Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil

Luiz Carlos Zeferino; Joana Bragança Bastos; Diama Bhadra Andrade Peixoto do Vale; Rita Maria Zanine; Yara Lucia Mendes Furtado de Melo; Walquíria Quida Salles Pereira Primo; Flávia de Miranda Corrêa; Isabel Cristina Chulvis do Val; Fábio Russomano

doi:10.1055/s-0038-1657754

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, Table of Contents

CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(06): 360-368
DOI: 10.1055/s-0038-1657754

Review Article

Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Guidelines for HPV-DNA Testing for Cervical Cancer Screening in Brazil

Recomendações para o uso de testes de DNA-HPV no rastreamento do câncer do colo útero no Brasil

Luiz Carlos Zeferino

¹Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil

,

Joana Bragança Bastos

¹Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil

,

Diama Bhadra Andrade Peixoto do Vale

¹Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil

,

Rita Maria Zanine

²Universidade Federal do Paraná, Curitiba, Paraná, Brazil

,

Yara Lucia Mendes Furtado de Melo

³Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

,

Walquíria Quida Salles Pereira Primo

⁴Universidade de Brasília, Brasília, Distrito Federal, Brazil

,

Flávia de Miranda Corrêa

⁵Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil

,

Isabel Cristina Chulvis do Val

⁶Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil

,

Fábio Russomano

⁷Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, da Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil

› Author Affiliations

Abstract

Evidence-based clinical guidelines ensure best practice protocols are available in health care. There is a widespread use of human papillomavirus deoxyribonucleic acid (HPV-DNA) tests in Brazil, regardless of the lack of official guidelines. On behalf of the Brazilian Association for the Lower Genital Tract Pathology and Colposcopy (ABPTGIC, in the Portuguese acronym), a team of reviewers searched for published evidence and developed a set of recommendations for the use of HPV-DNA tests in cervical cancer screening in Brazil. The product of this process was debated and consensus was sought by the participants. One concern of the authors was the inclusion of these tests in the assessment of women with cytologic atypia and women treated for cervical intraepithelial neoplasia (CIN). Testing for HPV is recommended in an organized screening scenario to identify women with precursor lesions or asymptomatic cervical cancer older than 30 years of age, and it can be performed every 5 years. It also has value after the cytology showing atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSILs) as a triage test for colposcopy, in the investigation of other cytological alterations when no abnormal findings are observed at colposcopy, seeking to exclude disease, or, further, after treatment of high-grade cervical intraepithelial neoplasia, to rule out residual disease.

Resumo

O uso de diretrizes clínicas baseadas em evidências visa assegurar as melhores práticas na área de cuidado à saúde. O uso de testes de ácido desoxirribonucleico de papilomavírus humano (DNA-HPV) vem crescendo e se disseminando sem que existam recomendações de uso no cenário brasileiro. Em nome da Associação Brasileira de Patologia do Trato Genital Inferior e Colposcopia (ABPTGIC), grupos de revisores pesquisaram evidências e formularam recomendações para o uso dos testes de DNA-HPV no rastreamento do câncer do colo do útero, no seguimento de mulheres com atipias citológicas, e após tratamento de neoplasia intraepitelial cervical (NIC). O produto desse processo foi debatido e foi buscado consenso entre participantes. Os testes de DNA-HPV são recomendados num cenário de rastreamento organizado para identificação de mulheres portadoras de lesões precursoras ou câncer assintomático com mais de 30 anos e podem ser realizados a cada 5 anos. Também têm valor após a citologia mostrando células escamosas atípicas de significado indeterminado (ASC-US) ou lesão intraepitelial escamosa de baixo grau (LSIL) como teste de triagem para colposcopia, na investigação de outras alterações citológicas quando não são observados achados anormais à colposcopia, buscando excluir doença, ou, ainda, no seguimento após tratamento das neoplasias intraepiteliais de alto grau, para exclusão de doença residual.

Keywords

screening - cervical neoplasms - DNA-HPV probes - cervical intraepithelial neoplasia - cytology

Palavras-chave

rastreamento - neoplasias do colo do útero - sondas de DNA de HPV - neoplasia intraepitelial cervical - citologia

Full Text

References

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