Associação multivariada entre alterações citológicas do colo uterino e comportamento de risco em mulheres profissionais do sexo / Multivariate association between the cervix cytological abnormalities and the risk behavior female sex workers

Neste trabalho foram identificadas as associações multivariadas entre as alterações citológicas (AC) do colo uterino e o comportamento de risco das profissionais do sexo (PS) atendidas no Centro de Referência em Saúde Sexual e Reprodutiva (CRESSER) – Sumaré, SP. Das 90 PS participantes, foram coletados dados sociocomportamentais por meio de questionário e amostras cérvico-vaginais para realização do exame de Papanicolaou. Para o teste estatístico foi utilizada a Análise Hierárquica de Agrupamentos (AHA). AC foram detectadas em 33 PS (36,7 por cento), sendo 18 (20,0 por cento) atipias de significado indeterminado possivelmente não neoplásica (ASC-US), quatro (4,4 por cento) atipias de significado indeterminado sem excluir lesão de alto grau (ASC-H), sete (7,8 por cento) lesão intraepitelial de baixo grau (LSIL) e quatro (4,4 por cento) lesão intraepitelial de alto grau (HSIL). Comparando os dados das PS com citologia normal e alterada, houve diferenças estatisticamente significativas quanto ao tabagismo, início da atividade sexual, relações com pessoas do mesmo sexo e detecção de Gardnerella vaginalis. AHA classificou as PS em quatro grupos distintos, em que as PS com idade média superior apresentaram maior proporção de DST, HIV, AC e pouco uso do preservativo. As PS com menor idade média mostraram menor frequência de AC, DST, atividade sexual precoce e HIV negativo.

Análise das discordâncias diagnósticas dos exames citopatológicos do Programa de Monitoramento Externo de Qualidade no Estado de São Paulo, Brasil, 2000-2010 / Analysis of the diagnostic disagreements in cytopathologic exams from the External Quality Assurance Program in the State of São Paulo, Brazil, 2000-2010

Introdução: O Programa de Monitoramento Externo de Qualidade (MEQ) dos exames citopatológicos cervicovaginais realizados pelo Sistema Único de Saúde (SUS ) foi proposto pelo Ministério da Saúde (MS) para melhorar o desempenho dos laboratórios de citologia da Rede Pública de Saúde. Objetivo: Avaliar as discordâncias diagnósticas dos exames citopatológicos cervicovaginais submetidos à revisão pelo Programa de MEQ do Estado de São Paulo, no período de 2000 a 2010. Método: Avaliação comparativa retrospectiva dos diagnósticos emitidos pelos lab-SUS e dos diagnósticos de revisão dos exames citopatológicos cervicovaginais. Resultados: Das 123.002 amostras revisadas,16.581 (13,48%) apresentaram discordância diagnóstica, sendo que, em 14.313 (11,64%) casos, houve divergência entre a conduta adotada e a preconizada pelo Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA). Foram considerados exames falso-positivos 2.530 (2,06%) e falso-negativos 2.154 (1,75%). A sensibilidade foi de 92,02% e especificidade de 96,49%. Houve concordância boa entre os diagnósticos originais e de revisão (kappa=0,77).Conclusão: Além do conjunto de atividades básicas propostas pelo MS, o MEQ do Estado de São Paulo destaca asações educativas implementadas, adotadas para promover a educação continuada no sentido da uniformização de critérios citomorfológicos e a consequente redução dos resultados falso-negativos e falso-positivos

Avaliação do desempenho da mistura verniz/xilol na diafanização de lâminas de citopatologia coradas com a técnica de Papanicolaou / Valuation of performance of solution varnish/xylene in the diaphanization of citopatology slides stained with Papanicolaou's technique

Introdução: O xilol é necessário para a diafanização de amostras citopatológicas. Pode trazer problemas de ordem ocupacional, proteção ao meio ambiente e de custos. Objetivo:Avaliar o desempenho de várias concentrações da mistura verniz/xilol em relação à diafanização e conservação em amostras de citologia coradas com a técnica dePapanicolaou (CP). Material e métodos: Foram avaliadas 75 lâminas de raspado bucal (RB) e 8.773 esfregaços cérvico-vaginais (CV). As lâminas foram coradas pela CP, com a retirada das etapas de álcool/xilol e xilol e foram secas à temperatura ambiente porvinte minutos antes da montagem com lamínula. A montagem foi realizada com soluções de verniz/xilol de concentrações 75/25%, 70/30%, 60/40%, 50/50% e 40/60%. As lâminas foram distribuídas de forma aleatória aos profissionais para avaliação da técnica, sendo conceituadas como boas, regulares ou ruins e reavaliadas após nove meses dearquivamento. A concentração de verniz/xilol que apresentou melhor qualidade final nas lâminas de RB foi aplicada também nos CV. Resultados: A concentração de 75/25% deverniz/xilol apresentou melhor desempenho para as duas situações, em RB e CV. Após nove meses, a qualidade foi mantida. Conclusão: A concentração de 75/25% apresentou melhor resultado.

[Critical evaluation of the diagnostic nomenclatures of cervical cytopathological exams used in the Brazilian Unified Health System (SUS)]. / Avaliação crítica das nomenclaturas diagnósticas dos exames citopatológicos cervicais utilizadas no Sistema Único de Saúde (SUS).

PURPOSE: to identify the nomenclature for reporting cervical cytological diagnoses used by laboratories which render services to the Brazilian Unified Health System (SUS) and which participate in External Quality Monitoring (MEQ). To evaluate the information acquired from gynecologists of the SUS regarding the various diagnostic classifications that they receive in the cervical cytology diagnostic reports. METHODS: we evaluated 94 cytology reports issued by laboratories which participate in the MEQ in the State of São Paulo, Brazil, and 126 questionnaires applied to gynecologists who work for the SUS. RESULTS: out of the 94 laboratories, 81 (86.2%) use one diagnostic classification: 79 (97.6%) use the Brazilian Nomenclature for Cytological Reports (NBLC), 1 (1.2%) uses the Papanicolaou classification and 1 (1.2%) uses the Richart diagnostic classification. Of the 13 (13.8%) laboratories that use more than one classification, 5 use 2 types and 8 use 3 to 4 types, with 9 including the Papanicolau diagnostic classification. The study showed that 52 (55.3%) laboratories presented more than one descriptive diagnosis in the same report. Out of the 126 gynecologists who filled out a questionnaire evaluating the cytopathology reports, 78 (61.9 %) stated that they received laboratory reports with only one diagnostic classification, 48 (38.1%) received reports with more than one classification and 2 received reports with all 4 classifications. Among the 93 (73.8%) gynecologists who prefer only one classification, 56 (60.2%) claimed that the NBLC contributes to clinical practice, 13 (14.0%) opted for the Richart classification, 8 (8.6%) for the Reagan classification and 16 (17.2%) for the Papanicolaou classification. Out of 33 (26.2%) gynecologists who prefer more than one classification, 5 opted for the 4 classifications. CONCLUSIONS: these data suggest that there is still resistance on the part of pathologists about using the official nomenclature in cytology reports for SUS. There is discrepancy between the information that gynecologists would like to see in the reports and the information provided by the pathologists. Greater efforts should be made to stimulate the use of the official nomenclature.

Avaliação crítica das nomenclaturas diagnósticas dos exames citopatológicos cervicais utilizadas no Sistema Único de Saúde (SUS) / Critical evaluation of the diagnostic nomenclatures of cervical cytopathological exams used in the Brazilian Unified Health System (SUS)

OBJETIVO: identificar as nomenclaturas diagnósticas dos exames citopatológicos cervicais utilizadas pelos laboratórios que atendem o Sistema Único de Saúde (SUS) e participantes do Monitoramento Externo de Qualidade (MEQ). Avaliar as informações adquiridas de profissionais ginecologistas que atuam no SUS sobre os tipos de classificação diagnóstica que recebem nos laudos citopatológicos cervicais. MÉTODOS: foram avaliados 94 laudos citopatológicos liberados pelos laboratórios participantes do MEQ no Estado de São Paulo e 126 questionários aplicados aos ginecologistas que atenderam o SUS. RESULTADOS: dos 94 laboratórios, 81 (86,2 por cento) utilizam uma única nomenclatura diagnóstica: 79 (97,6 por cento) utilizam a Nomenclatura Brasileira para Laudos Citopatológicos (NBLC), 1 (1,2 por cento) utiliza a classificação de Papanicolaou e 1 (1,2 por cento) utiliza a de Richart. Dos 13 (13,8 por cento) laboratórios que utilizam mais de uma nomenclatura, 5 apresentam 2 tipos, e 8, de 3 a 4, 9 dos quais incluem a classificação de Papanicolaou. O estudo demonstrou que 52 (55,3 por cento) laboratórios apresentaram mais de um diagnóstico descritivo num mesmo laudo. Dos 126 ginecologistas que responderam ao questionário de avaliação dos laudos citopatológicos, 78 (61,9 por cento) disseram receber laudos dos laboratórios com apenas uma classificação diagnóstica, 48 (38,1 por cento), laudos com mais de uma classificação, e 2 receberam as 4 classificações. Entre os 93 (73,8 por cento) ginecologistas que preferem uma classificação, 56 (60,2 por cento) alegaram que a NBLC contribui para a conduta clínica, 13 (14,0 por cento) optaram pela nomenclatura de Richart, 8 (8,6 por cento), de Reagan e 16 (17,2 por cento), a de Papanicolaou. De 33 (26,2 por cento) ginecologistas que preferem mais de uma nomenclatura, 5 optaram pelas 4 classificações...

PURPOSE: to identify the nomenclature for reporting cervical cytological diagnoses used by laboratories which render services to the Brazilian Unified Health System (SUS) and which participate in External Quality Monitoring (MEQ). To evaluate the information acquired from gynecologists of the SUS regarding the various diagnostic classifications that they receive in the cervical cytology diagnostic reports. METHODS: we evaluated 94 cytology reports issued by laboratories which participate in the MEQ in the State of São Paulo, Brazil, and 126 questionnaires applied to gynecologists who work for the SUS. RESULTS: out of the 94 laboratories, 81 (86.2 percent) use one diagnostic classification: 79 (97.6 percent) use the Brazilian Nomenclature for Cytological Reports (NBLC), 1 (1.2 percent) uses the Papanicolaou classification and 1 (1.2 percent) uses the Richart diagnostic classification. Of the 13 (13.8 percent) laboratories that use more than one classification, 5 use 2 types and 8 use 3 to 4 types, with 9 including the Papanicolau diagnostic classification. The study showed that 52 (55.3 percent) laboratories presented more than one descriptive diagnosis in the same report. Out of the 126 gynecologists who filled out a questionnaire evaluating the cytopathology reports, 78 (61.9 percent) stated that they received laboratory reports with only one diagnostic classification, 48 (38.1 percent) received reports with more than one classification and 2 received reports with all 4 classifications. Among the 93 (73.8 percent) gynecologists who prefer only one classification, 56 (60.2 percent) claimed that the NBLC contributes to clinical practice, 13 (14.0 percent) opted for the Richart classification, 8 (8.6 percent) for the Reagan classification and 16 (17.2 percent) for the Papanicolaou classification. Out of 33 (26.2 percent) gynecologists who prefer more than one classification, 5 opted for the 4 classifications...

Analysis of human kallikrein 7 expression as a potential biomarker in cervical neoplasia.

Overexpression of kallikrein 7, a proteolytic enzyme important for epithelial cell shedding, may be causally involved in carcinogenesis, particularly in tumor metastasis and invasion. In this study, we have evaluated hK7 (human kallikrein 7) protein levels by immunohistochemistry in 367 cervical histological samples including 35 cases of cervicitis, 31 low-grade cervical intraepithelial neoplasia, 51 high-grade cervical intraepithelial neoplasia (H-SIL), 197 squamous cervical carcinomas (SCC) and 53 cervical adenocarcinomas. We have observed that hK7 staining increased with the severity of cervical disease. Intense hK7 staining was found in 15.2% of cervicitis samples, in contrast to 55% of H-SIL and 68% of SCC. Moreover, 92.5% of adenocarcinomas also exhibited intense hK7 staining. Differences in the expression of hK7 could potentially be used as a biomarker for the characterization of different stages of cervical disease.

Simultaneous Chlamydia trachomatis and HPV infection in pregnant women.

Pregnancy is associated with HPV infection and with Chlamydia trachomatis (CT) infection mostly due to the natural immunosuppression. In addition, pregnancy associated to CT infection can lead to adverse conditions to the woman and fetus, and CT is also believed to be a co-factor in human immunodeficiency virus infection and HPV-induced cervical cancer. The aim of this study was to establish the odds ratios (OR) of CT infection in to HPV-infected pregnant women and vice versa of women stratified by age (<25 years) and marital status. This work is part of a national multicentric transversal study carried out in six Brazilian cities supported by the Ministry of Health of Federal Government of Brazil in 2003. Cervical scrapes of 371 pregnant women were sampled. We performed a hybrid capture-2 technique to diagnose these samples on HPV and CT infection, and the women responded a questionnaire. Significant association was observed between nonstable marital status and hr-HPV infection [OR = 2.61 (1.38-4.97) P = 0.003)], and age <25 years old [OR = 2.26 (1.09-4.71) P = 0.029]. Nonstable marital status was also associated with lr-HPV infection [OR = 2.67 (1.59-4.50) P < 0.001), and age <25 years old [OR = 2.55 (1.51-4.32) P < 0.001). Fifty of the 371 pregnant women were infected with hr-HPV (13.5%) and 111 (30.0%) were infected with lr-HPV. The coinfections of HPV and CT were found in 31 women, that is, 8.36% of the pregnant women (P < 0.001). The high rate of simultaneous CT and HPV infection in pregnant women favors the recommendation to screen pregnant women for both CT and HPV.

Monocarboxylate transporters 1 and 4 are associated with CD147 in cervical carcinoma.

Due to the highly glycolytic metabolism of solid tumours, there is an increased acid production, however, cells are able to maintain physiological pH through plasma membrane efflux of the accumulating protons. Acid efflux through MCTs (monocarboxylate transporters) constitutes one of the most important mechanisms involved in tumour intracellular pH maintenance. Still, the molecular mechanisms underlying the regulation of these proteins are not fully understood. We aimed to evaluate the association between CD147 (MCT1 and MCT4 chaperone) and MCT expression in cervical cancer lesions and the clinico-pathological significance of CD147 expression, alone and in combination with MCTs. The series included 83 biopsy samples of precursor lesions and surgical specimens of 126 invasive carcinomas. Analysis of CD147 expression was performed by immunohistochemistry. CD147 expression was higher in squamous and adenocarcinoma tissues than in the non-neoplastic counterparts and, importantly, both MCT1 and MCT4 were more frequently expressed in CD147 positive cases. Additionally, co-expression of CD147 with MCT1 was associated with lymph-node and/or distant metastases in adenocarcinomas. Our results show a close association between CD147 and MCT1 and MCT4 expressions in human cervical cancer and provided evidence for a prognostic value of CD147 and MCT1 co-expression.

Estudo retrospectivo dos diagnósticos cito-histopatológicos nas atipias de significado indeterminado / Retrospective study on cyto-histological diagnoses in the atypical squamous cells of undertermined signifance

No presente estudo foi avaliada a história de realização dos exames citológicos (EC) prévios e posteriores com diagnóstico citológico de células escamosas atípicas (ASC) e sua correlação com os resultados de exames de biópsias. Para tanto, foi realizado o estudo retrospectivo, de 60 casos de EC cérvico-vaginais com diagnóstico de ASC e biópsias correlatas, os exames prévios e posteriores de ASC e a periodicidade de exames realizados. Das 60 análises selecionadas, 57 apresentaram diagnóstico citológico anterior de ASC-US (possivelmente não neoplásico), 30 (52,6%) foram negativos no exame de biópsia, 16 (28,1%) de NIC 1, 11 (19,3%) com diagnósticos discrepantes acima de 2 graus; 3 (100%) casos de ASC-H (não se pode afastar lesão de alto grau) foram NIC 1 na biópsia. Dentre os 60 casos, 44 (73,3%) que tiveram exames anteriores, 14 (23,3%) eram positivos; 53 (88,3%) que fizeram EC posteriores à biópsia, 10 (16,7%) eram positivos. Quanto à periodicidade dos exames, 26 (43,3%) realizaram o exame com intervalo de até 1 ano, 29 (48,3%) de 1 a 3 anos, 1 (1,7%) em intervalo maior que 3 anos. De acordo com os achados observados neste estudo, os diagnósticos citológicos de ASC, quando comparado com os exames da biópsia, estavam mais frequentemente associados às alterações morfológicas reacionais. Estes dados mostram o valioso papel da correlação cito- histológica, uma vez que a execução apenas do seguimento citológico pode ser insuficiente para obter o diagnóstico morfológico. É salientada, ainda, a necessidade de efetuar o exame de acompanhamento de seis em seis meses, para realizar o controle evolutivo dessas atipias, bem como para auxiliar na conduta terapêutica das pacientes.

Frequência de diagnóstico de lesões do colo uterino por faixa etária em mulheres atendidas no Programa de Rastreamento Viva Mulher no período de 2004 a 2008 / Review on the occurrence of uterine cervix lesions according to age group among women enrolled in the Viva Mulher – Prevention Program during the period from 2004 to 2008

No presente estudo foi realizado o levantamento retrospectivo de diagnóstico citopatológico das lesões pré-neoplásicas e neoplásicas pela método de Papanicolaou e sua distribuição por faixa etária das mulheres atendidas no período de 2003 a 2008. Das 222.024 amostras analisadas, 3.674 (1,65%) foram classificadas como insatisfatórias, 206.439 (92,98%) foram negativas e 11.911 (5,36%) apresentaram algum tipo de atipias nucleares. Dentre as alterações epiteliais atípicas, 6.437 (54,04%) foram de ASC-US e 210 (1,76%) de ASC-H; 3.264 (27,40%) de LSIL; 1.279 (10,74%) de HSIL; 131 (1,10%) de SCC; 552 (4,63%) por AGC-US e 23 (0,19%) de AGC-H; 7 (0,06%) de AIS e 8 (0,07%) de ADENOCA. Quanto à ocorrência e distribuição dos diagnósticos de lesões intraepiteliais escamosas e glandulares, de acordo com a faixa etária em intervalos de 5 anos, foi observada maior frequência de diagnóstico de LSIL entre as mulheres mais jovens (15-25 anos) e os diagnósticos de ASC-US, ASC-H, AGC-US, HSIL, SCC e ADENOCA nas mulheres >50 anos de idade. As alterações glandulares, como AGC-H e AIS, ocorreram em mulheres na faixa etária entre 30-34 e 45-49 anos. Foram detectados dois (0,16%) casos de HSIL em pacientes <14 anos e em 51 (3,99%) pacientes na faixa entre 15-19 anos. Os dados da presente avaliação enfatiza a importância de campanhas orientativas, rastreamento e seguimento das pacientes para garantir a melhoria e a efetividade dos programas de prevenção.

Increasing expression of monocarboxylate transporters 1 and 4 along progression to invasive cervical carcinoma.

Solid tumor cells are known to be highly glycolytic and, to prevent apoptosis by cellular acidosis, cells increase proton efflux through pH regulators, such as monocarboxylate transporters (MCTs). However, the role of these membrane proteins in solid tumor development and survival is not fully understood. We aimed to evaluate the expression of the MCT isoforms 1, 2, and 4 in a large series of cervical lesions (neoplastic and non-neoplastic) and assess its clinical-pathologic significance. The series analyzed included 29 chronic cervicitis, 30 low-grade squamous intraepithelial lesions, 32 high-grade squamous intraepithelial lesions, 49 squamous cell carcinomas, 51 adenocarcinomas, and 30 adenosquamous carcinomas of the uterine cervix. Analysis of the expression of MCT isoforms 1, 2, and 4 was performed by immunohistochemistry with specific antibodies. Immunoreactions were evaluated both qualitatively and semiquantitatively. We found a significant increase in MCT expression from preinvasive to invasive squamous lesions and from normal glandular epithelium to adenocarcinomas. This is the first study evaluating the significance of MCT expression in lesions of the uterine cervix, including invasive carcinomas, and the results found herein led us to believe that these membrane proteins are involved in the progression to invasiveness in uterine cervix carcinoma.

Campanha de prevenção de câncer cervical: estudos no Instituto Adolfo Lutz mostram a necessidade de avaliação na faixa etária / Cervical cancer screening programs: study at Instituto Adolfo Lutz show a necessity of an age-group evaluation

O objetivo deste estudo foi identificar a faixa etária das mulheres atendidas nas Unidades de Saúde do Estado de São Paulo, que apresentaram lesão intraepitelial de alto grau e neoplasia cervical, e, também, avaliar se a faixa etária preconizada pelo Ministério da Saúde em campanhas de rastreamento é adequada. Foram analisados os resultados de 30.910 amostras cérvico-vaginais colhidas e analisadas pelo Método de Papanicolaou. Das 14.779 amostras cérvico-vaginais de mulheres da faixa etária <34 anos, 841 (5,7%)apresentaram alterações epiteliais atípicas (AEA); destas, em 74 (8,8%) o diagnóstico foi de lesão intraepitelial de alto grau (HSIL), 38 (4,5%) de células escamosas atípicas em que não pode excluir lesão intraepitelial de alto grau (ASC-H) e em 369 (43,9%) houve ocorrência de lesão intraepitelial de baixo grau(LSIL). Entre as amostras cérvico-vaginais de 9.710 mulheres da faixa etária de 35-49 anos, 442 (4,6%) foram diagnosticadas como AEA, destas, 41 (9,3%) eram HSIL, 29 (6,3%) ASC-H, 94 (21,2%) de LSIL e 2 (0,5%)carcinomas. Das 6.421 amostras cérvico-vaginais de mulheres da faixa etária >50 anos 327(5,1%) foram diagnosticados como AEA; destas, 35 (10,7%) apresentaram HSIL, 23 (7,0%) ASC-H, 26 (8,0%) LSIL, e 8(2,4%) carcinomas. Os achados mostram que há necessidade de especial atenção às mulheres jovens e adolescentes nos Programas de Rastreamento para Prevenção de Câncer Cervical.

Lymphatic vessel density and epithelial D2-40 immunoreactivity in pre-invasive and invasive lesions of the uterine cervix.

OBJECTIVE: We sought to determine the significance of lymphatic vessel density (LVD) in pre-malignant lesions and carcinomas of the uterine cervix and to evaluate the prognostic value of lymphatic invasion and D2-40 positivity in tumor cells in the three histological types of invasive lesions. The correlation of LVD, lymphatic invasion and D2-40 positivity in tumor cells with EGFR and COX-2 expressions was also evaluated. METHODS: We studied 50 cervicitis, 50 low-grade squamous intraepithelial lesions (LSIL) (CIN1), 51 high-grade squamous intraepithelial lesions (HSIL) (CIN2/CIN3), 49 invasive squamous cells carcinomas (SCC), 43 adenocarcinomas (AC) and 30 adenosquamous cells carcinomas (ASC). The immunoreaction assay was performed using the monoclonal antibody D2-40. RESULTS: Significant differences in LVD were found among all categories of pre-invasive and invasive lesions (p=0.001 and p<0.001, respectively). LVD in invasive lesions was significantly greater than in pre-invasive lesions (p<0.001) and no significant association was found between LVD in invasive lesions and both lymph node invasion and/or metastasis. D2-40 positivity in tumor cells was associated with a better prognosis in ASC cases. EGFR and COX-2 expressions in invasive lesions were not associated with LVD; however, they correlated with both lymphatic invasion and D2-40 positivity in tumor cells. CONCLUSIONS: Lymphatic neovascularization begins early in intraepithelial lesions and continues to increase towards malignancy. Both lymphatic invasion and decrease in D2-40 expression in tumor cells appear to have a prognostic value.

The association of p16(INK4A) and fragile histidine triad gene expression and cervical lesions.

OBJECTIVE: This cross-sectional study was intended to assess the association between immunohistochemical analysis of p16 and fragile histidine triad (FHIT) and the presence of precancerous cervical lesions. MATERIALS AND METHODS: Women seen at Pérola Byington Hospital, São Paulo, Brazil, with histologically confirmed cervicitis (n = 31), cervical intraepithelial neoplasia (CIN) 1 (n = 30), CIN 2,3 (n = 30), and cervical cancer (n = 7) had also cervical material collected for liquid-based cytology, human papillomavirus Hybrid Capture 2 (HC2) test, and p16 and FHIT immunohistochemical reactions. RESULTS: p16 and FHIT reactions were scored as the following: <1%, 1% to 5%, >5% to 25%, and >25%. Receiver operating curve analysis was used to select p16 and FHIT score cutoffs for further categorical analyses. All but one of the 37 CIN 2,3/cancer cases had a p16 score of greater than 1% to 5%. Among the 61 cervicitis/CIN 1 cases, 46 (75%) had a p16 score lower than 1% to 5%. In contrast, no association of FHIT expression and severity of cervical lesions could be demonstrated in this data set. Receiver operating curve analyses suggested the score of 1% to 5% for p16 as the cutoff that best discriminates CIN 2,3/cancer from cervicitis/CIN 1. No cutoff for FHIT scores could be suggested with data set. CONCLUSIONS: p16, but not FHIT expression, has the potential to be used as complementary diagnostic tool to investigate human papillomavirus-induced cervical lesions, if these results are confirmed in larger studies.

Prevalência de papilomavirus humano (HPV) anal, genital e oral, em ambulatório geral de coloproctologia / Prevalence of anal, genital and oral human papillomavirus (HPV) in general ambulatory for diseases of colon and rectum

O Papilomavirus Humano (HPV) anal tem alta prevalência e incidência na população. O objetivo deste trabalho é verificar a prevalência de HPV anal, bucal e genital em ambulatório público de Coloproctologia, com base no exame de captura hibrida. Foram estudados 64 pacientes atendidos no ambulatório geral de Coloproctologia do Hospital Heliópolis, no período de 22/11/2005 a 20/12/2005, onde foram levantados, de forma prospectiva, dados clínicos, pessoais e comportamentais, identificando o perfil do grupo como não sendo de risco para HPV. Nenhum paciente deste grupo veio à consulta com queixa ou apresentando sinais de HPV ou outra doença sexualmente transmissível. Foram colhidos para cada paciente um esfregaço com escova de boca, outro de vulva/pênis e outro do ânus. O resultado mostrou que 15,62 por cento dos pacientes apresentaram HPV anal, bucal ou genital, sendo que 4,68 por cento do total de pacientes apresentavam HPV anal, um paciente de alto risco associado ao HPV genital, outro misto e outro de baixo risco. Trinta por cento dos pacientes HPV+ apresentavam dor anal como queixa principal. A conclusão é que a prevalência de HPV anal, genital e bucal é elevada, sendo que 4,68 por cento apresentavam HPV anal e daqueles HPV positivos 30 por cento apresentavam dor anal na queixa principal.

Anal Human Papilomavirus (HPV) has a high prevalence and incidence in the population. The purpose of this project is to verify the prevalence of anal, oral and genital HPV at the Coloproctology Clinic, based on the hybrid capture exam. Sixty four patients were assisted at the clinic from November 22nd to December 20th 2005. Clinical, personal and behavioral data of the patients were set up in a prospective way. The group profile was identified as not being a risky one to HPV. No patient of this group, when was assisted, had complained of or had presented any symptoms of HPV or any other sexually transmitted disease (STD). From each patient it was collected a mouth sample, a vulva/penis sample and an anus sample. The result indicated that of the 15,62 percent of the patients that had anal, oral, or genital HPV; 4,68 percent of them presented anal HPV, one person with high risk of HPV to neoplasia had it associated to genital HPV; another one had a medium risk HPV and other a low risk one. The conclusion is that the prevalence of anal, genital and oral HPV was high, among this number, 4,68 percent suffers from anal HPV and among HPV positive patient 30 percent had anal pain as the main complainty.

Uterine cytopathology in a public health laboratory: impact from 20 years data (1984-2003)

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.

Pero Vaz de Caminha: an-interchange program for quality control between Brazil and Portugal.

OBJECTIVE: To start an interexchange program for quality control in cervical cytology and discuss conceptual criteria for diagnosis. STUDY DESIGN: Slides were selected in the archives of the 2 institutes and included cases with unsatisfactory, negative and positive results. Sets of slides were changed between the partners every 3 months. At the end of each year a senior cytopathologist was invited to discuss the major discrepancies found in the study. RESULTS: A total of 1,041 cases were analyzed. Full concordance was obtained in 74.4% (774) of cases and discrepancies in 25.6% (267 cases). Full agreement was achieved in 276 (39%) of 707 cases categorized as negative. In 421 negative cases from laboratory A, this concordance represents 65.5% and 96.5% for laboratory B, which submitted 286 negative cases. The main discordance was the high number of atypical squamous cells of undetermined significance cases: 3.1% for A and 128 (33.2%) for B. Samples with discrepancies related to the quality of the material was another controversial issue: of 16 cases from laboratory A, 6 (37.5%) unsatisfactory cases were the same and 10 (62.5%) different. Laboratory B presented 20 unsatisfactory cases, and 14 (70.0%) had other diagnoses. Low grade squamous intraepithelial lesion and high grade squamous intraepithelial lesion concordance ranged from 75% to 80%, and invasive carcinoma has 4 discordances (28.5%), 3 previously screened as high grade squamous intraepithelial lesion and 1 as atypical squamous cells of undetermined significance. The kappa value obtained was 0.65, indicating substantial agreement. CONCLUSION: Our results indicated that atypical squamous cells of undetermined significance diagnoses are the crucial point of controversies and concern the quality of routine diagnosis in cytopathology.

Molecular strategies for identifying human papillomavirus infection in routinely processed samples: focus on paraffin sections.

OBJECTIVE: To optimize the protocols of human papillomavirus (HPV) detection in clinical samples, we used polymerase chain reaction (PCR)-based techniques in paraffin-embedded tissue sections and compared the results with those obtained with PCR and Hybrid Capture II (HC2) performed in liquid-based cytology (LBC) preservation medium. MATERIALS AND METHODS: Forty-five consecutive cervical biopsy specimens were taken from women participating in the ongoing Latin American Screening Study at Leonor Mendes de Barros Hospital, São Paulo, Brazil, during 2003 and 2004. The biopsy specimens were analyzed for HPV by a modified GP5+/GP6+ PCR protocol, and the results were compared with those obtained by PGMY PCR and HC2 in samples collected in LBC preservation medium. RESULTS: beta-Globin was detected in 100% of the multiplex PCR system from LBC samples and 66.7% with PCO4+/PCO3+ PCR in biopsy specimens. Of the three methods, PGMY PCR system and HC2 were equally effective in detecting HPV; both detected 13 cases in 45 samples (28.9%). The GP5+/GP6+ PCR applied in biopsy specimens showed a 20% HPV detection rate (9/45). CONCLUSIONS: Our PCR protocols worked reasonably well and allowed us to compare the three molecular methods with histological and cytological findings. The reproducibility of the results makes the technique applicable in archival materials.

DCS liquid-based system is more effective than conventional smears to diagnosis of cervical lesions: study in high-risk population with biopsy-based confirmation.

OBJECTIVE: To compare the performances of Papanicolaou test (PapTest) and of a new liquid-based cytology method, DNA-Citoliq System (DCS), in a high-risk population, with histology confirmation. METHODS: Paired specimens of exfoliated cervical cells were collected under split-sample protocol. All patients were submitted to colposcopy and a biopsy taken when any atypical transformation zone was seen. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of both conventional and DCS methods were computed in relation to histology. RESULTS: A total of 1095 patients were analyzed by two cytology methods and, in 425 (38.8%), histologically. There were significantly more adequate samples with DCS (98.63%) than with conventional (89.6%) smears (P < 0.001). ASCUS was diagnosed significantly more with DCS than with conventional Pap (P < 0.001). Conventional Pap misclassified as normal 55.4% (158/285) of cases with either LSIL or HSIL or cancer at histology, whereas DCS misclassified 31.2% (89/285) of cases (P < 0.001). DCS had a significantly higher sensitivity (70% and 91.3%) than the conventional Pap (49.8% and 72.8%) to detect both LSIL+ and HSIL+ at histology, respectively. On the other hand, specificity of conventional smear (88.2% and 85.2%) was significantly higher than DCS (75.4% and 70.9%) considering both LSIL+ and HSIL+ at histology, respectively. CONCLUSIONS: This study confirms the superiority of the liquid-based cytology system DCS to detect cervical lesions. The rate of adequate DSC slides was significantly higher than with conventional cytology.