Description of Referrals for Colposcopy in a Hospital in Brazil.

Andréa Paula Peneluppi De Medeiros,Stephanie Hein De Carvalho,André Luis Ferreira Santos,Dayana Aparecida Nacimento Rosa

doi:10.1055/s-0040-1708886

Andréa Paula Peneluppi De Medeiros, Stephanie Hein De Carvalho + Show 2 more

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https://doi.org/10.1055/s-0040-1708886

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Abstract

To describe the referral for colposcopy in a Hospital in Brazil and the relative frequency of patients who benefited from it, considering the correct indications for the examination and its final diagnoses. A retrospective study was performed in the colposcopy service database of the Hospital Universitário de Taubaté, Taubaté, state of São Paulo, Brazil. The frequency validated in the analysis of the medical records of women referred for clinical indication or cytological alteration, attended from March 2015 to March 2017. The population selected and analyzed included 256 results that were correlated to the cytological, clinical data and the result of the colposcopy. Of the women referred, 45% presented out of the age of screening according to the guidelines of cervical cancer screening, 8.6% being adolescents and young adults < 25 years old, and 36.4% of the patients being ≥ 65 years old. A total of 50% of the patients had no indication of colposcopy, that is, normal cytologies, benign changes, ectopia, cervicitis, atypical squamous cells of indeterminate significance (ASC-US) and low-grade intraepithelial lesion (LSIL) without persistence and normal clinical appearance. A total of 39.84% who underwent colposcopy had high-grade lesion or cancer results, thus benefiting from the adequate referral. Most (60.16%) of the patients referred to the colposcopy service did not benefit from the referral for results without changes, such as negative colposcopies, histologies with no cervical intraepithelial neoplasm (CIN) or only CIN 1, or were out of the age for screening. These findings therefore demonstrate a significant number of unnecessary and inadequate referrals.

Highlights

Recognition of preinvasive phases of cervical cancer is fundamental and effective, as it allows reducing the incidence and mortality.1–5 Cervical intraepithelial neoplasms (CINs) are considered precursor lesions of squamous cancer of the uterine cervix
In view of the epidemiological situation of cervical cancer in Brazil and the difficulties of vacancies in the referral services of colposcopy, the present study aimed to describe the frequency of women being adequately forwarded to the referral service and who benefited from it, according to the correct indications for colposcopic examination and the final histological diagnoses of high grade intraepithelial lesion (HSIL) and cancer
There was a divergence in the cytological result of atypical squamous cells of indeterminate significance (ASC-US), in which 20.8% of the cases corresponded to high-grade precursor lesions, in addition to two cases of invasive adenocarcinoma. This result is significant given that in the guidelines of the Ministry of Health (MH)2 the cytological diagnosis of ASC-US corresponds to the absence of lesions in the vast majority of cases, not being a formal indication for colposcopy, diverging from our findings, and may infer quality problems in the cytological examination in our region

Summary

Introduction

Recognition of preinvasive phases of cervical cancer is fundamental and effective, as it allows reducing the incidence and mortality. Cervical intraepithelial neoplasms (CINs) are considered precursor lesions of squamous cancer of the uterine cervix. Cervical intraepithelial neoplasms (CINs) are considered precursor lesions of squamous cancer of the uterine cervix. They are divided into grades 1, 2 and 3, both by the morphological aspect of the epithelium compromise and by its variable evolutionary potential.. The oncologic cytology (OC), known as Pap smear test, when performed within the quality standards, presents a coverage of 80% for invasive cancer and, if the initial lesions are treated, the reduction in the rate of invasive cervical cancer can reach 90%.8–10. Colposcopy is rightly indicated when there is alteration in the screening cytology. Recent papers show that when you associate cytology results with colposcopy, the sensitivity increased to 98%. The main role of it is to determine the site of the biopsy that provides the histological diagnosis, which is the gold standard and the basis of the treatment.

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