Atypical Squamous Cells of Undetermined Significance: Bethesda Classification and Association with Human Papillomavirus

Introduction. To analyze patients with atypical squamous cells of undetermined significance (ASCUS) through a cytology review and the presence of microbiological agents, with consideration of colposcopy and semiannual tracking. Methods. 103 women with ASCUS were reviewed and reclassified: normal/inflammatory, ASCUS, low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL). If ASCUS confirmed, it was subclassified in reactive or neoplastic ASCUS, ASC-US, or ASC-H; and Regione Emilia Romagna Screening Protocol. Patients underwent a colposcopic examination, and test for Candida sp., bacterial vaginosis, Trichomonas vaginalis, and human papillomavirus (HPV) were performed. Results. Upon review, ASCUS was diagnosis in 70/103 (67.9%), being 38 (54.2%) reactive ASCUS and 32 (45.71%) neoplastic ASCUS; 62 (88.5%) ASC-US and 8 (11.41%) ASC-H. ASCUS (Regione Protocol), respectively 1-5: 15 (21.4%), 19 (27.1%), 3 (27.1%), 16 (22.8%), and 1 (1.4%). A higher number of cases of cervical intraepithelial neoplasia (CIN) II/III in the biopsies of patients with ASC-H compared to ASC-US (P = .0021). High-risk HPV test and presence of CIN II/III are more frequent in ASC-H than ASC-US (P = .031). Conclusions. ASC-H is associated with clinically significant disease. High-risk HPV-positive status in the triage for colposcopy of patients with ASC-US is associated with increased of CIN

Análise retrospectiva de 287 casos de abdome agudo em ginecologia e obstetrícia

OBJETIVO: O abdome agudo em ginecologia e obstetrícia apresenta baixo risco de vida para a paciente, entretanto, o retardo no diagnóstico e tratamento influencia na morbi-mortalidade. O objetivo deste trabalho foi estudar as principais causas de abdome agudo em tocoginecologia. MÉTODOS: Foram revisados 287 casos de abdome agudo em tocoginecologia de janeiro de 1987 a dezembro de 1997 atendidos na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. RESULTADOS: Os resultados mostraram que a prenhez ectópica foi a mais freqüente causa de abdome agudo hemorrágico com 98,5% dos casos. Nestes casos, a dor pélvica foi o sintoma mais comum (69,1%). Todas as pacientes foram submetidas à laparotomia e salpingectomia foi realizada em 92,6% dos casos. A causa mais freqüente de abdome agudo inflamatório foi a doença inflamatória pélvica com 94,8%. A dor pélvica aguda estava presente em 91,5% dos casos e a febre em 56,2% casos. A penicilina foi usada com sucesso em 92,1% dos casos. Do total de 201 casos de doença inflamatória pélvica, 13 (6,5%) foram submetidos à laparotomia. CONCLUSÕES: Os autores concluem que o abdome agudo de causa tocoginecológica apresenta quadro clínico variável, portanto, o ginecologista deve estar atento para estabelecer diagnóstico e tratamento precisos

Utilization of human papillomavirus testing for cervical cancer prevention in a university hospital

This study aimed to evaluate the performance and cost of using polymerase chain reaction (PCR) and hybrid capture in the detection of cervical intraepithelial neoplasia (CIN) in patients with cytological abnormalities (ASCUS/low-grade squamous intraepithelial lesion - LSIL), and the feasibility of implementing these methods in Brazil's Unified National Health System (SUS). Colposcopy gave a negative predictive value of 92.86% and efficiency of 87.8% for diagnosing CIN. The sensitivity of PCR and hybrid capture for detecting CIN was 83.33% and 66.67%, respectively, and the negative predictive value for diagnosing CIN2/CIN3 was 100% and 94.74%, respectively. The annual cost for 80 patients was lower when all patients with ASCUS/LSIL were referred for colposcopy than when HPV testing was performed and those with positive results were referred for colposcopy. Therefore, at present, it is financially unfeasible for the National Health System to implement HPV testing to screen patients with cytological abnormalities (ASCUS/LSIL). However, considering that large-scale use might make such methods cheaper, PCR should be the chosen method, since it is less expensive, more sensitive, and has a high negative predictive value