Abstract
ABSTRACT Introduction: Cervicovaginal atrophy is a condition that can affect women after menopause, and cytology is a diagnostic tool useful in such cases. Objective: To evaluate the cytomorphological profile of cervical smears in patients over 60 years old. Methods: Cytopathological examinations of 500 patients over 60 years old were selected consecutively in this cross-sectional, quantitative, retrospective study. Results: Only 114 (22.8%) presented the squamocolumnar junction (SCJ) sampled, and their presence decreased progressively with advancing age (p < 0.001). Most smears (95.6%) were classified as atrophic. Microbiological analysis showed that from the 22 non-atrophic smears, most presented lactobacillus flora. Among the atrophic swabs, the predominant flora was cocci, with 47.2%. Only 4% presented cytological changes: atypical squamous cells of undetermined significance [(ASC-US) - eight cases/40%], atypical squamous cells - cannot exclude high-grade squamous intraepithelial lesion [(ASC-H) - five cases/25%], high-grade squamous intraepithelial lesion [(HSIL) - three/15%], low-grade squamous intraepithelial lesion [(LSIL) - two cases/10%] and adenocarcinoma in situ [(ACI) - two cases/10%]. Among the modified smears, four (20%) presented SCJ cells, and four patients (20%) took hormones (from these, two cases of ASC-H (10%) and two cases ASC-US (10%), showing a relationship between the onset of the lesion and the use of hormones (p < 0.05). Conclusion: The absence of SCJ indicates a diagnostic limitation of sample collection. Although the frequency of lesions has been similar to other studies, and the recommended age range for the examination is between 25 and 60 years, it is important to note that many women older than this range should perform the collection of oncology cytology due to existence of elderly women with risk profile for the disease.
Highlights
Cervicovaginal atrophy is a condition that can affect women after menopause, and cytology is a diagnostic tool useful in such cases
Estrogens stimulate the proliferation of vaginal epithelial cells, which produce high levels of glycogen, which is metabolized by lactobacilli, resulting in an increase in lactic acid and other organic acids that maintain vaginal pH between 4.0 to 4.5(8, 10, 14, 15)
Urogenital atrophy is accompanied by a decline in estrogen levels, leading to depletion of lactobacilli and increased colonization by pathogenic microorganisms and urinary tract infections[11]
Summary
Cervicovaginal atrophy is a condition that can affect women after menopause, and cytology is a diagnostic tool useful in such cases. Four (20%) presented SCJ cells, and four patients (20%) took hormones (from these, two cases of ASC-H (10%) and two cases ASC-US (10%), showing a relationship between the onset of the lesion and the use of hormones (p < 0.05). The frequency of lesions has been similar to other studies, and the recommended age range for the examination is between 25 and 60 years, it is important to note that many women older than this range should perform the collection of oncology cytology due to existence of elderly women with risk profile for the disease. The evaluation of cervical cytopathology is an important diagnostic tool for preventing cervical cancer, since this test may detect preneoplastic lesions prior to the onset on carcinoma[2, 6]
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