ABSTRACT
Introducción: la incidencia del cáncer anal se ha duplicado en las últimas décadas. El virus del papiloma humano (VPH) es el causante de la enfermedad de transmisión sexual más frecuente del mundo y el causante del 90% de los cánceres anales. Es la primera vez que en nuestro país se realiza un protocolo de búsqueda de neoplasias rectoanales con PAP y anoscopía de alta resolución con biopsia. Objetivos: describir lesiones rectoanales vinculadas a VPH en una población de pacientes pertenecientes a grupos de riesgo mediante PAP anal (citología) y biopsias a través de AAR (anoscopía de alta resolución) con acetotinción. Comparar el rendimiento diagnóstico del PAP anal frente a la histología en muestras biópsicas dirigidas por AAR con acetotinción (patrón oro). Material y método: se realizó una descripción estadística de la población estudiada. Se realizó test de concordancia (índice Kappa). Se calcularon coeficientes de validez interna (sensibilidad y especificidad). Para el procesamiento de la información se utilizó paquete estadístico Epi-Info versión 3.5.1. Resultados: se consideraron en el estudio 60 pacientes, con una edad media de 33 años, 78% de sexo femenino. El índice Kappa para la concordancia entre la histología y la clasificación citológica a través del PAP fue de 0,403, IC 95% (0,17-0,63). La sensibilidad del PAP fue de 92%, la especificidad fue de 46%. Conclusión: la sensibilidad del PAP anal que hemos demostrado señala que podría ser considerada como técnica de tamizaje para el diagnóstico de estas lesiones. Su escasa especificidad sugiere en el futuro la confirmación con biopsia dirigida por AAR y acetotinción en los casos de PAP con citología positiva.
Abstract Introduction: the incidence of anal cáncer has doubled in the last decades. The HPV is the cause for the most frequent sexually transmitted disease in the world, and causes 90% of anal cancers. This is the first time a protocol for screening rectoanal neoplasias is followed in Uruguay, using PAPs and high resolution anoscopies with biopsies. Objetives: to describe rectoanal lesions associated with HPV in a population of patients belonging to risk groups with anal PAP (citology) and biopsies with high resolution anoscopy with aceto-whitening. To compare the diagnostic yield of anal PAP with histology in high resolution anoscopy with aceto-whitening guided biopsy samples (golden standard). Method: we conducted a statistical description of the population studied. We conducted the agreement test (Kappa coefficient). Internal validity coefficients were calculated (sensitivity and specificity). The Epi-Info version 3.5.1 statistics package was used to process the information. Results: 60 patients were considered for the study, average age was 33 years old, 78% were female. The Kappa coefficient for agreement between histology and the cell classification with PAP was 0.403, IC 95% (0.17-0.63). PAPA sensitivity was 92%, specificity was 46%. Conclusion: the sensitivity of anal PAP we have found suggests it could be considered as a screening technique for the diagnosis of these lesions. Its scarce specificity suggests the need for confirmation with high resolution anoscopy with aceto-whitening guided biopsy in the future in the cases when PAP cytology is positive.
Resumo Introdução: a incidência do câncer anal duplicou nas últimas décadas. O vírus do papiloma humano (VPH) é o agente causal da doença de transmissão sexual más frequente del mundo e é responsável por 90% dos cânceres anais. Esta é a primeira vez que se realiza no Uruguai um protocolo de pesquisa de neoplasias anorretais com PAP e anuscopia de alta resolução com biopsia. Objetivos: descrever lesões anorretais vinculadas ao VPH em uma população de pacientes pertencentes a grupos de risco utilizando PAP anal (citologia) e biopsias por AAR (anuscopia de alta resolução) com coloração acética. Comparar o rendimento diagnóstico do PAP anal com a histologia nas amostras biópsicas dirigidas por AAR com coloração acética (padrão ouro). Material e método: realizou-se uma descrição estadística da população estudada. Fez-se teste de concordância (índice Kappa). Foram calculados os coeficientes de validez interna (sensibilidade e especificidade). Para o processamento da informação foi utilizado o software estatístico Epi-Info versão 3.5.1. Resultados: foram estudados 60 pacientes, com idade media 33 anos, 78% do sexo feminino. O índice Kappa para a concordância entre a histologia e a classificação citológica por PAP foi de 0,403, IC 95% (0,17-0,63). A sensibilidade do PAP foi de 92%, e a especificidade 46%. Conclusión: a sensibilidade do PAP anal encontrada indica que poderia ser considerada como técnica de tamizagem para o diagnóstico destas lesões. A baixa especificidade sugere que sejam confirmadas com biopsia dirigida por AAR e coloração acética nos casos de PAP com citologia positiva.
Subject(s)
Humans , Anus Neoplasms/diagnosis , Papillomavirus Infections/diagnosis , Papanicolaou TestABSTRACT
OBJECTIVE: To analyze the performance of intraoperative cytological diagnosis and its contribution to enhance the diagnostic concordance of intraoperative procedures with definitive histological diagnosis in ovarian lesions. Descriptions of cytologic features of some ovarian lesions as seen in imprint and smear specimens are documented. Advantages and limitations of cytological specimens are underscored. STUDY DESIGN: We performed a retrospective review of intraoperative consultations of ovarian neoplastic and non-neoplastic lesions of 337 cases identified from the pathologic records of our laboratory. All cases evaluated had intraoperative cytological imprint or smear specimens. The intraoperative diagnosis transmitted to the surgeon was the combined result of a thorough macroscopic study of the surgical specimens, frozen section analysis of tissue samples obtained from the most representative areas, evaluation of smear and imprint cytological specimens, and cyto-histological correlation. The intraoperative diagnosis was compared with the final histological diagnosis. Blinded review of cytological slides in discrepant cases was carried out. RESULTS: Final histological diagnosis showed 268 benign lesions, 49 malignant tumors and 20 borderline epithelial tumors. Diagnostic accuracy was 97%, sensitivity 93%, specificity 98%, positive predictive value 91% and negative predictive value 98%. After the cytological review of the discrepant cases, accuracy increased to 98.5%, specificity to 100%, and positive predictive value to 100%. The sensitivity and negative predictive values did not change, remaining 93 and 98%, respectively. The proportion of false positives dropped from 7 (2.1%) to 0, and the proportion of false negatives from 9 (2.7%) to 5 (1.5%). The new values showed significant differences for specificity (p=0.0401), positive predictive value (p=0.0479) and for the proportion of false positives (p=0.0226). Cytologic evaluation contributed with wider sampling of tumors and excellent cyto-morphological details. CONCLUSION: Adding cytological evaluation of imprint and smear specimens and cyto-histologic correlation to the traditional gross examination and frozen sections results in better correlation of the intraoperative consultation with the definitive histological diagnosis. In this series cytology was more accurate than frozen sections in some cases. Cytological evaluation of imprints and smears should be considered an important complementary tool in the setting of intraoperative consultation.
