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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(03): 121-126
DOI: 10.1055/s-0038-1639466
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Management of Atypical Squamous Cell Cases: A Prospective Study of Women seen at a Private Health Service in Northeastern Brazil

Conduta em casos de células escamosas atípicas: um estudo prospectivo de mulheres atendidas pelo serviço de saúde privado no nordeste do Brasil
Geilson Gomes de Oliveira
1   Department of Pathology, Universidade Federal do Ceará, Fortaleza, Brazil
,
Judite Maria da Silva Costa de Oliveira
1   Department of Pathology, Universidade Federal do Ceará, Fortaleza, Brazil
,
Renata Mirian Nunes Eleutério
2   Department of Pharmacy, Universidade Federal do Ceará, Fortaleza, Brazil
,
José Eleutério Júnior
1   Department of Pathology, Universidade Federal do Ceará, Fortaleza, Brazil
3   Department of Motherhood and Child, Universidade Federal do Ceará, Fortaleza, Brazil
› Author Affiliations
Further Information

Publication History

10 November 2017

07 February 2018

Publication Date:
19 March 2018 (online)

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Abstract

Objective To assess the management chosen by gynecologists after atypical squamous cells (ASCs) cytology results, and to evaluate the outcomes of these cases in Brazilian women.

Methods A prospective observational study evaluated the initial management offered by the gynecologist in the case of 2,458 ASCs cytology results collected between January of 2010 and July of 2016. The outcomes of the cytology, high-risk human papilloma virus (HR-HPV) test and histology were compared in two subgroups: atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H).

Results In many cases of ASC-US (36.97%) and ASC-H (40.50%), no clinical actions were taken. Cytology was the most frequent follow-up chosen, including for cases of ASC-H, which goes against the conduct recommended in the national guideline. In women over 30 years of age, the period of time elapsed between an ASC-US result and a new cytology was in 13.03 months, in disagreement with the national guideline recommendations (p < 0.0001). Negative for intraepithelial lesions or malignancy (NILM) cytologic (p = 0.0026) and histologic (p = 0.0017) results in the follow-up were associated with prior ASC-US, while negative results for ASC-H were cytologically (p < 0.0001) and histologically associated with high-grade squamous intraepithelial lesion (HSIL) (p < 0.0001). Two invasive cervical carcinomas (ICCs) were found in the follow-up for ASC-H, and there was a statistically significant association (p = 0.0341). A positive HR-HPV test was associated with ASC-H (p = 0.0075).

Conclusion The data suggest that even for a population of Brazilian women assisted at private clinics, the national guidelines recommendations for ASCs results are not followed.

Resumo

Objetivo Avaliar a conduta adotada por ginecologistas após resultados citológicos apresentando células escamosas atípicas (ASCs) e os desfechos destes casos em mulheres brasileiras.

Métodos Um estudo observacional prospectivo avaliou o manejo clínico inicial do ginecologista nos casos de 2.458 resultados citológicos apresentando ASCs coletados entre janeiro de 2010 e julho de 2016. Os respectivos desfechos citológicos, histológicos e de detecção do papilomavírus humano (HPV) foram comparados entre os subgrupos células escamosas atípicas de significado indeterminado (ASC-US) e células escamosas atípicas não podendo excluir lesão intraepitelial de alto grau (ASC-H).

Resultados Nenhuma conduta foi adotada em 36,97% de citologias do tipo ASC-US e 40,5% do tipo ASC-H. A conduta mais escolhida foi a repetição da citologia, inclusive para acompanhamento de ASC-H, o que contraria as diretrizes nacionais. O tempo de realização de uma nova citologia para resultado do tipo ASC-US em mulheres com mais de 30 anos de idade foi de 13,03 meses, também em desacordo com as diretrizes (p < 0,0001). Resultados negativos para lesão intraepitelial ou neoplasia maligna (NILM), tanto citológicos (p = 0,0026) como histológicos (p = 0,0017), foram associados a ASC-US, enquanto que resultados negativos para lesões intraepiteliais escamosas de alto grau (HSILs), citológicos (p < 0,0001) e histológicos, foram associados a ASC-H (p < 0,0001). Dois carcinomas cervicais invasivos foram encontrados durante o acompanhamento para ASC-H e uma associação estatisticamente significante foi estabelecida (p = 0,0341). Um teste de HR-HPV positivo foi associado a ASC-H (p = 0,0075).

Conclusão Os dados sugerem que mesmo para uma população de mulheres brasileiras atendidas em clínicas privadas, as recomendações das diretrizes clínicas nacionais para resultados citológicos apresentando ASCs não são seguidas.

Keywords

uterine cervical neoplasm - disease management - atypical squamous cells of the cervix - papanicolaou test - human papillomavirus

Palavras-chave

neoplasia cervical uterina - manejo de doenças - células escamosas atípicas do colo do útero - teste de papanicolau - papilomavírus humano

Contributors

Oliveira G. G., Oliveira J. M. S. C., Eleutério R. M. N. and Eleutério Júnior J. contributed with project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.


 

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