ABSTRACT
INTRODUÇÃO: A avaliação citológica do derrame papilar é um método bem estabelecido para o diagnóstico rápido de carcinoma mamário em mulheres. OBJETIVOS: Estabelecer a freqüência das diferentes categorias diagnósticas, as características citomorfológicas das descargas papilares e, ainda, a relação entre o aspecto macroscópico dessas secreções e o citodiagnóstico. MATERIAL E MÉTODO: O presente estudo analisou o resultado obtido do derrame papilar de 423 pacientes no período de janeiro de 1997 a abril de 2002. Os derrames foram classificados em positivo, negativo ou suspeito para células neoplásicas. RESULTADOS: Dos 423 casos analisados, os derrames papilares foram positivos em quatro casos, suspeitos em 11 e negativos em 408. O aspecto macroscópico hemorrágico esteve presente em dois casos positivos, sete suspeitos e 62 negativos. Os achados citológicos mais freqüentes, nos casos positivos ou suspeitos, foram de grupamentos papilares de células epiteliais com hemácias ou células ductais com atipias. DISCUSSÃO E CONCLUSÕES: Com base nessa experiência, conclui-se que os esfregaços catalogados como hemorrágicos, macroscópica ou microscopicamente, devem ser cuidadosa e sistematicamente analisados, pois neles há uma maior possibilidade de serem detectadas lesões significativas.
BACKGROUND: The cytological evaluation of nipple discharge is a well-known method for the fast diagnosis of breast carcinoma in females. OBJECTIVES: To establish the frequency of different diagnosis categories, the cytomorphologic features of nipple discharge and, in addition, the relationship between the macroscopic aspect of those secretions and cytodiagnosis. MATERIAL AND METHOD: This study examined the results obtained from 423 patients with nipple discharge during the period from January 1997 to April 2002. The discharges were classified in positive, negative or suspicious for neoplastic cells. RESULTS: Of the 423 examined cases, nipple discharges were positive in four cases, suspicious in 11 and negative in 408. The bloody macroscopic appearance was present in two positive cases, suspicious in seven and negative in 62. The most frequent cytological features, in the positive or suspicious cases, were papillary clusters of epithelial cells with erythrocytes or ductal cells with atypical findings. DISCUSSION AND CONCLUSIONS: Based on this experience, we concluded that the smears classified as bloody, macroscopic or microscopically, should be careful and systematically analyzed because there is a larger possibility of detecting significant lesions in them.
ABSTRACT
The purpose of this study is to report the organization of a cost-effective screening program for cervical cancer in a developing country such as Brazil. The Cervical Cancer Screening Program of Paraná (CCSPP) was launched in October 1997 and was the result of a joint collaboration between the government of Paraná (Secretary of Health of the State of Paraná), scientific societies (pathologists, gynecologists, and nurses), and a non governmental organization called the Women's Popular Forum of Paraná. The main goal of the program was to enhance the Papanicolaou (Pap) smear screening to coverage up to 85% of female adult population with a 3-yr interval between examinations, as well as to reduce the incidence and mortality from cervical cancer in the state of Paraná, a Southern state of Brazil. The cytological findings in all Pap smears recorded in a central computer-based register during 5 yr of the program (October 1997-October 2002) are discussed. During that period, 2,244,158 Pap smears were performed in women included in the program from the 398 cities of the state of Paraná. The cytological smears were analyzed according to the Bethesda System. The previous year, before the program was launched, a Pap smear was taken from 43% of women of Paraná. At the end of 5 yr, coverage was increased to around 86%. The great majority of examinations had a negative result (98%). Only 2% of examinations had cytological abnormalities (n = 44,621). Low-grade lesions predominated in women aged 15-30 yr, and the high-grade lesions were more common in women aged 25-45 yr. Patients older than 40 yr had the greatest incidence of invasive cancer. Although the program is only 5 yr old, a decrease in the mortality from cervical cancer in women from Paraná is clearly apparent: in 1998, 297 women died of cervical cancer, as compared with 188 as of September 2002.
