High-grade cervical lesions among women attending a reference clinic in Brazil: associated factors and comparison among screening methods.

BACKGROUND: Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests. METHODS: A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present. RESULTS: A total of 291 women participated in the study. The median age was 38 years (DIQ: 30-48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%-22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01-19.04), history of smoking [OR = 2.4 (95%, CI: 1.14-5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10-5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79-26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high. CONCLUSIONS: The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.

Accuracy of magnetic resonance imaging in ovarian tumor: a systematic quantitative review.

OBJECTIVE: To estimate the diagnostic accuracy of magnetic resonance in ovarian tumors. STUDY DESIGN: A quantitative systematic review was performed. Studies that compared magnetic resonance and paraffin sections within subjects for diagnosis of ovarian tumors were included. RESULTS: Fifteen primary studies were analyzed, which included 1267 ovarian masses. For borderline or malignant ovarian cancer vs benign ovarian lesions, the pooled likelihood ratio for the occurrence of a positive magnetic resonance result was 6.6 (95% confidence interval, 4.7-9.2) and the posttest probability for borderline or malignant diagnosis was 77% (95% confidence interval, 70-82). Because specificity and likelihood ratio positive were heterogeneous, a random effect model was used and a summary receiver operating characteristic curve was generated. For borderline or malignant ovarian cancer vs benign ovarian lesions, the area under curve was 0.9526. CONCLUSION: Magnetic resonance seems to be a useful preoperative test for predicting the diagnosis of pelvic masses.

Adeno-associated virus and human papillomavirus types in cervical samples of pregnant and non-pregnant women.

OBJECTIVE: To investigate the prevalence of AAV and HPV DNA and their types in cervical secretion from pregnant and non-pregnant women. STUDY DESIGN: The samples were obtained from 40 pregnant and 62 non-pregnant women who were attended at the outpatient clinic of the Federal University Hospital of Espírito Santo, Southeastern Brazil. AAV and HPV were investigated by PCR and typed by PCR and/or RFLP. RESULTS: The occurrence of AAV in all samples was 25.5% (26/102): 81% (21/26) and 19% (5/26) for AAV2/3 and AAV5 species, respectively. AAV were observed in 35% (14/40) and 19% (12/62) of pregnant and non-pregnant women, respectively. HPV occurred in 22% of all samples; 25% (10/40) in pregnant and 20% (12/60) in non-pregnant women. HPV types were determined for 72.7% of the strains, most of which classified as high-risk. AAV-HPV co-infection was observed in 15.4% (4/26), mostly in pregnant women. CONCLUSIONS: There was a greater prevalence of AAV and HPV in pregnant than in non-pregnant women, which suggests that the gestational state may play a role in reactivating the viruses.