Garantia de qualidade em citopatologia: aspectos da correlação cito-histopatológica Quality assurance in cytopathology: aspects of the cytohistological correlation

Os autores avaliaram a concordância diagnóstica cito-histológica de lesões de colo uterino e discutiram as eventuais discrepâncias. OBJETIVO. Averiguar o nível de concordância cito-histológica nos casos da Divisão de Patologia do Instituto Adolfo Lutz (IAL) e aprimorar a estratégia de garantia de qualidade na instituição. MATERIAL E MÉTODO. Estudaram 157 casos consecutivos dos arquivos do IAL em que foram enviadas citologia cérvico-vaginal e biópsia. RESULTADO. Houve concordância absoluta em 119 (75,8%) casos; nos demais, a citologia superestimou 11 lesões (7,0%) e subestimou 27 (17,2%). Observou-se que em 5 casos, inicialmente diagnosticados como inflamatório pela citologia, dois foram, à revisão, considerados como NIC 1; os demais foram ratificados como inflamatórios, apesar de suas respectivas biópsias terem diagnóstico de neoplasia intra-epitelial cervical. CONCLUSÃO. Tais resultados demonstram a importância da correlação cito-histológica para o sistema de garantia de qualidade em diagnóstico citológico e apontam para a colheita como um dos fatores determinantes nas discrepâncias diagnósticas.<br>The cytohistologic diagnosis concordance of the cervix-uterine lesions was evaluated and the discordances are discussed. PURPOSE. To evalute the level of cytohistological diagnosis agreement in the Pathology Division of the Adolfo Lutz Institute and enhance parameters of quality assurance system developed in this institution. METHODS. The authors retrospectively evaluated 157 pairs of cytologyhistology consecutive cases from the files the Adolfo Lutz Institute (Division of Pathology). RESULTS. Agreement was found in 119 cases (75.8%); in the remaining cases cytologic diagnosis were higher than histology in 11 lesions (7.0%) and lower in 27 (17.2%). We also observed that in 5 cases previously diagnosed as inflammatory, 2 of them were reclassified as CIN 1; after revision, the others remained as inflammatory even though they had a histological diagnosis of CIN. CONCLUSION. These results showed the role of cytohistological correlation to the quality assurance system of cytological diagnosis and also stressed the importance of taking the cervical scrapes with accurate care to avoid diagnostic discrepances

Association Between Age At First Sexual Intercourse And Subsequent Human Papillomavirus Infection: Results Of A Brazilian Screening Program [associação Entre Idade Ao Início Da Atividade Sexual E Subsequente Infecção Por Papilomavírus Humano: Resultados De Um Programa De Rastreamento Brasileiro]

PURPOSE: to investigate women's age at their first sexual intercourse and its correlation with their present age, human papillomavirus (HFV] infection and cylological abnormalities at Pap smear. METHODS: women from the general population were invited to be screened for cervical cancer and pre-malignant lesions. After answering a behavior questionnaire, they were submitted lo screening with cervical cytology and high-risk HPV testing with Hybrid Capture 2 (HC2). This report is part of the Latin American Screening (LAMS) study, that comprises centers from Brazil and Argentina, and the data presented herein refer to the Brazilian women evaluated at the cities of Porto Alegre, São Paulo and Campinas. RESULTS: from 8,049 women that answered the questionnaire, 8,041 reported previous sexual activity and were included in this analysis. The mean age at the interview was 38.1±11.0 years and the mean age at the first sexual intercourse was 18.5±4.0 years. The age at the first sexual intercourse increased along with the age at the interview, i.e., younger women reported they had begun their sexual life earlier than older women (p<0.001). From the total of women who had already begun having sexual intercourse, 3,043 patients were tested for high-risk HPV infection and 17.3% of them had positive results. In all the centers, it became clear that the women with the first sexual intercourse at ages below the mean age of all the population interviewed presented higher rates of HPV infection (20.2%) than the women with the first sexual intercourse at ages above the mean (12.5%) - Odds Ratio (OR) 1.8 (IC95% 1.5-2.2;p<0,001). According to the cytology, the women with first sexual intercourse at ages under the mean, presented higher percentage of abnormal cytology ≥ASC-US (0.7%) than the women with the first sexual intercourse at ages above the mean (4.3%) - OR 1.6 (IC95% 1.3-2.;p<0.001). CONCLUSIONS: the high-risk HPV infection and cylological abnormalities identified during the asymptomatic population screening were significantly associated to the women's age at the first sexual intercourse. Additionally, we have also identified that the women's age at the first sexual intercourse has decreased during the last decades, suggesting an important contribution to the increase of HPV infection and the subsequent cervical lesions.2911580587Castle, P.E., Schiffmann, M., Herrero, R., Hildesheim, A., Rodríguez, A.C., Bratti, M.C., el al, A prospective study of age trends in cervical humman papillomavirus acquisition and persistence in Guanacaste, Costa Rica (2005) J Infect Dis, 191 (11), pp. 1808-1816Giuliana, A.R., Harris, R., Sedjo, R.L., Baldwin, S., Roe, D., Papenfuss, M.R., Incidence, prevalence, and clearance of type-specific human papillomavirus infections: The Young Women's Health Study (2002) J Infect Dis, 186 (4), pp. 462-469Schlecht, N.F., Kulaga, S., Robitaille, J., Ferreira, S., Santos, M., Miyamura, R.A., Persistent human papillomavirus infection as a predictor of cervical intraepithelial neoplasia (2001) JAMA, 286 (24), pp. 3106-3114Walboomers, J.M., Jacobs, M.V., Manos, M.M., Bosch, F.X., Kummer, J.A., Shah, K.V., Human papillomavirus is a necessary cause of invasive cervical cancer worldwide (1999) J Pathol, 189 (1), pp. 12-19(1995) Monographs on the evaluation of carcinogenic risks to humans: Human papillomaviruses, 64. , International Agency for Research on Cancer IARC, Lyon: IARC;(2005) Monographs on the evaluation of carcinogenic risks to humans: Human papillomaviruses, 90. , International Agency for Research on Cancer IARC, Lyon: IARC;Ho, G.Y.F., Bierman, R., Beardsley, L., Chang, C.J., Burk, R.D., Natural history of cervicovaginal papillomavirus infection in young women (1998) N Engl J Med, 338 (7), pp. 423-428Bosch, F.X., Lorincz, A., Muñoz, N., Meijer, C.J., Shah, K.V., The causal relation between human papillomavirus and cervical cancer (2002) J Clin Pathol, 55 (4), p. 24445Myers, E.R., McCrory, D.C., Nanda, K., Bastian, L., Matchar, D.B., Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis (2000) Am J Epidemiol, 151 (12), pp. 1158-1171Bekkers, R.L., Meijer, C.J., Massuger, L.F., Snijders, P.J., Melchers, W.J., Effects of HPV detection in population-based screening programmes for cervical cancer: A Dutch moment (2006) Gynecol Oncol, 100 (3), pp. 451-454Bory, J.P., Cucherousset, J., Lorenzato, M., Gabriel, R., Quereux, C., Birembaut, P., Recurrent human papillomavirus infection detected with the hybrid capture II assay selects women with normal cervical smears at risk for developing high grade cervical lesions: A longitudinal study of 3,091 women (2002) Int J Cancer, 102 (5), pp. 519-525Kahn, J.A., Rosenthal, S.L., Succop, P.A., Ho, G.Y., Burk, R.D., The interval between menarche and age of first sexual intercourse as a risk factor for subsequent HPV infection in adolescent and young adult women (2002) J Pediatr, 141 (5), pp. 718-723Baseman, J.G., Koulsky, L.A., The epidemiology of human papillomavirus infections (2005) J Clin Virol, 32 (SUPPL. 1), pp. S16-S24Koutsky, L., Epidemiology of genital human papillomavirus infection (1997) Am J Med, 102 (5 A), pp. 3-8Moscicki, A.B., HPV infections in adolescents (2007) Dis Markers, 23 (4), pp. 229-234Kahn, J.A., Rosenthal, S.L., Succop, P.A., Ho, G.Y., Burk, R.D., Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection (2002) Pediatrics, 109 (1), pp. E5Villa LL, Ault KA, Giuliano AR, Costa RL, Petta CA, Andrade RP, et al. Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18. Vaccine. 2006;24(27-28):5571-83Harper, D.M., Franco, E.L., Wheeler, C.M., Moscicki, A.B., Romanowski, B., Roteli-Martins, C.M., Sustained efficacy up to 4.5 years of a bivalent LI virus-like particle vaccine against human papillomavirus types 16 and 18: Follow-up from a randomised control trial (2006) Lancet, 367 (9518), p. 124755Bosch, X., Harper, D., Prevention strategies of cervical cancer in the HPV vaccine era (2006) Gynecol Oncol, 103 (1), pp. 21-24Syrjänen, K., Naud, P., Derchain, S., Roteli-Martins, C., Longatto-Filho, A., Tatti, S., Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America. Study design and baseline data of the LAMS study (2005) Anticancer Res, 25 (5), pp. 3469-3480Signorelli, C., Colzani, E., Age at first intercourse and HPV immunization (2007) J Prev Med Hyg, 48 (2), pp. 37-38Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: Collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies (2007) Int J Cancer, 120 (4), pp. 885-891. , International Collaboration of Epidemiological Studies of Cervical CancerCollins, S.I., Mazloomzadeh, S., Winter, H., Rollason, T.P., Blomfield, P., Young, L.S., Proximity of first intercourse to menarche and the risk of human papillomavirus infection: A longitudinal study (2005) Int J Cancer, 114 (3), pp. 498-500Moscicki, A.B., Cervical cytology screening in teens (2003) Curr Womens Health Rep, 3 (6), pp. 433-437Trottier, H., Franco, E.L., Human papillomavirus and cervical cancer: Burden of illness and basis for prevention (2006) Am J Manag Care, 12 (17 SUPPL.), pp. S462-S472Kjaer, S., Hogdall, E., Frederiksen, K., Munk, C., van den Brule, A., Svare, E., The absolute risk of cervical abnormalities in high-risk human papillomavirus-positive, cytologically normal women over a 10-year period (2006) Cancer Res, 66 (21), pp. 10630-10636Koutsky, L.A., Holmes, K.K., Critchlow, C.W., Stevens, C.E., Paavonen, J., Beckmann, A.M., A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection (1992) N Engl J Med, 327 (18), pp. 1272-1278Pereira, C.R., Rosa, M.L., Vasconcelos, G.A., Faria, P.C., Cavalcanti, S.M., Oliveira, L.H., Human papillomavirus prevalence and predictors for cervical cancer among high-risk women from Rio de Janeiro, Brazil (2007) Int J Gynecol Cancer, 17 (3), pp. 651-660Bosch, F.X., Munoz, N., De Sanjose, S., Izarzugaza, I., Gili, M., Viladiu, P., Risk factors for cervical cancer in Colombia and Spain (1992) Int J Cancer, 52 (5), pp. 750-758Moscicki AB, Schiffman M, Kjaer S, Villa LL Chapter 5: Updating the natural history of HPV and anogenital cancer. 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Value Of Conventional Pap Smear, Liquid-based Cytology, Visual Inspection And Human Papillomavirus Testing As Optional Screening Tools Among Latin American Women < 35 And ≥ 35 Years Of Age: Experience From The Latin American Screening Study

Objective: To compare performance of conventional Pap test, liquid-based cytology (LBC) and visual inspection with acetic acid (VIA), as well as human papillomavirus (HPV) testing in 2 subcohorts of women, < 35 and ≥ 35 years of age. Study Design: Performance indicators were calculated using colposcopic biopsies as the gold standard; all results were corrected for verification bias using maximum likelihood. Results: Both conventional Pap test and Hybrid Capture 2 (HC2) assay performed significantly better among older women than younger; no difference was observed in performance of LBC and VIA, both inferior to Pap and HC2. The Pap test was more specific than HC2 in both subcohorts; HC2 had the highest sensitivity. For individual tests, the best balance between sensitivity and specificity was obtained for HC2 assay corrected for verification bias in the older women's subcohort; this was further improved by the combined use of the Pap test and HC2. Conclusion: Age of the target population is an important determinant of the performance of different screening tests. The choice of optimal test for women < 35 and ≥ 35 years of age depends on whether the highest positive predictive value (Pap test) or the best SE/SP balance (HC2) is used as the selection criterion. © The International Academy of Cytology.526641653Syrjänen, K., Early detection of CIN and HPV: Prevention of cervical cancer (2000) Papillomavirus Infections in Human Pathology, pp. 167-188. , Edited by K Syrjänen, S Syrjänen. New York, J Wiley & SonsMiller, A.B., Nazeer, S., Fonn, S., Brandup-Lukanow, A., Rehman, R., Cronje, H., Sankaranarayanan, R., Onsrud, M., Report on Consensus Conference on Cervical Cancer Screening and Management, , Int J Cancer 200086:440-447Hakama, M., Screening for cervical cancer: Experience from the Nordic Countries (1997) New Developments in Cervical Cancer Screening and Prevention, pp. 190-199. , Edited by E Franco, J Monsonego. Oxford, Blackwell ScienceMonsonego, J., HPV infections and cervical cancer prevention: Priorities and new directions (2005) Gynecol Oncol, 96, pp. 830-839Monsonego, J., Bosch, F.X., Coursaget, P., Cox, J.T., Franco, E., Frazer, I., Sankaranaraynanan, R., Meijer, C., Cervical cancer control, priorities and new directions (2004) Int J Cancer, 108, pp. 329-333Anttila, A., Nieminen, P., Cervical cancer screening programme in Finland with an example on implementing alternative screening methods (2007) Coll Anthropol, 31 (SUPPL. 2), pp. 17-22(1987) Papillomaviruses and Human Disease, pp. 1-518. , Syrjänen K, Gissmann L, Koss LG editors, Berlin, Heidelberg, Springer Verlag(2003) Papillomavirus Humains: Biologie et Pathologie Tumorale, pp. 1-759. , Aubin F, Pretet JL, Mougin C editors, Paris, Editions TEC & DOC(2006) Papillomavirus Research: From Natural History to Vaccines and Beyond, pp. 1-424. , Campo S editor, Norwich, U.K, Caister Academic PressLorincz, A.T., Richart, R.M., Human papillomavirus DNA testing as an adjunct to cytology in cervical screening programs (2003) Arch Pathol Lab Med, 127, pp. 959-968Arbyn, M., Buntinx, F., Van Ranst, M., Paraskivaidis, E., Martin-Hirsch, P., Dillner, J., Virologic versus cytologic triage of women with equivocal Pap smears: A meta-analysis of the accuracy to detect high-grade intraepithelial neoplasia (2004) J Natl Cancer Inst, 96, pp. 280-293Koss, L.G., Performance of cytology in screening for precursor lesions and early cancer of the uterine cervix (1997) New Developments in Cervical Cancer Screening and Prevention, pp. 147-150. , Edited by E Franco, J Monsonego. Oxford, Blackwell ScienceNanda, K., McCrory, D.C., Myers, E.R., Bastian, L.A., Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review (2000) Ann Intern Med, 132, pp. 810-819Wright Jr, T.C., Schiffman, M., Solomon, D., Cox, J.T., Garcia, F., Goldie, S., Hatch, K., Saslow, D., Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening (2004) Obstet Gynecol, 103, pp. 304-309Ferris, D.G., The 2001 ASCCP management guidelines for cervical cytology (2004) Am Fam Physician, 70, pp. 1866-1868Cox, T., Cuzick, J., HPV DNA testing in cervical cancer screening: From evidence to policies (2006) Gynecol Oncol, 103, pp. 8-11Franco EL, Bosch FX, Cuzick J, Schiller JT, Garnett GP, Meheus A, Wright TC: Knowledge gaps and priorities for research on prevention of HPV infection and cervical cancer. Vaccine (Supp 13) 2006;24:S242-S249Cuzick, J., Beverley, E., Ho, L., Terry, G., Sapper, H., Mielzynska, I., Lorincz, A., Soutter, P., HPV testing in primary screening of older women (1999) Br J Cancer, 81, pp. 554-558Clavel, C., Masure, M., Bory, J.P., Putaud, I., Mangeonjean, C., Lorenzato, M., Nazeyrollas, P., Birembaut, P., Human papillomavirus testing in primary screening for the detection of high-grade cervical lesions: A study of 7932 women (2001) Br J Cancer, 84, pp. 1616-1623Duttagupta, C., Sengupta, S., Roy, M., Sengupta, D., Chakraborty, S., Bhattacharya, P., Roy, S., Ghosh, S., Oncogenic human papillomavirus (HPV) infection and uterine cervical cancer: A screening strategy in the perspective of rural India (2002) Eur J Cancer Prev, 11, pp. 447-456Goldie, S.J., Kim, J.J., Wright, T.C., Cost-effectiveness of human papillomavirus DNA testing for cervical cancer screening in women aged 30 years or more (2004) Obstet Gynecol, 103, pp. 619-631Holmes, J., Hemmett, L., Garfield, S., The cost-effectiveness of human papillomavirus screening for cervical cancer: A review of recent modelling studies (2005) Eur J Health Econ, 6, pp. 30-37Ronco, G., Giorgi-Rossi, P., Carozzi, F., Dalla Palma, P., Del Mistro, A., De Marco, L., De Lillo, M., Cuzik, J., New Technologies for Cervical Cancer Screening Working Group: Human papillomavirus testing and liquid-based cytology in primary screening of women younger than 3 5 years: Results at recruitment for a randomised controlled trial (2006) Lancet Oncol, 7, pp. 547-555Kitchener, H.C., Almonte, M., Wheeler, P., Desai, M., Gilham, C., Bailey, A., Sargent, A., Peto, J., ARTISTIC Trail Study Group: HPV testing in routine cervical screening: Cross sectional data from the ARTISTIC trial (2006) Br J Cancer, 95, pp. 56-61Wiley, D.J., Monk, B.J., Masongsong, E., Morgan, K., Cervical cancer screening (2004) Curr Oncol Rep, 6, pp. 497-506Baay, M.F., Tjalma, W.A., Lambrechts, H.A., Pattyn, G.G., Lardon, F., Weyler, J., Van Royen, P., Vermorken, J.B., Combined Pap and HPV testing in primary screening for cervical abnormalities: Should HPV detection be delayed until age 35? (2005) Eur J Cancer, 41, pp. 2704-2708Agorastos, T., Dinas, K., Lloveras, B., de Sanjose, S., Komegay, J.R., Bond, H., Bosch, F.X., Bonds, J., Human papillomavirus testing for primary screening in women at low risk of developing cervical cancer: The Greek experience (2005) Gynecol Oncol, 96, pp. 714-720Ronco, G., Cuzick, J., Segnan, N., Brezzi, S., Carozzi, F., Folicaldi, S., Dalla Palma, P., Giorgi-Rossi, P., NTCC Working Group: HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology (2007) Eur J Cancer, 43, pp. 476-480Syrjänen, K., Naud, P., Derchain, S.M., Roteli-Martins, C., Longatto-Filho, A., Tatti, S., Branca, M., Syrjänen, S., Comparing PAP smear cytology, aided visual inspection, screening colposcopy, cervicography and HPV testing as optional screening tools in Latin America: Study design and baseline data of the LAMS Study (2005) Anticancer Res, 25, pp. 3469-3480Longatto-Filho, A., Maeda, M.Y., Erzen, M., Branca, M., Roteli-Martins, C., Naud, P., Derchain, S.F., Syrjänen, K., Conventional Pap smear and liquid-based cytology as screening tools in low-resource settings in Latin America: Experience of the Latin American Screening Study (2005) Acta Cytol, 49, pp. 500-506Sarian LO, Derchain SF, Naud P, Roteli-Martins C, Longatto-Filho A, Tatti S, Branca M, Erzen M, Serpa-Hammes L, Matos J, Gontijo R, Bragança JF, Lima TP, Maeda MY, Lörincz A, Dores GB, Costa S, Syrjänen S, Syrjänen K: Evaluation of visual inspection with acetic acid (VIA), Lugol's iodine (VILI) cervical cytology and HPV testing as cervical screening tools in Latin America: This report refers to partial results from the LAMS (Latin AMerican Screening) study. 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(2006) Int J Gynecol Pathol, 25, pp. 38-41Shastri, S.S., Dinshaw, K., Amin, G., Goswami, S., Patil, S., Chinoy, R., Kane, S., Sankaranarayanan, R., Concurrent evaluation of visual, cytological and HPV testing as screening methods for the early detection of cervical neoplasia in Mumbai, India (2005) Bull World Health Organ, 83, pp. 186-194Sankaranarayanan, R., Nene, B.M., Dinshaw, K.A., Mahe, C., Jayant, K., Shastri, S.S., Malvi, S.G., Panse, N., Osmanabad District Cervical Screening Study Group: A cluster randomized controlled trial of visual, cytology and human papillomavirus screening for cancer of the cervix in rural India (2005) Int J Cancer, 116, pp. 617-623dos Santos Silva, I., (1999) Cancer Epidemiology: Principles and Methods, pp. 355-383. , Lyon, IARC Pres