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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(04): 385-390
DOI: 10.1055/s-0042-1743102
Original Article
Lower Genital Tract Diseases

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal

Neoplasia intraepitelial cervical: Analisando a doença presente exclusivamente no canal endocervical
Fernanda Villar Fonseca 
1   Department of Gynecology and Obstetrics, Universidade Positivo, Curitiba, PR, Brazil
,
Maria Victória Gutierrez Cordeiro 
1   Department of Gynecology and Obstetrics, Universidade Positivo, Curitiba, PR, Brazil
,
Ariadne Cristine Pozza 
1   Department of Gynecology and Obstetrics, Universidade Positivo, Curitiba, PR, Brazil
,
Carlos Afonso Maestri 
1   Department of Gynecology and Obstetrics, Universidade Positivo, Curitiba, PR, Brazil
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Abstract

Objective To evaluate the role of cervical cytology (Pap smear) in the diagnosis of cervical intraepithelial neoplasia 2 or greater (CIN2 + ), presented exclusively in the endocervical canal, the clinical-epidemiological characteristics of this lesion, the necessary length of canal to be removed to treat, and the rate of invasive lesion hidden in the endocervical canal.

Methods Cross-sectional study, by database analysis, of patients with abnormal cytology (high-grade squamous intraepithelial lesion [HSIL]), without visible colposcopy lesion, submitted to loop electrosurgical procedure (LEEP) to evaluate the association of cytology results with the histological product of the conization, to identify the epidemiological characteristics of endocervical lesion and clinical evolution, using a p-value < 0.05 and 95% CI.

Results In 444 cases, the Pap smear sensitivity for CIN2+ diagnosis was 75% (95% CI: 69.8–79.7), specificity was 40% (95% CI: 30.2–49.5), and the prevalence rate of histological lesion was 73% (95% CI: 70.1–78.7). There was a higher prevalence of CIN2+ in women over 42 years old and invasive cancer in those over 56 years old (p < 0.001), and it was necessary to remove 2.6 cm in length of the canal to reduce the chance of recurrence (p < 0.006). The rate of invasive cancer was 2.7%.

Conclusion Cytology was related to a high prevalence to histological lesion (73%) in the diagnosis of CIN2+ in the endocervical disease; older patients presented a higher relationship with histological lesions in the canal disease, and it was necessary to remove an average of 2.6 cm in length of the endocervical canal to avoid the persistence and progression of CIN. The rate of occult neoplasia in the endocervical canal was 2.7%.

Resumo

Objetivo Avaliar o papel da citologia oncótica (CO) no diagnóstico da neoplasia intraepitelial cervical 2 ou maior (NIC2 + ) presente exclusivamente no canal endocervical, as características clínico-epidemiológicas deste tipo de lesão, o comprimento necessário de canal a ser retirado na conização, e a taxa de lesão invasora oculta no canal endocervical.

Métodos Estudo transversal, por análise de base de dados, de pacientes com citologia alterada, sem lesão colposcópica visível, submetidas a conização por cirurgia de alta frequência (CAF), para avaliar a associação dos resultados citológicos com o produto histológico da conização, as características epidemiológicas da lesão endocervical, e evolução clínica, utilizando o valor de p < 0.05 e intervalo de confiança (IC) de 95%.

Resultados Nos 444 casos analisados, a sensibilidade da CO para o diagnóstico de NIC 2+ foi de 75% (IC 95%: 69.8–79.7), a especificidade foi de 40% (IC 95%: 30.2–49.5), e a taxa de prevalência de lesão histológica foi de 73% (IC 95%: 70.1–78.7). Houve maior prevalência de NIC2+ em pacientes com mais de 42 anos de idade e de neoplasia invasora naquelas com mais de 56 anos (p < 0.001), e foi necessário a retirada de 2.6 cm de comprimento de canal para diminuir a taxa de recidiva (p < 0.006). Foi identificada uma taxa de 2.7% de neoplasia invasora.

Conclusão A citologia esteve relacionada a uma alta prevalência de lesão (73%) no diagnóstico das NIC2+ na doença endocervical; quanto maior a idade, maior foi a relação da histologia com a citologia de canal, e se fez necessário retirar uma média de 2.6 cm de comprimento de canal para evitar a persistência e a progressão da NIC. A taxa de neoplasia oculta no canal endocervical foi 2.7%.

Keywords

CIN - oncotic cytology - cervical intraepithelial neoplasia

Palavras-chave

NIC - citologia oncótica - neoplasia intraepiteliais cervicais

Contributors

All authors collaborated with data collection and analysis as well as with the writing and conclusions of this research.




Publication History

Received: 27 July 2021

Accepted: 17 December 2021

Article published online:
11 March 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/)

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