Oncotic Cytology Research Articles

Social inequalities in the diagnosis of cervical cancer in Brazil: a hospital-based study

The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Pap Smear Cancer Coverage in Brazilian Capitals including the Pandemic Period Caused by the SARS-CoV-2 Virus: Ecological Study.

Cervical cancer develops slowly and may not manifest signs and symptoms at an early stage. It is worth mentioning the factors that can influence the onset of cervical cancer: smoking, early sexual life, multiple sexual partners, use of oral contraceptives, multiparity, low socioeconomic status, among others. An important risk factor for the onset of this disease is HPV infection, a virus associated with most cases of precursor lesions of this type of cancer. It is essential to understand the comprehensiveness of the scope and adherence to the recommended guidelines throughout the national territory. Therefore, health indicators are important management tools that make it possible to evaluate the services offered, measuring the reach of the target population, the supply and access to preventive exams. To analyze the trend of progress in cervical cancer coverage actions in Brazilian capitals from 2016 to 2021. This is an ecological study with temporal analysis that used secondary data referring to process indicators for cervical cancer control actions in women aged between 25 and 64 years living in Brazilian capitals between 2016 and 2021. Aspects related to the quality of care in the cervical cancer prevention program were evaluated using databases of the Cancer Information System (SISCAN), available in DATASUS. The indicators used to monitor and evaluate cervical cancer control actions were (i) cervical coverage, (ii) reason for cervical surgery, and (iii) proportion of cervical cancer every 3 years. In 2016, 410,000 tests were performed and notified in the SISCAN system in all Brazilian capitals, with emphasis on Curitiba, with 65,715 tests performed, and Porto Velho, with 174. In 2020, there was a reduction in exams compared to the previous year in all capitals, with the exception of Palmas, which went from 7655 exams to 9604. It was observed that all the capitals studied showed an increase in the annual percentage variation of Pap smear coverage, with the exception of Brasília, Manaus, Porto Alegre and Porto Velho, which did not show a statistically significant increase (APC = 3.01, 2.746, 3.987, 3.69, respectively). When analyzing the performance of oncotic cytology exams in the capitals according to the years 2019 and 2020, it was observed that only Manaus registered an increase in the number of procedures performed, reaching a difference of 56.5% from one year to the next. The ecological analysis revealed a worrying drop in the number of tests performed in 2020, reflecting a sharp drop in coverage actions in Brazilian capitals during the pandemic caused by the SARS-CoV-2 virus. The pandemic has exacerbated existing inequalities and highlighted the need for adaptive strategies to maintain essential screening services in times of crisis.

Neovaginoplasty With Nile Tilapia Skin: Cytological and Microbiota Evaluation.

To study the clinical, cytological, and vaginal microbiota findings in patients with Mayer-Rokitansky-Küster-Hauser syndrome who underwent neovaginoplasty using Nile tilapia fish skin. This is a cross-sectional study with 7 cisgender women with Mayer-Rokitansky-Küster-Hauser syndrome who had previously undergone neovagina reconstruction using Nile tilapia fish skin at a university hospital. Local institutional review board approval and written permission from the patient were obtained. Between August 2019 and November 2021, within 12 to 24 months after surgery, vaginal specimens were obtained for conventional oncotic and hormonal cytology, and for Gram staining. The Nugent scores were calculated. Colposcopy was also performed. Squamous cells without atypia were found in all patients. Five patients had intermediate vaginal microbiota (Nugent score of 4), which was determined by the presence of few lactobacilli on Gram staining. In hormonal cytology, 4 patients presented with findings compatible with menacme. No colposcopic change was observed. When postsurgical dilation was performed correctly, a mean vaginal length of 8.3 cm was maintained after 1 year of follow-up. Squamous cells without atypia were present in neovaginas with Nile tilapia fish skin. Most vaginal contents revealed intermediate microbiota and hormonal results compatible with menacme. Studies with a greater number of patients are necessary for a more comprehensive understanding of the microbiome in neovaginas with this new technique, thereby providing support for the treatment and prevention of associated pathologies.

The use of menstrual cups is associated with the maintenance of healthy vaginal microbiota: A prospective longitudinal study

Background: Menstrual cups are reusable flexible collectors adjustable to the body. Besides the economic and environmental advantages, it is possible that the use of menstrual cups influences modifications in the vaginal microbiota. We aimed to evaluate the influence of menstrual cups on the vaginal microbiota of reproductive-age women in comparison to sanitary pads and to determine its acceptance. Methods: A prospective longitudinal study was conducted with undergraduate/graduate volunteers, whose usual method of menstrual management was sanitary pads. In the first three menstrual cycles (M1 to M3), participants kept using sanitary pads. In the three consecutive cycles (M4 to M6), they used the menstrual cup offered by the research group. A questionnaire was used to obtain gynecological background and sexual behavior. In the first (M1) and third (M3) follow-up visits, participants underwent gynecological examinations including vaginal microbiota evaluation, oncotic cytology, diagnosis of Human Papillomavirus (HPV), Chlamydia trachomatis and Neisseria gonorrhoeae, and Trichomonas vaginalis. At each visit, vaginal samples were collected for analysis of microbiota. A generalized linear model with binomial distribution for repeated measures was used and the model was adjusted for confounding factors, using the SAS software. Results and Discussion: We included 47 participants who completed the 6 follow-up examinations. The prevalence of HPV was 48.9% at M1 and 51.1% at M3 and the prevalence of C. trachomatis infection was 2.1% and 6.7%, respectively. None of the participants were infected by N. gonorrhoeae or T. vaginalis. One participant had altered cytology results and was referred to the colposcopy service. Patients with C. trachomatis and/or altered vaginal microbiota were treated. During the three months of sanitary pad usage, 27.7%, 12.8%, and 10.6% of women presented altered vaginal microbiota (bacterial vaginosis, intermediate microbiota, aerobic vaginitis, and/or vulvovaginal candidiasis), while only 8.5%, 12.8% and 8.5% of them had vaginal dysbiosis while using a menstrual cup (P = 0.04). Overall acceptance of menstrual cups among those who completed all the examinations was 93.6%. Conclusion: Our results show that menstrual cups are associated with the maintenance of healthy vaginal microbiota. Additionally, the acceptance of menstrual cups was high in our population.

Blue Light-Emitting Diode Therapy for Chronic Vulvovaginitis Symptoms: A Series of Cases.

Objective: This pilot study aimed to evaluate the characteristic signs and symptoms of chronic vulvovaginitis after blue light-emitting diode (LED) treatment. Methods: Women with characteristic signs and symptoms of vulvovaginitis were interviewed to obtain clinical and sociodemographic data. They answered the Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life (WHOQOL)-bref questionnaires. Women with a suspected diagnosis of vulvovaginitis underwent clinical examination by a gynecologist, followed by microbiological evaluation, potassium hydroxide testing, vaginal pH assessment, and collection of vaginal fluid for oncotic cytology and fungal culture. The study participants were instructed to return after 15 days to undergo the 405 nm blue LED treatment, which consisted of three biweekly sessions. After 28 days of treatment completion, the patients returned for clinical re-evaluation and reassessment of the FSFI and WHOQOL-bref scores. Results: All eight women reported improvement or cure of at least one characteristic sign or symptom of vulvovaginitis, and five showed improvement in total FSFI and WHOQOL-bref scores. Conclusions: Treatment with blue LED may improve or cure symptoms associated with vulvovaginitis, sexual function, and the global quality of life score. Clinical Trial registration: NCT03075046 dated March 9, 2017.

Neurocryptococcosis and leptomeningeal carcinomatosis in metastatic prostate adenocarcinoma: differential diagnoses or overlapping symptoms?

Acute headaches with red flags in patients with cancer may indicate metastasis or infection. This report describes a case of acute headache with red flags in a patient with metastatic prostate adenocarcinoma who presented a positive latex fixation test without pleocytosis in cerebrospinal fluid (CSF) analysis. Antifungal treatment was initiated based on the test's high accuracy combined with the patient’s clinical condition and radiological impression of infectious meningitis, although we could not exclude associated secondary neoplastic involvement. Clinical improvement was first observed on D4 of treatment. On D14, CSF examination revealed therapeutic efficacy but positive oncotic cytology. The patient subsequently had new episodes of headache with warning signs and magnetic resonance imaging showed leptomeningeal carcinomatosis. Although neurocryptococcosis and leptomeningeal carcinomatosis are rare neurological complications, they may coexist with overlapping symptoms.

Nutcracker Esophagus: Investigation In A Female Patient With Dysphagia And Odinophagy

Introduction: Odinophagia and dysphagia are important symptoms related to the upper gastrointestinal tract, specifically at the level of the oropharynx and esophagus. Objective: to investigate the possible cause of these symptoms through clinical history and complementary exams, thus outlining a more specific approach. Methodology: anamnesis was performed followed by neck ultrasound, fine needle aspiration (FNAP), videolaryngoscopy, computed tomography of the neck, ultrasound with thyroid dopller, esophagogastroduodenal seriography, esophageal manometry, hormone and thyroid antibodies dosage, and evaluation of thyroid antibodies. speech therapy. Results: neck ultrasound with topical thyroid gland, diffusible to swallow, diffusely heterogeneous, mixed nodule in upper / middle and anterior third of the left lobe measuring about 2.2cm x 1.6cm x 1.0 cm, in addition to sparse colloidal cysts by the glandular parenchyma, no larger than 0.6 cm, cervical lymph nodes increased in number and dimensions, some coalescent, the largest being located in the left submandibular region, measuring 1.8 cm in its longest axis. US-guided FNAB: Oncotic Cytology- Benign nodule (Category II of the Bethesda system) consistent with benign follicular nodule (Colloid goiter). Paraffin inclusion- Some follicular epithelial ceslls, in addition to leukocytes, amidst eosinophilic background (system I category) Bethesda). High digestive endoscopy without changes. Videolaryngoscopy without alterations. Computed tomography of the neck showing homogeneous prominent palatine tonsils. Heterogeneous thyroid lobes. Submandibular prominent lymph node on the right (IIA) measuring 1.1 cm. Ultrasonography with thyroid doppler confirms the p revious findings. Manometry showed hypertonia of the lower esophageal sphincter, compatible with nutcracker esophagus. Final Considerations: A patient admitted to investigate dysphagia with two months of evolution associated with odynophagia reaches a final diagnosis of nutcracker esophagus, in addition to a benign thyroid nodule. Thus, the investigation should be supplemented on an outpatient basis with high-resolution manometry. He is discharged with a medical prescription and guidance to start monitoring with a gastroenterologist.

Clinical treatment of intra-epithelia cervical neoplasia with photodynamic therapy

Objectives This clinical study was developed to primarily evaluate the Complete Cytopathological Response Rate of Cervical Intraepithelial Neoplasms to PDT using chitosan nanocapsules containing Chlorocyan-aluminum phthalocyanine as a photoactive agent. Analyses of the Free Recurrence Interval, toxicity profile (immediate and late), and complications (immediate and late), were secondarily analyzed. Methods This study was previously approved by the National Council of Ethics in Research of Brazil (CONEP), on May 28, 2014, under case number 19182113.4.0000.5009. On the surface of the cervix of each selected patient was applied one mL of the formulated gel, and after 30 min, the light was applied. Reports or the identification of adverse effects and/or complications were observed in follow-up visits, in addition to the collection of cervical oncotic cytology. Results Out of the total group, 11 (91.7%) primarily treated patients evolved with negative cervical oncotic cytology as soon as in the first evaluation following treatment, and one did not achieve any therapeutic benefit, even after reapplication. Two patients with initially positive response presented cytological recurrence determined by histopathology. A new round of PDT was developed, and both evolved with cytological remission three weeks later, remaining negative until the last follow-up. No important side effects were observed in all the patients. Conclusions Our trial demonstrates that treatment of CIN 1 and 2 lesions using our PDT formulation is feasible and safe. Large randomized clinical trials are required to establish efficacy.

Performance of the UroVysion® FISH assay for the diagnosis of malignant effusions using two cutoff strategies.

The cytological examination of cavity fluids has limited sensitivity in the diagnosis of malignancy. Aneuploidy, which is commonly observed in neoplastic cells, could potentially be used as an ancillary diagnostic tool. To evaluate the detection of aneuploid cells in cavitary effusion samples using the fluorescence in situ hybridization (FISH) assay UroVysion ® with some adaptations and two different cutoff strategies. Seventy samples of pleural or peritoneal fluid with positive (n = 40), negative (n = 15), or suspicious (n = 15) oncotic cytology were subjected to FISH assay with the multitarget UroVysion ® kit, which is composed of probes that hybridize to the centromeric region of chromosomes 3, 7, and 17 and to the locus 9p21. FISH performance was evaluated using two different cutoffs: (1) the manufacturer's cutoff (M‐FISH) and 2) a proposed cutoff (P‐FISH). Using M‐FISH, the diagnostic sensitivity was 57.1%, specificity 87.5%, and accuracy 60.0%; with P‐FISH, the sensitivity was 87.3%, specificity 71.4%, and accuracy 85.7%. When combined with cytology, the sensitivity, specificity, and accuracy were 88.0%, 83.3%, and 87.8%, respectively. Malignant cells presented a predominance of chromosomal gains. The UroVysion ® test using the P‐FISH cutoff was effective in demonstrating aneuploid cells in all malignant effusions, confirming the diagnosis of malignancy even in cases with suspicious cytology.

Georeferencing of cervical cancer in primary care

Objective: to analyze the area distribution of cervical cancer screening. Methods: a cross-sectional study was carried out with 211 women, aged 38-69 years. The georeferencing technique was used to obtain geographic information, with coordinates of Global Positioning System. Results: of the 211 women, 93.8% (198) underwent an oncotic cytology examination. Of these, 74.2% (147) were examined at irregular intervals. 16 cases of human papillomavirus with cervical oncotic cytology reports with Cervical Intraepithelial Neoplasia I, II and III were georeferenced. Conclusion: the area distribution of cervical cancer screening allowed the identification of coverage above the recommendations of the Brazilian Ministry of Health. In addition, in relation to the intervals between the cervical oncology cytology tests, the majority demonstrated execution at inappropriate intervals.

Pleural Fluid Adenosine Deaminase (ADA) Predicts Survival in Patients with Malignant Pleural Effusion.

Systemic and local inflammations have been described as relevant prognostic factors in patients with cancer. However, parameters that stand for immune activity in the pleural space have not been tested as predictors of survival in patients with malignant pleural effusion. The objective of this study was to evaluate pleural lymphocytes and Adenosine Deaminase (ADA) as predictors of survival in patients with recurrent malignant pleural effusion. Retrospective cohort study includes patients who underwent pleurodesis for malignant pleural effusion in a tertiary center. Pleural fluid protein concentration, lactate dehydrogenase, glucose, oncotic cytology, cell count, and ADA were collected before pleurodesis and analyzed. Survival analysis was performed considering pleurodesis as time origin, and death as the event. Backwards stepwise Cox regression was used to find predictors of survival. 156 patients (out of 196 potentially eligible) were included in this study. Most were female (72%) and breast cancer was the most common underlying malignancy (53%). Pleural fluid ADA level was stratified as low (<15U/L), normal (15≤ADA<40), and high (≥40). Low and high ADA levels were associated with worse survival when compared to normal ADA (logrank: 0.0024). In multivariable analysis, abnormal ADA (<15 or ADA≥40) and underlying malignancies different from lymphoma, lung, or breast cancer were associated with worse survival. Pleural fluid cell count and lymphocytes number and percentage did not correlate with survival. Pleural fluid Adenosine Deaminase levels (<15 or ≥40U/L) and neoplasms other than lung, breast, or lymphoma are independent predictors of worse survival in patients with malignant pleural effusion who undergo pleurodesis.

Prevalence of human papillomavirus infection, distribution of viral types and risk factors in cervical samples from human immunodeficiency virus-positive women attending three human immunodeficiency virus-acquired immune deficiency syndrome reference centres in northeastern Brazil.

Human immunodeficiency virus (HIV)-positive patients have a greater prevalence of coinfection with human papillomavirus (HPV) is of high oncogenic risk. Indeed, the presence of the virus favours intraepithelial squamous cell lesion progression and may induce cancer. The aim of this study was to evaluate the prevalence of HPV infection, distribution of HPV types and risk factors among HIV-positive patients. Cervical samples from 450 HIV-positive patients were analysed with regard to oncotic cytology, colposcopy and HPV presence and type by means of polymerase chain reaction and sequencing. The results were analysed by comparing demographic data and data relating to HPV and HIV infection. The prevalence of HPV was 47.5%. Among the HPV-positive samples, 59% included viral types of high oncogenic risk. Multivariate analysis showed an association between HPV infection and the presence of cytological alterations (p = 0.003), age greater than or equal to 35 years (p = 0.002), number of partners greater than three (p = 0.002), CD4+ lymphocyte count < 200/mm3 (p = 0.041) and alcohol abuse (p = 0.004). Although high-risk HPV was present in the majority of the lesions studied, the low frequency of HPV 16 (3.3%), low occurrence of cervical lesions and preserved immunological state in most of the HIV-positive patients were factors that may explain the low occurrence of precancerous cervical lesions in this population.

Efficacy of two fluorescence in situ hybridization (FISH) probes for diagnosing malignant pleural effusions

It is difficult to differentiate tumor cells in pleural fluid from reactive benign mesothelium. Fluorescence in situ hybridization (FISH) can increase diagnostic accuracy. Two hundred pleural fluid samples were analyzed by using FISH probes for chromosomes 11 and 17. Histological analysis was used to diagnose cancer. Clinical, radiological, and histological data were used to exclude malignancy. Eighty-two pleural effusion samples had positive cytology, 51 were benign, and 67 were atypical, but inconclusive. The 82 positive cases were confirmed to be malignant. Among the 51 negative cytology cases, videothoracoscopy-guided pleural biopsy revealed malignancy in three; aneuploid cells were detected by FISH in all cases. In 43 of the 67 cases with inconclusive cytology, malignancy was confirmed based on histology and fluorescence in situ hybridization. One case of parapneumonic effusion with no evidence of cancer during clinical follow-up had a suspicious cytology and positive fluorescence in situ hybridization result. The remaining 23 cases had no histological, radiological, clinical, or genetic evidence of malignancy. This study demonstrated that cytogenetic analysis of fresh pleural fluid samples using only two FISH probes is a valuable ancillary method for the identification of malignant pleural effusion, particularly in cases in which oncotic cytology is inconclusive.

Cost-Effectiveness of Primary and Secondary Prevention Strategies for Cervical Cancer in Brazil: A Systematic Review

Background: Although Cervical Cancer (CC) can be effectively prevented, it is still a serious public health problem, especially in developing countries. In Brazil, almost 18,000 new cases are expected in 2013, and it is the type of neoplasia that claims the most lives of young women. New secondary prevention strategies (such as the HPV-DNA test) and primary prevention strategies (vaccination against HPV) have been developed. However, applying these strategies to large populations is costly, and their use is limited in Brazil. Because financial resources are scarce in Brazilian scenario, studies about the economic implications of the new preventative technologies for CC may support rational and evidence-based decisions in public health. Methods: A systematic search of the articles (1970 to 2013) was conducted in MEDLINE, EMBASE, Cochrane Collaboration of Systematic Reviews, and LILACS. The aim was original articles that evaluated the cost-effectiveness of primary and/or secondary prevention strategies for cervical cancer in Brazil. Results: A total of 6 articles were included in this review. Two articles described economic analyses of population screening strategies in comparison to the current strategy in Brazil (oncotic cytology). Four articles evaluated the addition of a vaccine against the HPV (genotypes 16 and 18) for Brazil in comparison to population screening. Conclusion: Despite raising the costs of preventing cervical cancer, new preventive technologies reveal a favorable cost-effectiveness profile for the case of Brazil. Ignoring the new preventative technologies for CC can lead to misguided and perverse consequences in a country where programs based on the Papanicolaou technique have only been partially successful.

Comparative study of the results from conventional cervico-vaginal oncotic cytology and liquid-based cytology

To compare two oncotic cervical cytology techniques, the conventional and the liquid-based cytology, in low risk patients for uterine cervical cancer. Comparative prospective study with 100 patients who came to their annual gynecological exam, and were submitted simultaneously to both techniques. We used the McNemar test, with a significance level of p < 0.05 to compare the results obtained related to adequacy of the smear quality, descriptive diagnosis prevalence, guided biopsy confirmation and histology. Adequacy of the smear was similar for both methods. The quality with squamocolumnar junction in 93% of conventional cytology and in 84% of the liquid-based cytology had statistical significance. As for the diagnosis of atypical cells they were detected in 3% of conventional cytology and in 10% of liquid-based cytology (p = 0.06). Atypical squamous cells of undetermined significance were the most prevalent abnormality. The liquid-based cytology performance was better when compared with colposcopy (guided biopsy), presenting sensitivity of 66.7% and specificity of 100%. There was no cytological and histological concordance for the conventional cytology. Liquid-based cytology had a better performance to diagnose atypical cells and the cytohistological concordance was higher than in the conventional cytology.

Cartografia do cuidado na saúde da gestante

This work uses cartography as a method for mapping the trajectory of primary healthcare provided to pregnant women. The scope of the study comprises 9 Basic Healthcare Units located in the city of Juazeiro do Norte in the State of Ceará. In all, fifteen women in the 37th to 39th week of pregnancy were selected. Interviews were conducted with these women during the period from January to June 2010. The cartographic findings were depicted in stages in the flowchart, which exposed lacunas in prenatal healthcare, such as the low number of oncotic cytology exams conducted and the lack of educational counseling. Nevertheless, in the interviews, a significant number of pregnant women expressed satisfaction with the prenatal care provided. The good relationships developed between the healthcare professionals and the pregnant women were the main reason that led them to continue the treatment. This fact reinforces the importance of dialogue between these two actors for the success of prenatal healthcare.

P1-246 National prevalence and risk behaviours of Chlamydia trachomatis infection among pregnant women aged 15 to 24 in Brazil

IntroductionChlamydia trachomatis (CT) is a sexually transmitted infection having repercussions on reproductive health and impact on the fetus.PurposeTo estimate Chlamydia trachomatis prevalence and risk factors in pregnant women aged 15...

PaPilomavírus Humano (HPv) em mulHeres submetidas a rastreamento Para CânCer de CérviCe uterina, belém – Pará – brasil

Introduction: human papillomavirus (HPV) is the agent of cervical uterine cancer. Objective: determine the prevalence of genital infection due to HPV and their correlation with results in the oncotic cytology. Methods: in a cross-sectional study, 1021 women, age 30 to 45 years were enrolled and submitted to cervical cancer screening. All patients answered a standard protocol. Samples of the uterine cervix were sent to citopathological analysis and to identification of HPV. Results: prevalence of HPV was 12.4%; in women with normal cervical cytology the prevalence of HPV was 8,7% compared to 43,4% in women with altered cervical cytology (28.9% among women with ASCUS/AGUS; 60.0% among women with LSIL; 90.0% among women with HSIL and 100.0% both in women with invasive carcinoma and in situ adenocarcinoma). Chance of detection of HSIL was 94 times higher in women who had HPV in the uterine cervix. A separate analysis including only the 116 HPV infected women revealed that HPV oncogenic types corresponded to 79.3% of the cases (71.8% in women with negative cervical cytology and 91.1% in women with altered cervical cytology). The frequency of oncogenic HPV types in 116 women infected with HPV was 79.3% [71.8% in women with negative citology and 91.1% in women with abnormalities in the citology exam). The odds to detect abnormalities in the citopatology exam was four times greater in the presence of HPV of high risk. HPV 16 was the most frequent type observed (24.4% of women with abnormal cytology and in 7,0% of those with negative cytology). Multiinfection was detected in 5.7% of women with abnormal cytology and in 1.1% with negative cytology. Conclusion: in this study, HPV infection and abnormal cytological findings in the uterine cervix were frequently observed and there was an association between them.

Avaliação da frequência de realização do exame físico das mamas, da colpocitologia cervical e da ultrassonografia obstétrica durante a assistência pré-natal: uma inversão de valores

Although ultrasound examination is a frequent procedure during pregnancy, routine use has not been effective to reduce maternal or perinatal morbidity-mortality. Assess frequency of breast examination and of oncotic cervical cytology among prenatal exams and compare it to frequency of obstetrical ultrasound. This was a cross-sectional evaluation conducted in the city of Rio Grande, RS, Brazil between May and July 2007. Data obtained with a structured questionnaire were entered into the Epi-Info 6.04 program and analyzed using the SPSS software. Among the 230 puerperae interviewed, 99.1% had undergone an ultrasound during pregnancy, while 37.5% and 33.6% had been submitted to clinical examination of the breasts and cervical cytology, respectively. It was noted that a larger number of obstetrical echographies increased the probability that a patient would be submitted to clinical examination of the breasts. On the other hand, the number of cytopathological evaluations of the uterine cervix was not influenced by the number of ultrasound examinations. Obstetrical echography was given priority and performed as a routine exam, whereas clinical examination of the breasts and cervical cytopathological examination were not, although considered obligatory during the prenatal period. These data confirm the tendency documented in literature indicating an inversion of priorities, favoring ultrasonography over breast examination and cervical pathological exams. For this reason, further studies and evaluations of health programs, also of the real impact of this inversion on the population health indices are recommended.

Acuidade da citologia oncótica para o diagnóstico da infecção pelo HPV no colo uterino de mulheres portadoras do HIV

to verify the accuracy of uterine cervix cytology for HPV diagnosis, as compared to polymerase chain reaction (PCR) in samples of women with HIV. 158 patients who had undergone a first collection of material from the uterine cervix with Ayre's spatula for PCR were included in the study. Then, another collection with Ayre's spatula and brush for oncotic cytology was performed. Only 109 slides were reviewed, as 49 of them had already been destructed for have being filed for over two years. the prevalence of HPV was 11% in the cytological exam and 69.7% in the PCR. Age varied from 20 to 61 years old, median 35 years. The HIV contagious route was heterosexual in 91.8% of the cases, and 79.1% of the patients had had from one to five sexual partners along their lives. The most frequent complaint was pelvic mass (5.1%), and 75.3% of the women had looked for the service for a routine medical appointment. The categorical variable comparison was done through contingency tables, using the chi2 test with Yates's correction to compare the ratios. The Fisher's test was used when one of the expected rates was lower than five. In the comparison of diagnostic tests, sensitivity, specificity and similarity ratios have been calculated. Among the 76 patients with HPV, detected by PCR, only 12 had the diagnosis confirmed by cytology (sensitivity=15.8%), which on the other hand did not present any false-positive results (specificity=100%). Concerning the HPV presence, the cytological prediction for positive results was 100% and 33.3% for negative, when both results were compared. Among the 12 patients with HPV positive cytology, four (33.3%) presented cervical intraepithelial neoplasia (OR=56; positive similarity ratio=positive infinity; negative similarity ratio=0.83). As the cytology specificity is quite high, it is possible to rely on the positive result, which means that a positive result will surely indicate the presence of HPV. The low sensitivity of cytology does not qualify it as a survey exam for HPV detection in this female group.