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      Prevalência de lesões intraepiteliais em atipias de significado indeterminado em um serviço público de referência para neoplasias cervicais Translated title: Prevalence of atypical squamous cell intraepithelial lesions of undetermined significance in a public health referral service for cervical cancer Translated title: Prevalencia de lesiones intraepiteliales en atipias de significado indeterminado en un servicio público de referencia para neoplasias cervicales

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          Abstract

          OBJETIVOS: Determinar a prevalência de lesões intraepiteliais de baixo e alto grau, em mulheres com diagnóstico colpocitológico de atipias de significado indeterminado no Município de Maceió, Alagoas. Conhecer a influência da idade e dos agentes etiológicos para doenças sexualmente transmissíveis sobre o risco de desenvolvimento das lesões intraepiteliais de baixo e alto grau. MÉTODOS: Estudo transversal de prevalência em um serviço público de referência para neoplasias cervicais. Foram estudados 253 prontuários de mulheres com diagnóstico de atipias de significado indeterminado, no ano de 2007. RESULTADOS: A prevalência de lesões intraepiteliais foi a de 23,7%, sendo 26,7% de baixo grau e 73,3% de alto grau. CONCLUSÕES: A prevalência de lesões intraepiteliais de alto grau em mulheres com diagnóstico colpocitológico de atipias de significado indeterminado (ASCUS) foi de 23,7%, o aumento do risco foi diretamente proporcional ao da idade e houve maior prevalência de lesão intraepitelial de baixo grau,associada à infecção pelo Papilomavirus humano.

          Translated abstract

          OBJECTIVE: To determine the prevalence of low and high grade intraepithelial lesions in women with Pap smear diagnosis of atypical squamous cells of undetermined significance, in the city of Maceió, Alagoas. Knowing the influence of age and the etiological agents for sexually transmitted diseases on the risk of developing low and high grade intraepithelial lesions. METHODS: Cross sectional prevalence study at a public referral center for cervical cancer. We studied records of 253 women with atypical diagnoses of undetermined significance, in 2007. RESULTS: The prevalence of intraepithelial lesions was 23.7%; 26.7% were low grade and 73.3% high grade. CONCLUSIONS: The prevalence of high-grade intraepithelial lesions in women with Pap smear diagnosis of atypical squamous cells of undetermined significance (ASCUS) was 23.7%; the increase in risk was directly proportional to the age and higher prevalence of low grade squamous intraepithelial lesion associated with papillomavirus infection.

          Translated abstract

          OBJETIVOS: Determinar la prevalencia de lesiones intraepiteliales de bajo y alto grado, en mujeres con diagnóstico colpocitológico de atipias de significado indeterminado en el Municipio de Maceió, Alagoas. Conocer la influencia de la edad y de los agentes etiológicos para enfermedades sexualmente transmisibles sobre el riesgo de desarrollo de las lesiones intraepiteliales de bajo y alto grado. MÉTODOS: Se trata de un estudio transversal de prevalencia realizado en un servicio público de referencia para neoplasias cervicales. Fueron estudiadas 253 historias clínicas de mujeres con diagnóstico de atipias de significado indeterminado, en el año 2007. RESULTADOS: La prevalencia de lesiones intraepiteliales fue del 23,7%, siendo 26,7% de bajo grado y 73,3% de alto grado. CONCLUSIONES: La prevalencia de lesiones intraepiteliales de alto grado en mujeres con diagnóstico colpocitológico de atipias de significado indeterminado (ASCUS) fue del 23,7%, el aumento del riesgo fue directamente proporcional al de la edad y hubo mayor prevalencia de lesión intraepitelial de bajo grado, asociada a la infección por el Papilomavirus humano.

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          Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance.

          (2003)
          This study was undertaken to compare alternative strategies for the initial management of a cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS). A total of 3488 women with a community-based ASCUS interpretation were randomly assigned to immediate colposcopy, triage that was based on enrollment HPV DNA testing and liquid-based cytology at a colposcopy referral threshold of high-grade squamous intraepithelial lesion (HSIL), or conservative management based on repeat cytology at a referral threshold of HSIL. All arms included 2 years of semiannual follow-up and colposcopy at exit. Loop electrosurgical excision procedure was offered to women with histologic diagnoses of cervical intraepithelial neoplasia (CIN) grade 2 or 3 at any visit or persistent CIN grade 1 at exit. The study end point was 2-year cumulative diagnosis of CIN grade 3. The 2-year cumulative diagnosis of CIN grade 3 was 8% to 9% in all study arms. The immediate colposcopy strategy yielded 53.6% sensitivity for cumulative cases of CIN grade 3 diagnosed over 2 years. The human papillomavirus (HPV) triage strategy referred 55.6% of women and detected 72.3% of cumulative cases of CIN grade 3. A conservative management strategy of repeat cytology at the HSIL threshold referred 12.3% of women while detecting 54.6% of cumulative CIN grade 3. To compare triage tests, we re-estimated the performance of HPV and cytology in successfully referring women with underlying CIN grade 3 (ie, ignoring the insensitivity we discovered in colposcopically directed biopsies). A single enrollment HPV test identified 92.4% of the women diagnosed with CIN grade 3. Serial cytology, even at an ASCUS threshold, would have required two visits to achieve similar sensitivity (95.4%) and would have referred 67.1% to colposcopy. HPV triage is at least as sensitive as immediate colposcopy for detecting CIN grade 3 and refers about half as many women to colposcopy. Follow-up that used repeat cytology is sensitive at an ASCUS referral threshold but requires two follow-up visits and ultimately more colposcopic examinations than HPV triage.
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            Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: a study of 7932 women

            High-risk human papillomaviruses (HR-HPV) are the necessary cause of cervical carcinomas. To determine whether HPR-HPV DNA detection in primary routine screening could represent a sensitive and reliable technique for the detection of high-grade squamous intraepithelial lesions (HGSIL), laboratory analysis using 2 cytologic techniques (conventional and liquid-based), HPV testing with Hybrid Capture II assay (HC-II), followed by colposcopic examination of women with abnormal cervical finding and/or persistent HR-HPV infection, was conducted in 7932 women who had routine cervical examination. The sensitivity of HPV testing for detecting a histologically proven HGSIL was 100%, higher than that of conventional (68.1%) and liquid-based (87.8%) cytology. The low specificities of 85.6% and 87.3% of HPV testing slightly increased to 88.4% and 90.1% if HPV testing was reserved for woman >30 years old. The quantitative approach provided by the HC-II assay for the assessment of the viral load was not reliable for predicting HGSIL in normal smears. HR-HPV testing could be proposed in primary screening in association with cytology. With conventional cytology it significantly improves the detection of HGSIL. With the use of the same cervical scrape for HPV testing and liquid-based cytology, HR-HPV testing would allow to select positive samples treated in a second time for cytology which gives a good specificity. © 2001 Cancer Research Campaign http://www.bjcancer.com
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              2006 consensus guidelines for the management of women with abnormal cervical screening tests.

              To provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening test results. A group of 146 experts, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, met in Bethesda, MD, September 18-19, 2006, to develop the guidelines. MAJOR CHANGES IN GUIDELINES: The core recommendations for managing women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions were changed minimally. Postcolposcopy management for women with these cytological abnormalities is now identical. Management recommendations for these conditions did change for "special populations," such as adolescents for whom a more conservative approach incorporating cytological follow-up for 2 years was approved. Core recommendations for managing women with high-grade squamous intraepithelial lesions and atypical glandular cells also underwent only minor modifications. More emphasis is placed on immediate "screen-and-treat" approaches when managing women with high-grade squamous intraepithelial lesion. Testing for high-risk human papillomavirus DNA is incorporated into the management of women with atypical glandular cells after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening in women 30 years and older was formally adopted with only very minor modifications. The 2006 Consensus Guidelines reflect recent data from large clinical trials and advances in technology and are designed to assist clinicians of all subspecialties.
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                Author and article information

                Journal
                ape
                Acta Paulista de Enfermagem
                Acta paul. enferm.
                Escola Paulista de Enfermagem, Universidade Federal de São Paulo (São Paulo, SP, Brazil )
                0103-2100
                1982-0194
                2011
                : 24
                : 3
                : 400-406
                Affiliations
                [02] São Paulo SP orgnameUniversidade Federal de São Paulo Brasil
                [01] Maceió AL orgnameFaculdade Integrada Tiradentes Brasil
                Article
                S0103-21002011000300015 S0103-2100(11)02400315
                6c94e918-4dbc-40b8-8953-cd63a2dc3ecd

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 23 February 2010
                : 01 March 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 7
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                SciELO Brazil

                Self URI: Texto completo somente em PDF (PT)
                Categories
                Artigos Originais

                Salud de la mujer,Prevalencia,Neoplasia intraepithelial del cuello uterino,Enfermería,Women's health,Prevalence,Cervical intraepithelial neoplasia,Nursing,Saúde da Mulher,Prevalência,Enfermagem,Neoplasia intraepitelial cervical

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