CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(02): 178-186
DOI: 10.1055/s-0042-1742289
Original Article
Lower Genital Tract Diseases

Colposcopic Findings and Diagnosis in Low-Income Brazilian Women with ASC-H pap Smear Results

Achados colposcópicos e diagnóstico em mulheres brasileiras de baixa renda com resultado de exame citopatológico ASC-H
1   Department of Obstetrics and Gynecology, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
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2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
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2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
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3   Department of Gynecology and Obstetrics, Lower Genital Tract Disease and Colposcopy Sector, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
› Author Affiliations

Abstract

Objective To determine the accuracy of colposcopy findings in diagnosing cervical intraepithelial neoplasia (CIN) in women with an atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) pap smear result and analyze whether the prevalence of HSIL and cancer correlates with sociodemographic risk factors and specific colposcopic findings.

Methods Colposcopic findings and sociodemographic risk factors were analyzed as possible predictors of a CIN 2 or worse diagnosis in women with an ASC-H pap smear result.

Results Accuracy of the colposcopic impression was 92%, sensitivity was 91.6%, and specificity was 93.1%, with a positive predictive value of 96.4% and negative predictive value of 84.3%. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. Identification of major colposcopic findings, dense acetowhite epithelium, coarse mosaicism, and punctuation correlated significantly with CIN 2 or worse.

Conclusion Colposcopy performed by an experienced examiner can accurately differentiate patients with CIN 1 or less from patients with CIN 2 or worse. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. The degree of acetowhite changes was the best colposcopic feature to predict CIN2 or worse.

Resumo

Objetivo: Determinar a acurácia dos achados colposcópicos no diagnóstico das neoplasias intraepiteliais cervicais (NIC) em mulheres com resultado de exame citopatológico de células escamosas atípicas de significado indeterminado não podendo excluir lesão intraepitelial de alto grau (ASC-H) e analisar a correlação entre a prevalência de HSIL ou câncer com fatores de risco sociodemográficos e achados colposcópicos específicos.

Métodos: Os achados colposcópicos, e os fatores de risco sociodemográficos foram analisados como possíveis preditores de diagnóstico NIC 2 ou mais grave em mulheres com resultado de exame citopatológico ASC-H.

Resultados: A acurácia da impressão colposcópica foi de 92%, sensibilidade foi 91,6%, e a especificidade foi de 93,1%, com um valor preditivo de 96,4% e valor preditivo negativo de 84,3%. O diagnóstico de NIC 2 ou mais grave foi mais frequente em pacientes com história pregressa de displasia cervical e nas que não estavam na pós menopausa. A identificação de achados colposcópicos maiores, epitélio acetobranco denso, mosaico e pontilhados grosseiros se correlacionaram positivamente com o diagnóstico NIC 2 ou mais grave.

Conclusão: A colposcopia realizada por um examinador experiente pode diferenciar com acurácia pacientes com NIC 1 ou menos grave de pacientes com NIC 2 ou mais grave. O diagnóstico de NIC 2 ou mais grave foi mais frequente em pacientes com história pregressa de displasia cervical e pacientes que estavam na pré menopausa. A densidade da acetorreação foi o melhor preditor colposcópico para NIC 2 ou mais grave.

Contributions

C. F. MAFFINI: Data collection from medical records, data analysis and manuscript writing. L. M. COLLAÇO: Cytological panel review execution. A. P. M. SEBASTIÃO: Cytological panel review execution. R. M. ZANINE: Colposcopic impression findings, conceived and planned the study design and supervised the project execution.




Publication History

Received: 07 January 2021

Accepted: 13 October 2021

Article published online:
25 February 2022

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