Perfil dos exames citopatológicos do colo do útero de mulheres residentes no estado de Minas Gerais / Profile of cytopathological examinations of the cerever of women resident in the state of Minas Gerais

Introdução: O diagnóstico precoce e referenciamento ao serviço especializado são essenciais para melhorar as taxas de cura e sobrevida das mulheres acometidas pelo câncer de colo de útero. Assim, a realização deste estudo tornará possível o levantamento de informações que serão essenciais para o desenvolvimento de medidas preventivas, que almejam contribuir com o desenvolvimento de ações de educação em saúde e o diagnóstico precoce para reduzir a morbimortalidade dessa enfermidade. Objetivo: Identificar o perfil dos resultados dos exames citopatológicos do colo do útero de mulheres residentes no estado de Minas Gerais a partir dos dados de exames correspondentes ao ano de 2019, utilizando as variáveis disponibilizadas pelo Sistema de Informação do Câncer. Métodos: Trata-se de um estudo retrospectivo, exploratório, quantitativo realizado por meio de base de dados secundários. Os dados foram submetidos à análise no software SPSS, versão 20.0. Realizou-se estatística descritiva (frequência absoluta, porcentagem, média e desvio padrão). Para verificar associação entre variáveis qualitativas foi utilizado teste qui-quadrado (x²) e exato de Fisher. A força das associações entre as variáveis foi aferida pelo risco relativo (RR) e intervalos de confiança (IC 95%). Resultados: As principais alterações presentes nos exames foram: alterações por células escamosas atípicas de significado indeterminado e lesão intraepitelial de baixo grau. Após análises estatísticas, notou-se que algumas alterações possuem risco maior de se desenvolverem no público fora da faixa etária preconizada, ou seja, entre mulheres com idade <25 anos ou >64 anos. Conclusão: O estudo realizado contribui para identificação do perfil atual vivenciado na área da saúde da mulher e possibilita a criação de condutas e ações que visem intervir frente aos resultados obtidos, impactando positivamente na realidade de Minas Gerais

Introduction: Early diagnosis and referral to a specialized service are essential to improve the cure and survival rates of women affected by cervical cancer. Thus, carrying out this study will make it possible to collect information that will be essential for the development of preventive measures, which aim to contribute to the development of health education actions and early diagnosis to reduce the morbidity and mortality of this disease. Objective: Identify the profile of the results of cervical cytopathological examinations of women residing in the State of Minas Gerais from the data of examinations corresponding to the year 2019, using the variables made available by the Cancer Information System.Methods: This is a retrospective, exploratory, quantitative study carried out by means of a secondary database. The data were submitted to analysis using the SPSS software, version 20.0. Descriptive statistics (absolute frequency, percentage, mean and standard deviation) were performed. To verify the association between qualitative variables, the chi-square test (x²) and Fisher's exact test were used. The strength of the associations between the variables was measured by the relative risk (RR) and confidence intervals (95% CI). Results: The main alterations present in the cytopathological exams performed were: changes due to atypical squamous cells of undetermined significance and low- grade intraepithelial lesion. After statistical analysis, it was noted that some changes have a higher risk of developing in the public outside the recommended age range, that is, among women aged <25 years or> 64 years. Conclusion: The study carried out contributes to the identification of the current profile experienced in the area of women's health and enables the creation of conducts and actions that aim to intervene in view of the results obtained, positively impacting the reality of Minas Gerais.

Alterações em exames citopatológicos realizados em Unidade Básica de Saúde: um estudo analítico transversal / Alterations in cytopathological tests performed in a Basic Health Unit: a cross-cutting analytical study

Objetivo: Com o presente estudo, buscou-se verificar a quantidade de exames de colpocitologia oncótica coletados em Unidade Básica de Saúde (UBS) escolhida, determinar quantas e quais são as alterações encontradas nesses exames e quais foram as condutas e acompanhamentos realizados em pacientes com exames alterados. Métodos: Foram analisados 446 exames de colpocitologia oncótica realizados em uma UBS do centro-oeste do Paraná. As pacientes com exame alterado foram selecionadas e foi feita uma análise desses prontuários a fim de verificar a conduta e o acompanhamento dessas pacientes. Resultados: Foram encontrados 32 exames com alterações, sendo três de uma mesma paciente. Dessas 30 pacientes, a grande maioria correspondia a células escamosas atípicas de significado indeterminado (ASC-US), possivelmente não neoplásicas, e 28 pacientes retornaram para receber uma conduta inicial, sendo principalmente o encaminhamento para a coleta de novo preventivo em seis meses ao serviço de oncologia clínica. Conclusão: O presente estudo concluiu que a hipótese principal foi verdadeira, a qual foi descrita como prevalência significativa de lesões intraepiteliais de alto grau, embora não seja a mais frequente, e descontinuidade por parte das pacientes que obtiveram esse resultado. Além disso, notou-se grande encaminhamento à atenção terciária, o que não é indicado pelo Ministério da Saúde.(AU)

Objective: With the present study, we sought to verify the amount of cytopathological tests collected in the chosen basic health unit, to determine how many and what are the alterations found in these tests and what were the conducts and follow-ups performed in patients with altered exams. Methods: We analyzed 446 preventive tests performed in a basic health unit in the Midwest of Paraná, and patients with altered examination were selected and an analysis of these medical records was made in order to verify the conduct and follow-up of the patients. Results: Thirty-two tests with alterations were performed, 3 of which were the same patient. Of these 30 patients, the vast majority corresponded to atypical cells of squamous meaning ­ possibly non-neoplastic (ASC-US), and 28 patients returned to receive an initial approach, mainly being referred to the collection of preventive new in 6 months and to the clinical oncology service. Conclusion: The present study concluded that the main hypothesis was true, which was described as a significant prevalence of high-grade intraepithelial lesions (HSIL), although not the most frequent, and discontinuity on the part of the patients who obtained this result. In addition, there was a large referral to tertiary care, which is not indicated by the Ministry of Health.(AU)

Impacto da estrogenização vaginal no seguimento de citologia oncótica de significado indeterminado na pós-menopausa / Impact of vaginal estrogenization in follow-up of oncotic cytology of undetermined significance in postmenopausal women

Avaliar a estrogenização tópica vaginal no seguimento de citologia oncótica de significado indeterminado, tipo ASC-H, na pós-menopausa. Estudo, tipo caso-controle, que avaliou mulheres menopausadas com diagnóstico de ASC-H, divididas em dois grupos, com e sem uso de estrogênio tópico vaginal (GE e GNE). Foi calculada razão de chance a partir de tabelas de contingência construídas com variação robusta. Foram analisados 128 prontuários, sendo 27% de pacientes do GNE e 72% do GE. Houve aumento de diagnósticos ASC-H no GNE. No GE, aproximadamente 68 vezes menos colposcopias inadequadas e diminuição do número de colposcopias e Cirurgia de Alta Frequência (CAF), com evidência na redução em 21 e 12,5 vezes, respectivamente. Diminuição do número de colposcopias com melhor adequação ao exame, número de biópsias inalterado e diminuição do número de cirurgias de alta frequência, no grupo com uso de estrogênio tópico vaginal durante o seguimento.

Current paper evaluates topic vaginal estrogenization following oncotic cytology of undetermined significance, type ASC-H, in postmenopausal women. A case-control study evaluated menopausal women diagnosed with ASC-H, divided into two groups, with and without the use of topic vaginal estrogen (GE and GNE). Odds ratios were calculated from contingency tables built with robust variation. 128 medical records were analyzed, 27% of which were from the GNE and 72% from the GE. There was an increase in ASC-H diagnoses in GNE. In GE, approximately 68 times less inappropriate colposcopies and a decrease in the number of colposcopies and High Frequency Surgery (HFS), with a reduction of 21 and 12.5 times, respectively. Decrease in the number of colposcopies with better adaptation to the exam, unchanged number of biopsies and decrease in the number of high-frequency surgeries, in the group using topic vaginal estrogen during the follow-up.

Hallazgos en colposcopia. Experiencia en una unidad de referencia / Findings in colposcopy. Experience in a reference unit

Resumen OBJETIVO: Describir los desenlaces colposcópicos de pacientes con alteraciones citológicas atendidas en una institución colombiana. MATERIALES Y MÉTODOS: Estudio observacional, trasversal y retrospectivo al que se incluyeron pacientes a quienes se tomó una colposcopia, indicada por reporte anormal en la citología (2012-2106). La muestra se seleccionó a partir de un muestreo aleatorio, estratificado por grupos etarios. Se establecieron las frecuencias de las alteraciones colposcópicas y de los reportes histológicos. RESULTADOS: Se incluyeron 372 pacientes. La principal indicación de la colposcopia fue el reporte de atipia de células escamosas de significado indeterminado (70.6%), seguido por lesiones intraepiteliales de bajo grado (16.9%) y pólipos endocervicales (2.9%). La colposcopia fue negativa en 32% de los casos, positiva en 31% y con inflamación en 21%. El resto de los casos correspondió a atrofia o pólipos. De las colposcopias positivas, el principal reporte fue de cambios menores o grado 1; sobre todo en las pacientes de 15 a 24 años. De las pacientes con biopsia se reportó un caso de adenocarcinoma (3.1%) y otro de carcinoma in situ (3.1%) en el mismo grupo etario. CONCLUSIÓN: La colposcopia identificó lesiones de alto y bajo grado clínicamente no significativas. La colposcopia es una herramienta decisiva para el diagnóstico de lesiones premalignas del cuello uterino.

Abstract OBJECTIVE: This study describes the colposcopic results of patients with cytological alterations in a Colombian institution. MATERIALS AND METHODOS: Observational Cross-sectional study based on retrospective data. Patients who underwent colposcopy due to abnormal cytologies during 2012-2106 were included. A stratified random sampling was carried out by age groups. The frequencies of colposcopic alterations and histological results were established. RESULTS: 372 patients were selected. The main indication for colposcopy was the ASCUS report (70.6%), followed by LSIL (16.9%) and endocervical polyps (2.9%). Colposcopy was negative in 32% of the cases, positive in 31% and inflammation in 21%. The rest of cases corresponded to varied findings such as atrophy or polyps. Of the positive colposcopies the main report was minor changes or grade 1; especially in patients between 15-24 years. Of the patients with a biopsy, one case of adenocarcinoma (3.1%) and another of carcinoma in situ (3.1%) were reported in the same age group. CONCLUSIONS: The realization of colposcopy identified the high-grade lesions in this population, but also detected clinically insignificant low-grade lesions. Colposcopy is a key tool for the diagnosis of premalignant lesions of the cervix.

Management of atypical squamous cell cases: A prospective study of women seen at a private health service in northeastern Brazil / Conduta em casos de células escamosas atípicas: um estudo prospectivo de mulheres atendidas pelo serviço de saúde privado no nordeste do Brasil

Abstract Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women. Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H). Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p< 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p< 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p< 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075). Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Resumo Objetivo Avaliar a conduta adotada por ginecologistas após resultados citológicos apresentando células escamosas atípicas (ASCs) e os desfechos destes casos em mulheres brasileiras. Métodos Um estudo observacional prospectivo avaliou o manejo clínico inicial do ginecologista nos casos de 2.458 resultados citológicos apresentando ASCs coletados entre janeiro de 2010 e julho de 2016. Os respectivos desfechos citológicos, histológicos e de detecção do papilomavírus humano (HPV) foram comparados entre os subgrupos células escamosas atípicas de significado indeterminado (ASC-US) e células escamosas atípicas não podendo excluir lesão intraepitelial de alto grau (ASC-H). Resultados Nenhuma conduta foi adotada em 36,97% de citologias do tipo ASC-US e 40,5% do tipo ASC-H. A conduta mais escolhida foi a repetição da citologia, inclusive para acompanhamento de ASC-H, o que contraria as diretrizes nacionais. O tempo de realização de uma nova citologia para resultado do tipo ASC-US em mulheres com mais de 30 anos de idade foi de 13,03 meses, também em desacordo com as diretrizes (p< 0,0001). Resultados negativos para lesão intraepitelial ou neoplasia maligna (NILM), tanto citológicos (p = 0,0026) como histológicos (p = 0,0017), foram associados a ASC-US, enquanto que resultados negativos para lesões intraepiteliais escamosas de alto grau (HSILs), citológicos (p< 0,0001) e histológicos, foram associados a ASC-H (p< 0,0001). Dois carcinomas cervicais invasivos foram encontrados durante o acompanhamento para ASC-H e uma associação estatisticamente significante foi estabelecida (p = 0,0341). Um teste de HR-HPV positivo foi associado a ASC-H (p = 0,0075). Conclusão Os dados sugerem que mesmo para uma população de mulheres brasileiras atendidas em clínicas privadas, as recomendações das diretrizes clínicas nacionais para resultados citológicos apresentando ASCs não são seguidas.

Incidencia y caracterización de pacientes con células escamosas atípicas de significado indeterminado / Incidence and Characterization of Patients with Atypical Squamous Cells of Undetermined Significance

Fundamento: el estudio citológico es el más importante en los programas de detección precoz de cáncer cervicouterino, siendo la atipia de células escamosas de significado indeterminado la anomalía más frecuente encontrada. Objetivo: determinar la incidencia de atipia de células escamosas de significado indeterminado en la consulta de patología de cuello del Hospital Universitario Ginecobstétrico Mariana Grajales de la provincia Villa Clara. Método: se realizó un estudio de tipo transversal en el que el universo estuvo constituido por las 206 pacientes remitidas a la consulta de patología de cuello durante el año 2011, la muestra fue de 120 mujeres que en el libro de registro de citologías orgánicas del departamento de anatomía patológica del Hospital, contaban con la totalidad de los datos requeridos con un reporte de células escamosas atípicas de significado indeterminado. Las variables estudiadas fueron: edad en años cumplidos al momento del diagnóstico, la edad en años de las primeras relaciones sexuales y el número de partos. Se confeccionó un fichero de datos en Excel donde se realizaron los cálculos necesarios. Se emplearon números absolutos y porcentajes para resumir las variables cualitativas y media, desviación estándar, valores mínimos y máximos para las cuantitativas. Resultados: se obtuvo una incidencia de células escamosas atípicas de significado indeterminado de un 0,37 %, predominó en las mujeres mayores de 40 y menores de 50 años, la mayoría inició sus relaciones sexuales antes de los 20 años y tuvieron 2 hijos. Conclusión: la incidencia de reportes de células escamosas atípicas durante el período de tiempo estudiado fue baja, predominó en mujeres de mediana edad, en aquellas que iniciaron sus primeras relaciones sexuales de manera precoz y en las multíparas.

Foundation: cytological study in the most important of the programs for early detection of cervical uterus cancer. The most frequently atypia found was squamous cells of undetermined significance. Objective: to determine the incidence of squamous cells of undetermined significance in the consultation of Cervix Pathology at the Gyneco-Obstetric University Hospital Mariana Grajales. Method: it was a cross-sectional study in a universe constituted by the 206 patients referred to the cervix pathology consultation during the year 2011. The sample was 120 women from the organic cytology registration book at the pathological anatomy department of the Hospital, who had all the required data with a report of atypical squamous cells of undetermined significance. The studied variables were: age in years completed at the time of diagnosis, age in years of the first sexual relations and the number of births. A data file was created in Excel where the necessary calculations were made. Absolute numbers and percentages were used to summarize the qualitative and average variables, standard deviation, minimum and maximum values for the quantitative variables. Results: an incidence of atypical squamous cells of undetermined significance of 0.37 % was obtained, it predominated in women older than 40 and younger than 50 years old and most of them started their sexual relations before the age of 20 and had 2 children. Conclusion: the report incidence of atypical squamous cells during the studied period of time was low; it predominated in middle-aged women, in those who had an early sexual relation and in multiparous women.

Caracterización de lesiones intraepiteliales en mujeres del cantón Penipe, Ecuador. Noviembre 2014 / Characterization of intraepithelial lesions in women of Penipe town, Ecuador. Novem-ber 2014

El proceso investigativo tuvo un enfoque cuantitativo, de tipo observacional, descriptivo, transversal; con el propósito de caracterizar las lesiones intraepiteliales en 100 pacientes del cantón Penipe, con edades comprendidas entre 20 a 65 años, que asistieron a consulta gineco-lógica del Centro de Erradicación del Bocio y Capacitación a Minusválidos (CEBYCAM), durante el mes de noviembre de 2014. Los datos fueron obtenidos empleando la técnica de la medición, a través del empleo del Sistema Internacional de Reporte de Bethesda. El prome-dio de la edad fue 41.44 años (± 13.60); la media aritmética de la edad de inicio de las relacio-nes sexuales fue de 16,37 (± 4.49); predominaron las mujeres con dos hijos, aquellas cuyo test resultó negativo (88 %) y las que no utilizaban algún método anticonceptivo, así como para la presencia de microorganismos con potencial patológico. La prueba de correlación de Pearson arrojó la existencia de una relación fuerte y positiva entre las variables paridad y edad.

The researching process had a quantitative, observational, descriptive, cross-sectional approach. It aimed to characterize the intraepithelial lesions in 100 patients from Penipe town, aged between 20 and 65 years, who are treated at the gynecological consultation of Centro de Erradicación del Bocio y Capacitación a Minusválidos during the month of November 2014. The data were obtained through the use of the Bethesda International Reporting System measurement technique. The age was on average 41.44 (± 13.60); the arithmetic mean of the age of onset of sexual intercourse was 16.37 (± 4.49); women with two children predominated, those whose test was negative (88%) and those who did not use any contraceptive method, as well as the presence of microorganisms with pathological potential. The Pearson correlation test showed the existence of a strong and positive relationship between parity and age variables.

Significance of p16/Ki-67 double immunocytochemical staining in cervical cytology ASCUS, LSIL,and ASC-H / 中华妇产科杂志

Objective To investigate the application value of p16/cell proliferation associated nuclear antigen (Ki-67) double-staining and human papillomavirus mRNA in the cytological screening.Methods Two hundred and fifty-one cases who suffered from atypical squamous cell of undetermined significance (ASCUS),low-grade squamous intraepithelial lesion (LSIL),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion (ASC-H) in ThinPrep cytologic test (TCT) were collected in Peking University First Hospital between October 2015 and March 2016.And p16/Ki-67 double-staining and hybrid capture Ⅱ (HC-Ⅱ) detection were performed on the cervical cells.The result was compared with the pathological result of colposcope guided biopsy.All statistical analysis was completed by Stata 12.0 statistical software analysis.The results of diagnostic tests were described by using the sensitivity,specificity,positive predictive value,negative predictive value,and the area under the receiver operating characteristic (ROC) curve.Results (1) One hundred and eight cases of liquid based cytology diagnosis of ASCUS patients,the positive rate of p16/Ki-67 was 13.9％ (15/108),102 cases of liquid based cytology diagnosis of LSIL patients,the positive rate of p16/Ki-67 was 21.6％ (22/102),41 cases of liquid based cytology diagnosis of ASC-H patients,the positive rate of p16/Ki-67 was 39.0％ (16/41),compared amongthree groups,the difference was statistically significant (x2=78.516,P＜0.05);cervical exfoliated cells p16/Ki-67 expression rate was 13.0％ (28/215) in cervical low-grade lesions [cervical intraepithelial neoplasia (CIN)Ⅰ],which was 69.4％ (25/36) in high level lesions (CIN Ⅱ-Ⅲ),the difference was statistically significant (x2=7.932,P＜0.05).(2) The specificity of p16/Ki-67 detection and diagnosis were higher than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (89.8％ vs 71.4％,83.3％ vs 15.6％,88.9％ vs 40.7％;all P＜0.05),meanwhile,the positive predictive value of p16/Ki-67 detection and diagnosis exceed those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (33.3％ vs 26.3％,31.8％ vs 12.6％,81.3％ vs 38.5％;all P＜0.05).Moreover,the ROC curve of p16/Ki-67 were bigger than those of HC-Ⅱ in ASCUS,LSIL,and ASC-H (0.799 vs 0.696,0.708 vs 0.531,0.909 vs 0.561;all P＜0.05).Conclusion For patients with cytological diagnosis of ASCUS,LSIL,and ASC-H,p16/Ki-67 double staining method could be used as an effective method to assist in the diagnosis of high-grade cervical lesions,and the screening efficiency is superior to that of high-rist HPV.

Impact of age on the false negative rate of human papillomavirus DNA test in patients with atypical squamous cells of undetermined significance

OBJECTIVE: Human papillomavirus (HPV) test was incorporated into the triage of lesser abnormal cervical cytologies: atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL). This study aimed to evaluate the impact of age on the efficacy of HPV testing in patients with lesser abnormal cervical cytologies. METHODS: A total of 439 patients with ASCUS or LSIL were included. The association between age groups and the diagnostic performances of HPV test for high-grade cervical intraepithelial neoplasia (CIN2+) was evaluated. RESULTS: Median age was 44 years (range, 17 to 75 years). ASCUS was more frequently observed in older patients while LSIL was more common in younger patients (P=0.002). CIN2+ was found in 11.3% (32/284) of the ASCUS patients and 12.9% (20/155) of patients with LSIL. Older patients with ASCUS showed lower HPV infection rates (P=0.025), but not LSIL (P=0.114). However, the prevalence of CIN2+ was similar between the age groups with ASCUS or LSIL. In patients with ASCUS, the false negative rate of HPV test for CIN2+ was 6.2%. The false negative rate of the HPV test became higher with increasing of the age after the age of 50 (P=0.034). CONCLUSION: Our findings suggest that false negative rate of the HPV test for CIN2+ in ASCUS patients older than 50 years might become higher with increasing of the age. Negative HPV results in patients of the age >50 years with ASCUS should be carefully interpreted.