 cases of cervical cancer were collected, of which 480 cases were cervical adenocarcinoma patients. Finally, 409 cases of cervical adenocarcinoma were analyzed. The average age of all included patients was (46.8±11.4) years old. The proportion of the patients aged 35-55 was 59.2%. All the patients were divided into three groups, i.e., group A (cytology detection, n=208), group B (high-risk HPV test, n=103), and group C (cytology and high-risk HPV combined test, n=98). There were 142 (68.3%), 85 (82.5%), and 93 (94.9%) positive cases in group A, B, and C, respectively. There was a statistically significant difference among the three groups (P=0.000). In the patients with cervical in situ adenocarcinoma, the positive detection rates in group A, B and C were 70.6%, 100.0% and 100.0%, respectively (P=0.000). And in the patients with cervical invasive adenocarcinoma, the positive detection rates in group A, B, and C were 67.9%, 75.8% and 91.8%, respectively (P=0.000). Conclusion • Cervical cytology combined with high-risk HPV detection can significantly increase the positive detection rate of cervical adenocarcinoma.

Perfil das mulheres usuárias do sus com lesões intraepiteliais em um município do oeste do Paraná / Profile of female users of the brazilian unified health system with intraepithelial lesions in a city in western Parana

O câncer cervical é o quarto tipo de tumor mais frequente entre mulheres e quarta causa de mortalidade feminina por câncer no Brasil. Neste trabalho o objetivo foi demostrar o perfil das mulheres atendidas pelo SUS que apresentaram lesões intraepiteliais de baixo grau (LSIL) e alto grau (HSIL) no exame preventivo citopatológico realizado por um laboratório de citopatologia credenciado ao SUS que atende Cascavel-PR e distritos. No período de maio de 2014 a maio de 2015 foram observados 395 exames citopatológicos com LSIL e 160 com HSIL, cuja faixa etária predominante foi dos 25 aos 64 anos (70,64%). Em média observou-se os seguintes resultados: a JEC esteve presente em 90,56% das amostras; o colo cervical apresentou-se normal em 77,31% das mulheres e 43,58% destas mulheres em estudo haviam realizado um exame anterior em até um ano, sendo que o maior motivo para realização do mesmo foi o rastreamento (89,11%). Mais que 90% das mulheres não apresentaram sangramentos, seja após a relação sexual ou menopausa. As lesões também prevaleceram em mulheres atendidas na UBS (61,98%) mesmo elas sendo em menor número se comparadas àquelas atendidas por USF. Esses dados demostram a importância da realização desse exame, pois na maioria das lesões as mulheres não apresentaram sintomas ou alterações clínicas.

Cervical cancer is the fourth most frequent kind of cancer among women and the fourth cause of female mortality due to cancer in Brazil. The purpose of this work was to present the profile of women attended by the Brazilian Unified Health System (SUS) who showed low-grade (LSIL) and high-grade (HSIL) intraepithelial lesions at the cytopathology screening test performed by a SUS-accredited cytopathology laboratory serving the city of Cascavel-PR and its districts. In the period between May 2014 and May 2015, a total of 395 cytopathologic test presenting LSIL and 160 with HSIL were observed. The age group ranged from 25 to 64 years old (70.64%). The following average results were observed: squamocolumnar junction was present in 90.56% of the samples; normal cervix in 77.31% of women and 43.58% of the women in the study had already had an examination within the previous year, with the main reason for the present exam was screening (89.11%). More than 90% of women did not present any bleeding, either after sexual intercourse or menopause. The lesions also prevailed in women attending primary health care (61.98% of lesions) even though they were in lower number when compared to those served by family health programs. Such information demonstrates the importance of carrying out this examination, since most lesions are asymptomatic or do not show any clinical changes.

Correlación citohistológica de ASC-H en el Hospital Nacional Guillermo Almenara Irigoyen durante el período enero 2013 a julio 2015 / Cyto-histological correlation of ASC-H at Hospital Nacional Guillermo Almenara Irigoyen, January 2013 - July 2015

En nuestro país, el cáncer de cuello uterino es aún la neoplasia maligna más frecuente en mujeres. Como prueba de tamizaje se utiliza el examen de Papanicolaou o citología cérvico-vaginal, el cual es informado utilizando el Sistema de Bethesda. En dicho sistema, la categoría ASC-H (atypícal squamous cells - cannot exclude HSIL-high grade squamous epithelial lesions, por sus siglas en inglés) designa los casos con presencia de células escamosas atípicas en las cuales los cambios son sugestivos de una lesión intraepitelial escamosa de alto grado pero insuficientes para una interpretación citopatológica definitiva, por lo que es importante determinar la correlación citohistológica de esta categoría. Objetivo. Correlacionar los resultados citopatológicos informados como ASC-H con los diagnósticos histopatológicos. Diseño. Estudio de tipo descriptivo, transversal y retrospectivo. Material. Citología cérvico-vaginal e histopatología. Métodos. Se revisó los casos con estudio citopatológico realizado entre enero de 2013 y julio de 2015, y con estudio histopatológico hasta un año después. Mediante la base de datos se determinó la cantidad poblacional y los diagnósticos. Se consideró como prueba de oro el diagnóstico histopatológico. Principales medidas de resultados. Correlación cito-histológica en casos de ASC-H. Resultados. Durante el período de estudio se realizaron 53 716 estudios de citología cérvico-vaginal convencional; de estos, 119 fueron catalogados como ASC-H; finalmente, 43 casos (0,07%) cumplieron los criterios de inclusión. El rango de edad de las pacientes fue de 22 a 70 años, siendo la media 43,8 años. El 42% de casos de ASC-H tuvo el diagnóstico de NIC2 y NIC3 en el estudio histopatológico. Conclusión. Se encontró una correlación entre los resultados de ASC-H y las lesiones intraepiteliales de alto grado (NIC II y NIC III), que concuerda con la encontrada en la bibliografía.

Cervical cancer is the most prevalent neoplasm in women in our country. The Papanicolaou test is used as a screening test, and is reported using the Bethesda System. In this system, the ASC-H (atypical squamous cells - cannot exclude HSIL-high grade squamous epithelial lesions) category designates cases with atypical squamous cells, where the changes are suggestive of a high grade squamous intraepithelial lesion but insufficient for a definitive cytopathologic interpretation. It becomes important to determine the cyto-histological correlation in this group. Objective: To correlate cytopathologic results reported as ASC-H with histopathological diagnoses. Designs: Descriptive, cross sectional retrospective study. Material: Cervicovaginal cytology and histology. Method: We reviewed the cases with a cytologicalpathological study between January 2013 and July 2015 and with a histopathological study until a year later. The population and diagnoses were determined using the database. Histopathological diagnosis was considered as the gold standard. Main outcome measures: Cyto-histological correlation in ASC-H cases. Results: Out of the total of 53 716 cervical cytology studies performed during the study period, 119 were classified as ASC-H; 43 (0.07%) cases met the inclusion criteria. The age ranged between 22 and 70 years, with an average of 43.8 years; 42% of ASC-H cases were diagnosed as presenting CIN2 and CIN3 in the histopathological study. Conclusion: This study showed correlation between ASC-H results and high-grade intraepithelial lesions (CIN2 and CIN3), in line with findings in the literature.

Alteraciones cérvico uterinas en mujeres de Santa Marta / Cervical alterations in Santa Marta women

Introducción: la citología cérvico uterina es la prueba de cribado de bajo costo que permite identificar las alteraciones cervicales en un amplio grupo de mujeres. Objetivos: determinar las alteraciones cérvico uterinas, basadas en el análisis de pruebas citológicas, en mujeres de Santa Marta. Métodos: estudio descriptivo retrospectivo de diseño documental y enfoque cuantitativo, llevado a cabo en una entidad de primer nivel de atención en salud de la ciudad de Santa Marta, Colombia. La recogida de datos se hizo sobre 2 958 registros de pruebas citológicas, correspondientes al periodo comprendido entre 2011 - 2014. Para el análisis de la información se utilizó la hoja de cálculo de Excel, el cual permitió el diseño de las tablas para el análisis de frecuencia de las alteraciones. Resultados: presentó alteraciones cérvico uterinas 7,16 por ciento; el 54,71 por ciento, Ascus; el 22,64 por ciento, neoplasia intraepitelial cervical I; 16,50 por ciento, Virus del papiloma humano; 3,77 por ciento, neoplasia intraepitelial cervical III y 1,88 por ciento, carcinoma. El 8,72 por ciento, infecciones vaginales, compatibles con vaginitis bacteriana el 62,51 por ciento y con cándida albicans 37,20 por ciento. Conclusiones: a pesar de la existencia de programas dirigidos a la prevención y detección precoz de lesiones cérvico uterinas y de las directrices de organismos internacionales y nacionales, estas alteraciones siguen representando un problema de salud pública en la región(AU)

Introduction: The cervical cytology is the low-cost screening test that allows the identification of cervical changes in a large group of women. Objectives: To determine the cervical alterations, based on the analysis of cytological tests, in Santa Marta women. Methods: Retrospective descriptive study of documentary design and quantitative approach, carried out in a first level health care institution in the city of Santa Marta, Colombia. The data collection was done from 2958 records of cytological tests, corresponding to the period between 2011 and 2014. For the analysis of the information we used an Excel processor sheet, which allowed the design of tables for the analysis of frequency of alterations. Results: 7.16 percent presented cervical alterations; 54.71 percent, ascus; 22.64 percent, cervical intraepithelial neoplasia I; 16.50 percent, human papillomavirus; 3.77 percent, cervical intraepithelial neoplasia III; and 1.88 percent, carcinoma. 8.72 percent presented vaginal infections, 62.51 percent compatible with bacterial vaginitis and 37.20 percent with candida albicans. Conclusions: Despite the existence of programs aimed at the prevention and early screening of cervical lesions, and the guidelines of international and national agencies, these alterations continue to represent a public health concern in the region(AU)

Infección por virus papiloma humano en pacientes con citología de cuello uterino negativa

Objetivo: Examinar la prevalencia de la infección por virus papiloma humano en pacientes con citologías de cuello uterino negativas, en un programa de pesquisa de cáncer de cuello de la Misión Barrio Adentro. Métodos: Se analizaron 3883 muestras citológicas convencionales de cuello uterino según el sistema Bethesda 2001, de las cuales 3651 (94,0 %) eran citologías normales. Se usó PCR/RFLP para la detección y tipificación de virus de papiloma humano. Resultados: La edad promedio de las pacientes fue de 34,8 ± 12,20 años (rango: 13 a 89). La prevalencia general de la infección fue de 28,5 % (1038/3651). En 31,9 % se detectó virus de papiloma humano de alto riesgo oncogénico y en 21,2 % de bajo riesgo oncogénico. El virus de papiloma humano 6 (57,7 %) fue el genotipo de mayor prevalencia, seguido de secuencias desconocidas del virus (45,4 %). El virus de papiloma humano 16 fue el más comúnmente encontrado (28,09 %) entre los de alto riesgo, seguido del 18 (17,5 %) y el 31 (14,2 %) (p<0,000). También se detectó 33 (4,8 %), 52 (4,2 %), 53 (3,6 %) y 58 (3,1 %). A medida que aumentó la edad, disminuyó la positividad para la infección por el virus de papiloma humano (p<0,000) y la mayor prevalencia viral se presentó en menores de 25 años (35,1 %). Conclusiones: La prevalencia de virus de papiloma humano en pacientes con citologías negativas es elevada y heterogénea en este medio, observándose una mezcla de virus de alto y bajo riesgo.

Objective: To examine the prevalence of human papillomavirus infection in patients with negative cervical cytology in a cervical cancer screening program of the Barrio Adentro Mission in Venezuela. Methods: A total of 3,883 conventional cervical cytology samples were analyzed according to the Bethesda 2001 system, of which 3651 (94.0%) were reported normal cytology. PCR / RFLP were used for the detection and typing of human papilloma virus. Results: The mean age of the patients was 34.8 ± 12.20 years (range: 13 to 89). The overall prevalence of infection was 28.5% (1038/3651). In 31.9% of cases high oncogenic risk human papillomavirus were detected and 21.2% of HPV low oncogenic risk. Human papillomavirus 6 (57.7%) was the most prevalent genotype, followed by unknown virus sequences (45.4%). Human papillomavirus 16 was the most commonly found (28.09%) among high risk, followed by 18 (17.5%) and 31 (14.2%) (p <0.000). We also detected 33 (4.8%), 52 (4.2%), 53 (3.6%) and 58 (3.1%). As age increased, the positivity for human papillomavirus (p <0.000) decreased, and the highest viral prevalence occurred in women’s under 25 (35.1%). Conclusions: The prevalence of human papilloma virus in patients with negative cytology is high and heterogeneous in this medium, with a mixture of high and low risk viruses.

Actualización en el reporte de citología cervicovaginal basado en el Sistema Bethesda 2014

El cáncer cervical representa la segunda causa de mortalidad en la mujer venezolana. La pesquisa de esta neoplasia fue mejorada significativamente desde que Papanicolaou introdujera la citología como prueba para seleccionar pacientes de alto riesgo. La citología es una pieza fundamental en el diagnóstico del cáncer cervical y sus lesiones precursoras, aparte de su indiscutible valor en la orientación etiológica de infecciones e inflamaciones, y en casos muy puntuales realiza una valoración hormonal indirecta. A través de los años se han utilizado diferentes reportes citológicos, desde Papanicoloau hasta el Sistema Bethesda, siendo este último el más aceptado y utilizado a nivel mundial. Desde su creación en 1988, el mismo ha sido objeto de modificaciones, siendo la última actualización en 2014, con miras a facilitar la comunicación entre los citólogos y el clínico, mejorar la correlación cito-histológica y ofrecer al clínico una terminología adecuada para el tratamiento y pronóstico de la patología cervical.

Cervical cancer is the second leading cause of mortality in women in reproductive age in Venezuela. The research of this neoplasia was improved significantly since introduced PAP cytology as a test to select patient at high risk. Cytology is a fundamental part in the diagnosis of cervical cancer and its precursor lesions, apart from their undeniable value in etiologic orientation of infections and inflammations, and very specific cases made a hormonal assessment in an indirect way. Over the years, different ways to perform cytology report, from Papanicoloau to the Bethesda system, this last being the most have been accepted and used worldwide. Since its creation in 1988, it has undergone modifications, the last update in 2014, with a view to facilitating communication between cytologists and the clinician, improving the cyto-histological correlation and providing the clinician with adequate terminology for treatment and prognosis of cervical pathology.

Nuevas perspectivas de la citología en diagnóstico molecular del cáncer epitelial de ovario y endometrio / New perspectives of cytology in molecular diagnosis of ovarian and endometrial epithelial cancer

Resumen OBJETIVO: describir la bibliografía donde se identificaron biomarcadores moleculares en muestras de citología cervical en base líquida para detectar cáncer epitelial de endometrio y ovario. METODOLOGÍA: búsqueda electrónica en las principales bases de datos de artículos relacionados con la detección de cáncer de ovario y de endometrio con los siguientes términos: citología en base líquida, cáncer epitelial de ovario, cáncer epitelial de endometrio, biomarcadores moleculares. RESULTADOS: los cánceres epitelial de ovario y de endometrio son enfermedades que carecen de un método de tamizaje eficaz. La citología en base líquida ofrece una manera eficaz de detectar alteraciones celulares y moleculares. Mediante la asociación entre la citología en base líquida y los métodos moleculares en el aparato genital inferior es posible identificar biomarcadores específicos; esto abre la posibilidad de desarrollar métodos de tamizaje para cáncer epitelial de endometrio y ovario. CONCLUSIONES: mediante el uso de la citología en base líquida es posible detectar cáncer epitelial de endometrio y ovario.

Abstract OBJECTIVE: To describe the literature that has identified molecular biomarkers in liquid-based cervical cytology samples to detect endometrial and ovary epithelial cancer. METHODOLOGY: An electronic search was conducted in the main databases in articles related to the detection of ovarian and endometrial cancer with the following search terms: liquid-based cytology, ovarian epithelial cancer, endometrial epithelial cáncer, molecular biomarkers. RESULTS: Epithelial ovarian and endometrial cancer are diseases that lack an effective screening method. Liquid-based cytology provides an effective way to detect cellular and molecular alterations in the detection of these neoplasms. Through the association between liquid-based cytology and molecular methods it is possible to identify specific biomarkers in the lower genital tract, opening up the possibility of developing screening methods for endometrial and ovary epithelial cancer. CONCLUSIONS: It is possible the detection of endometrial cancer and, to a lesser extent of epithelial ovarian cancer by using liquid-based Pap test.

Analysis of the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion on primary cervical cytology diagnosis / 中国综合临床

Objective To explore the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion(HSIL)on primary cervical cytology diagnosis.Methods Two hundred and thirty-nine patients with initially diagnosed HSIL on cervical cytology and received cervical conization from January 2012 and December 2016 were selected in this study.Overtreatment was defined as he highest level of pathologic diagnosis which was less than or equal to the low-grade squamous intraepithelial lesion(LSIL).The relevance of patients' age,menstrual status,colposcopy finding,the level of high-risk-HPV-DNA and treatment protocol to overtreatment were investigated.Results The most serious pathological diagnosis confirmed that no CIN,LSIL,HSIL,adenocarcinoma in situ(AIS)and squamous carcinoma of cervix(SCC)were detected,with 3.8%(9/239),5.6%(14/239),87.9%(210/239),0.4%(1/239),2.1%(5/239)respectively.The overall overtreatment rate was 9.6%(23/239).The level of high-risk-HPV-DNA and colposcopic findings were significantly related to overtreatment, and colposcopic finding with LSIL was the risk factor for HSIL overtreatment(OR= 8.786,95%CI= 1.671-17.311,P= 0.015),while HPV-DNA≥1000 ng/L was the protective factor(OR=0.201,95%CI=0.043-0.951,P=0.041).Conclusion The level of high-risk-HPV-DNA and the colposcopic finding are the influencing factors for overtreatment in patients with HSIL on primary cervical cytology diagnosis.

Analysis of the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion on primary cervical cytology diagnosis / 中国综合临床

Objective To explore the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion(HSIL)on primary cervical cytology diagnosis.Methods Two hundred and thirty-nine patients with initially diagnosed HSIL on cervical cytology and received cervical conization from January 2012 and December 2016 were selected in this study.Overtreatment was defined as he highest level of pathologic diagnosis which was less than or equal to the low-grade squamous intraepithelial lesion(LSIL).The relevance of patients' age,menstrual status,colposcopy finding,the level of high-risk-HPV-DNA and treatment protocol to overtreatment were investigated.Results The most serious pathological diagnosis confirmed that no CIN,LSIL,HSIL,adenocarcinoma in situ(AIS)and squamous carcinoma of cervix(SCC)were detected,with 3.8%(9/239),5.6%(14/239),87.9%(210/239),0.4%(1/239),2.1%(5/239)respectively.The overall overtreatment rate was 9.6%(23/239).The level of high-risk-HPV-DNA and colposcopic findings were significantly related to overtreatment, and colposcopic finding with LSIL was the risk factor for HSIL overtreatment(OR= 8.786,95%CI= 1.671-17.311,P= 0.015),while HPV-DNA≥1000 ng/L was the protective factor(OR=0.201,95%CI=0.043-0.951,P=0.041).Conclusion The level of high-risk-HPV-DNA and the colposcopic finding are the influencing factors for overtreatment in patients with HSIL on primary cervical cytology diagnosis.

Study of cervical cytology in papanicolaou smears in a tertiary care center

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions. Materials and methods: This was a prospective study aimed to evaluate all pap smears examined at KGH over a period of 6 months i.e. from December 2016 to May 2017. Detailed clinical data and pap smear cytology reports were obtained and data noted in a structured proforma. All PAP smears reported as per THE BETHESDA System 2014. Women with abnormal smears were followed up by repeat pap smears or acetic acid guided cervical biopsy. Results: Total of 770 pap smears were examined in 6 months duration. Max no. of patients (around 40%) were of 31-40 years age group. Most of the patients (90.77%) were categorized into NILM (negative for intraepithelial lesion or malignancy). Among the five organisms, we found trichomonas were 38 (4.9%), and candida 38 (4.9%) cases of total NILM cases. Epithelial cell abnormalities in cytological examination were found in total 61 cases constituting 7.92%. Among epithelial cell abnormalities, LSIL was the commonest (27 cases, 3.57%). Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.