PDF herunterladen
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
Cibele Feroldi Maffini 
1   Department of Obstetrics and Gynecology, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Luiz Martins Collaço 
2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Ana Paula Martins Sebastião 
2   Department of Pathology of Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
,
Rita Maira Zanine 
3   Department of Gynecology and Obstetrics, Lower Genital Tract Disease and Colposcopy Sector, Clinics Hospital of the University of Paraná, Curitiba, PR, Brazil
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

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.

Keywords

colposcopy - cervical intraepithelial neoplasia - cervical cancer - ASC-H - cervix uteri

Palavras-chave

colposcopia - neoplasia intraepithelial cervical - câncer de colo uterino - células escamosas atípicas do colo do útero - colo do útero

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.




Publikationsverlauf

Eingereicht: 07. Januar 2021

Angenommen: 13. Oktober 2021

Artikel online veröffentlicht:
25. Februar 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Solomon D, Davey D, Kurman R. et al; Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002; 287 (16) 2114-2119 DOI: 10.1001/jama.287.16.2114.
    CrossrefPubMedGoogle Scholar
  • 2 Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes brasileiras para o rastreamento do câncer de colo do útero. Rio de Janeiro: INCA; 2011. [cited 2017 Apr 27]. Available from: http://www1.inca.gov.br/inca/Arquivos/Diretrizes_rastreamento_cancer_colo_utero.pdf
    Google Scholar
  • 3 Massad LS, Einstein MH, Huh WK. et al; 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17 (5, Suppl 1) S1-S27 DOI: 10.1097/LGT.0b013e318287d329.
    CrossrefPubMedGoogle Scholar
  • 4 Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 92 (4 Pt 2): 727-735 DOI: 10.1016/s0029-7844(98)00245-2.
    CrossrefPubMedGoogle Scholar
  • 5 Wheeler CM. Natural history of human papillomavirus infections, cytologic and histologic abnormalities, and cancer. Obstet Gynecol Clin North Am 2008; 35 (04) 519-536, vii DOI: 10.1016/j.ogc.2008.09.006.
    CrossrefPubMedGoogle Scholar
  • 6 Bekkers RL, van de Nieuwenhof HP, Neesham DE, Hendriks JH, Tan J, Quinn MA. Does experience in colposcopy improve identification of high grade abnormalities?. Eur J Obstet Gynecol Reprod Biol 2008; 141 (01) 75-78 DOI: 10.1016/j.ejogrb.2008.07.007.
    CrossrefPubMedGoogle Scholar
  • 7 Stoler MH, Vichnin MD, Ferenczy A. et al; FUTURE I, II and III Investigators. The accuracy of colposcopic biopsy: analyses from the placebo arm of the Gardasil clinical trials. Int J Cancer 2011; 128 (06) 1354-1362 DOI: 10.1002/ijc.25470.
    CrossrefPubMedGoogle Scholar
  • 8 Pretorius RG, Zhang WH, Belinson JL. et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol 2004; 191 (02) 430-434 DOI: 10.1016/j.ajog.2004.02.065.
    CrossrefPubMedGoogle Scholar
  • 9 Spinillo A, Gardella B, Chiesa A, Cesari S, Alberizzi P, Silini EM. Diagnostic accuracy of colposcopy in relation to human papillomavirus genotypes and multiple infection. Gynecol Oncol 2014; 134 (03) 527-533 DOI: 10.1016/j.ygyno.2014.07.006.
    CrossrefPubMedGoogle Scholar
  • 10 Mitchell MF, Schottenfeld D, Tortolero-Luna G, Cantor SB, Richards-Kortum R. Colposcopy for the diagnosis of squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 1998; 91 (04) 626-631 DOI: 10.1016/s0029-7844(98)00006-4.
    CrossrefPubMedGoogle Scholar
  • 11 Bornstein J, Bentley J, Bosze P. et al. Nomenclatura Colposcópica da Federação Internacional de Patologia Cervical e Colposcopia [Internet]. 2011 [cited 2017 Apr 27]. Available from: http://www.ifcpc.org/images/docs/nomenportug.pdf
    PubMedGoogle Scholar
  • 12 Ministério da Saúde. Secretaria de Atenção à Saúde. Instituto Nacional de Câncer. Coordenação de Prevenção e Vigilância. Nomenclatura brasileira para laudos cervicais e condutas preconizadas: recomendações para profissionais de saúde [Internet]. 2a ed.. Rio de Janeiro: INCA; 2006. [cited 2017 Apr 27]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/Nomenclaturas_2_1705.pdf
    Google Scholar
  • 13 Confortini M, Di Stefano C, Biggeri A. et al. Daily peer review of abnormal cervical smears in the assessment of individual practice as an additional method of internal quality control. Cytopathology 2016; 27 (01) 35-42 DOI: 10.1111/cyt.12195.
    CrossrefPubMedGoogle Scholar
  • 14 Simsir A, Ioffe O, Sun P, Elgert P, Cangiarella J, Levine PH. Effect of Bethesda 2001 on reporting of atypical squamous cells (ASC) with special emphasis on atypical squamous cells-cannot rule out high grade (ASC-H). Diagn Cytopathol 2006; 34 (01) 62-66 DOI: 10.1002/dc.20334.
    CrossrefPubMedGoogle Scholar
  • 15 Sherman ME, Castle PE, Solomon D. Cervical cytology of atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): characteristics and histologic outcomes. Cancer 2006; 108 (05) 298-305 DOI: 10.1002/cncr.21844.
    CrossrefPubMedGoogle Scholar
  • 16 Xu L, Verdoodt F, Wentzensen N, Bergeron C, Arbyn M. Triage of ASC-H: A meta-analysis of the accuracy of high-risk HPV testing and other markers to detect cervical precancer. Cancer Cytopathol 2016; 124 (04) 261-272 DOI: 10.1002/cncy.21661.
    CrossrefPubMedGoogle Scholar
  • 17 Louro AP, Roberson J, Eltoum I, Chhieng DC. Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion. A follow-up study of conventional and liquid-based preparations in a high-risk population. Am J Clin Pathol 2003; 120 (03) 392-397 DOI: 10.1309/NPU3-WRQC-TAB8-1XLW.
    CrossrefPubMedGoogle Scholar
  • 18 Barreth D, Schepansky A, Capstick V, Johnson G, Steed H, Faught W. Atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion (ASC-H): a result not to be ignored. J Obstet Gynaecol Can 2006; 28 (12) 1095-1098 DOI: 10.1016/S1701-2163(16)32330-1.
    CrossrefPubMedGoogle Scholar
  • 19 Nogara PR, Manfroni LA, Consolaro ME. Cervical cytology of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H): histological results and recurrence after a loop electrosurgical excision procedure. Arch Gynecol Obstet 2011; 284 (04) 965-971 DOI: 10.1007/s00404-010-1731-7.
    CrossrefPubMedGoogle Scholar
  • 20 Kietpeerakool C, Cheewakriangkrai C, Suprasert P, Srisomboon J. Feasibility of the ‘see and treat’ approach in management of women with ‘atypical squamous cell, cannot exclude high-grade squamous intraepithelial lesion’ smears. J Obstet Gynaecol Res 2009; 35 (03) 507-513 DOI: 10.1111/j.1447-0756.2008.00992.x.
    CrossrefPubMedGoogle Scholar
  • 21 Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006; 367 (9509): 489-498 DOI: 10.1016/S0140-6736(06)68181-6.
    CrossrefPubMedGoogle Scholar
  • 22 Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med 2012; 9 (11) e1001336 DOI: 10.1371/journal.pmed.1001336.
    CrossrefPubMedGoogle Scholar
  • 23 Brasil UNAIDS. Estatísticas [Internet]. 2015 [cited 2017 Jan 1]. Available from: http://unaids.org.br/estatisticas/
    PubMedGoogle Scholar
  • 24 Bonvicino A, Huitron S, Fadare O. Papanicolaou test interpretations of “atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion” : an investigation of requisite duration and number of colposcopic procedures to a definitive diagnosis of high-grade dysplasia in routine practice. Cancer 2007; 111 (06) 477-481 DOI: 10.1002/cncr.23121.
    CrossrefPubMedGoogle Scholar
  • 25 Patton AL, Duncan L, Bloom L, Phaneuf G, Zafar N. Atypical squamous cells, cannot exclude a high-grade intraepithelial lesion and its clinical significance in postmenopausal, pregnant, postpartum, and contraceptive-use patients. Cancer 2008; 114 (06) 481-488 DOI: 10.1002/cncr.23949.
    CrossrefPubMedGoogle Scholar
  • 26 Evans HS, Newnham A, Hodgson SV, Møller H. Second primary cancers after cervical intraepithelial neoplasia III and invasive cervical cancer in Southeast England. Gynecol Oncol 2003; 90 (01) 131-136 DOI: 10.1016/s0090-8258(03)00231-2.
    CrossrefPubMedGoogle Scholar
  • 27 Vinokurova S, Wentzensen N, Einenkel J. et al. Clonal history of papillomavirus-induced dysplasia in the female lower genital tract. J Natl Cancer Inst 2005; 97 (24) 1816-1821 DOI: 10.1093/jnci/dji428.
    CrossrefPubMedGoogle Scholar
  • 28 Underwood M, Arbyn M, Parry-Smith W. et al. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 2012; 119 (11) 1293-1301 DOI: 10.1111/j.1471-0528.2012.03444.x.
    CrossrefPubMedGoogle Scholar
  • 29 Olaniyan OB. Validity of colposcopy in the diagnosis of early cervical neoplasia–a review. Afr J Reprod Health 2002; 6 (03) 59-69
    CrossrefPubMedGoogle Scholar
  • 30 Shaw E, Sellors J, Kaczorowski J. Prospective evaluation of colposcopic features in predicting cervical intraepithelial neoplasia: degree of acetowhite change most important. J Low Genit Tract Dis 2003; 7 (01) 6-10 DOI: 10.1097/00128360-200301000-00003.
    CrossrefPubMedGoogle Scholar