RESUMO
Cervical cancer is the third most common cancer among women in Brazil, after breast and skin cancer. The exam of Papanicolaou is well-recognized method to safety and efficiently option to recognize pre-malignant alterations of the uterine cervix. This study focused the comparison of three methodologies of internal quality control (QC) of cytologic diagnoses: 1) morphological guide-list to be revised (MGLR); 2) the rapid-rescreening (RR); 3) the revision of 10%. The objective was to evaluate the performance and the viability of the internal QC strategies in a Health Public Laboratory of the State of São Paulo. The uterine-cervix samples were examined at the Adolfo Lutz Institute during the period from 2002 to 2004. Of the 4184 samples, 1117 were submitted to MGLR revision, and with the lasting ones, were held revised by 10% method and RR. The RR was made by two trained professionals, who had adopted the turret method to the rescreening, for 60 seconds. The histopathology was used as gold standard. The final diagnosis of the cases without biopsy, were evaluated by diagnostic consensus of two pathologists. MGLR samples, 20.7% of cases showed alterations; the revision of 10% found 6.0% and RR, 2.5%. The kappa index between both observes in the RR was kw= 0.98. Cases prepared with liquid based cytology method presented better performance than conventional smear. The diagnosis concor
Apresenta resumo em inglês.
RESUMO
The objective of this study was to identify the distribution of cytological diagnosis by means of Pap test on pre-neoplastic and neoplastic lesions from women at different age group in the period of 20 years. Retrospective survey of cytological cervicovaginal diagnoses was done to achieve this goal. Diagnoses results from 1,020,853 cytological samplings on Pap test, were studied according to age groups. In the period of 20 years from 1984 to 2003 the distribution of cervicovaginal cytological diagnoses according to age was analyzed four intervals of 5 year - (four quinquennia). Of analyzed cytological samples 27,314 (2.68%) were unsatisfactory, 980,985 (96.09%) were negative, and 12,554 (1.23%) resulted in squamous intraepithelial lesions and cancer. LSIL peak was observed within the four quinquennia and in the 20-24 age group, HSIL was most frequent in the 30-34 year age group, and SCC/ADENO Ca were present in women above 50 years old. In women of 15-19 years of age, a clear-increase in LSIL frequency was observed in four quinquennia, of 66 (9.19%) in the first quinquennium, 109 (9.83%) in the second, 441 (17.46%) in the third, and 467 (15.97%) in the last one. The outcome of the uterine cervix cancer prevention programs can be measured by the high frequency of LSIL type lesions in the past five years, and the data disclosed in the present study are in accordance with the data
O objetivo deste estudo foi identificar a distribuição dos diagnósticos citológicos pelo método de Papanicolaou das lesões pré neoplásicas e neoplásicas nos diferentes grupos etários no período de 20 anos. Foram utilizados dados retrospectivos dos diagnósticos citológicos cérvico-vaginais realizados no período de 1984 a 2003 no Setor de Citologia Oncótica. A distribuição dos diagnósticos de 1.020.853 amostras citológicas foi analisada por faixa etária em quatro intervalos de 5 anos (4 quinqüênios). Das amostras analisadas, 27.314 (2,68%) casos foram inadequados, 980.985 (96,09%) foram negativos e 12.554 (1,23%) lesões intraepiteliais e câncer. Neste período, o pico de LSIL foi observado entre a faixa etária dos 20-24 de idade, HSIL foi mais freqüente no intervalo entre 30-34 anos de idade, e SCC/ADENO Ca foram acima dos 50 anos de idade. Nas mulheres entre 15-19 anos de idade foi observado acentuado aumento na freqüência de LSIL nos quatro qüinqüênios, de 66 (9,19%) no primeiro, 109 (9,83%) no segundo, 441 (17,46%) no terceiro e 467 (15,97%) no último. A qualidade dos programas de prevenção de câncer de colo uterino pode ser medido pela freqüência das lesões do tipo LSIL. Os resultados do presente estudo são concordantes com os de outros programas contínuos e importantes para evitar a mortalidade em virtude dessas lesões.