Programa De Rastreamento Populacional De Câncer De Colo Uterino Organizado: é Um Bom Momento Para O Brasil De Hoje

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Assessment of cytology laboratory performance within the Brazilian Unified Health System

Objective: To assess the profile of cytopathology laboratories which render services to the Brazilian Unified Health System (SUS), and to create quality indicators for cytopathological exams. Methods: A postal survey of 1,028 laboratories that render services to the SUS and participated in the Cervix Cancer Information System (SISCOLO) in the year 2002. Information concerning cytopathological exams from the SISCOLO, available on the Internet (www.datasus.gov.br) for the same year was analyzed. Results: Out of the 1,028 laboratories which reported results of cervix-vaginal cytopathology exams to DATASUS in 2002, 739 answered the survey (71.9%). From these, 18.9% processed 15,000 exams or more in that year; 70.2% were private; 50.2% were vinculated to municipal administrations; and 48.7% performed histopathological exams. In 74.8% of cases, a physician was in charge of the technical responsibility. Out of 10,505.773 exams included in the SISCOLO in 2002, 1.66% of samples were considered unsatisfactory. The following alterations were detected: atypical squamous cells of undetermined significance (ASCUS), 1.26%; human papillomavirus (HPV), 0.93%; cervical intraepithelial neoplasia I (CIN I), 0.84%, CIN II = 0.20%, CIN III = 0.17%; invasive squamous carcinoma, 0.05%, atypical glandular cells of undetermined significance (AGUS), 0.14%, in situ adenocarcinoma, 0.01; and invasive adenocarcinoma, 0.01%. Conclusion: This study made it possible to assess the profile of cytopathology laboratories, which rendered services to the SUS in 2002, and the SISCOLO proved to be an excellent tool to assess the quality of cytopathological exams performed in Brazil.Conhecer o perfil dos laboratórios de citopatologia que prestam serviços ao Sistema Único de Saúde (SUS) e elaborar indicadores de qualidade dos exames citopatológicos. MÉTODOS: Foi realizada uma enquete postal dirigida aos 1.028 laboratórios que prestaram serviço ao SUS e participaram do Sistema de Informação do Câncer do Colo do Útero (SISCOLO) em 2002. As informações referentes aos exames citopatológicos constantes do SISCOLO e disponibilizadas na página do Departamento de Informática do Sistema Único de Saúde (DATASUS) na Internet (www.datasus.gov.br) para o mesmo ano foram analisadas. RESULTADOS: Dos 1.028 laboratórios que informaram os resultados dos exames citopatológicos cervicovaginais ao DATASUS, em 2002, 739 responderam à enquete (71,9%). Desses, 18,9% processaram 15 mil exames ou mais no ano; 70,2% eram privados; 50,2% encontravam-se vinculados à gestão municipal; e 48,7% realizavam exames histopatológicos. Em 74,8% dos casos o responsável técnico pelo laboratório era médico. Dos 10.505.773 exames incluídos no SISCOLO em 2002, uma parcela das amostras (1,66%) foi considerada insatisfatória. As alterações detectadas foram: células escamosas atípicas de significado indeterminado (ASCUS), 1,26%; papilomavírus humano (HPV), 0,93%; neoplasia intra-epitelial cervical I (NIC I), 0,84%; NIC II, 0,20%; NIC III, 0,17%; carcinoma escamoso invasivo, 0,05%; células glandulares atípicas de significado indeterminado (AGUS), 0,14%; adenocarcinoma in situ, 0,01; e adenocarcinoma invasivo, 0,01%. CONCLUSÃO: Este estudo permitiu avaliar o perfil dos laboratórios de citopatologia que prestaram serviço ao SUS em 2002, e o SISCOLO se mostrou um excelente instrumento para o monitoramento da qualidade dos exames citopatológicos realizados no país432103114To assess the profile of cytopathology laboratories which render services to the Brazilian Unified Health System (SUS), and to create quality indicators for cytopathological exams. Methods: A postal survey of 1,028 laboratories that render services to the SUS and participated in the Cervix Cancer Information System (SISCOLO) in the year 2002. Information concerning cytopathological exams from the SISCOLO, available on the Internet (www.datasus.gov.br) for the same year was analyzed. Results: Out of the 1,028 laboratories which reported results of cervix-vaginal cytopathology exams to DATASUS in 2002, 739 answered the survey (71.9%). From these, 18.9% processed 15,000 exams or more in that year; 70.2% were private; 50.2% were vinculated to municipal administrations; and 48.7% performed histopathological exams. In 74.8% of cases, a physician was in charge of the technical responsibility. Out of 10,505.773 exams included in the SISCOLO in 2002, 1.66% of samples were considered unsatisfactory. The following alterations were detected: atypical squamous cells of undetermined significance (ASCUS), 1.26%; human papillomavirus (HPV), 0.93%; cervical intraepithelial neoplasia I (CIN I), 0.84%, CIN II = 0.20%, CIN III = 0.17%; invasive squamous carcinoma, 0.05%, atypical glandular cells of undetermined significance (AGUS), 0.14%, in situ adenocarcinoma, 0.01; and invasive adenocarcinoma, 0.01%. Conclusion: This study made it possible to assess the profile of cytopathology laboratories, which rendered services to the SUS in 2002, and the SISCOLO proved to be an excellent tool to assess the quality of cytopathological exams performed in Brazi

Idade Precoce De Início Da Atividade Sexual Está Associada A Elevada Prevalência De Lesão Intraepitelial Escamosa De Alto Grau

To evaluate the association of age at first sexual intercourse with the results of the cervicovaginal cytology. Study Design Observational analytical study about the prevalence of altered cervicovaginal cytology results in women aged between 18 and 34 years from a densely populated area in Brazil, during 10 years. The patients were stratified into 2 categories according to their age at first sexual intercourse (13–16 years and 17–24 years). Results From the total of 2,505,154 exams, 898,921 tests were in accordance with the inclusion criteria. Considering women with 4 years or less from the first sexual intercourse as a reference, those with 5 to 9 years and 10 years or more showed a higher prevalence of high-grade squamous intraepithelial lesions (HSILs). Women with an earlier onset of sexual intercourse (13–16 years) showed higher prevalence ratios for atypical squamous cells (ASC), low-grade squamous intraepithelial lesion (LSIL) and HSIL. The prevalence ratio for HSIL adjusted by age at diagnosis and by age at first sexual intercourse was higher only for women with an earlier onset of sexual intercourse. Conclusions The age of first sexual intercourse could be a variable that might qualify the selection among young women who are really at a higher risk for HSIL. © 2017 by Thieme-Revinter Publicações Ltda, Rio de Janeiro, Brazil.3928085UNICAMP, Universidade Estadual de Campina

Prognostic value of Dna and Mrna E6/e7 of human papillomavirus in the evolution of cervical intraepithelial neoplasia grade 2

Objective: This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL).Methods: This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months.Results: Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant.Conclusions: The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution. © the authors.This study aimed at evaluating whether human papillomavirus (HPV) groups and E6/E7 mRNA of HPV 16, 18, 31, 33, and 45 are prognostic of cervical intraepithelial neoplasia (CIN) 2 outcome in women with a cervical smear showing a low-grade squamous intraepithelial lesion (LSIL).Methods: This cohort study included women with biopsy-confirmed CIN 2 who were followed up for 12 months, with cervical smear and colposcopy performed every three months.Results: Women with a negative or low-risk HPV status showed 100% CIN 2 regression. The CIN 2 regression rates at the 12-month follow-up were 69.4% for women with alpha-9 HPV versus 91.7% for other HPV species or HPV-negative status (P < 0.05). For women with HPV 16, the CIN 2 regression rate at the 12-month follow-up was 61.4% versus 89.5% for other HPV types or HPV-negative status (P < 0.05). The CIN 2 regression rate was 68.3% for women who tested positive for HPV E6/E7 mRNA versus 82.0% for the negative results, but this difference was not statistically significant.Conclusions: The expectant management for women with biopsy-confirmed CIN 2 and previous cytological tests showing LSIL exhibited a very high rate of spontaneous regression. HPV 16 is associated with a higher CIN 2 progression rate than other HPV infections. HPV E6/E7 mRNA is not a prognostic marker of the CIN 2 clinical outcome, although this analysis cannot be considered conclusive. Given the small sample size, this study could be considered a pilot for future larger studies on the role of predictive markers of CIN 2 evolution9152

Factors associated with false-negative cervical cytopathological results

Purpose: to evaluate whether factors related to the adequacy of the sample, cell pattern and cytomorphological criteria are associated with false-negative (FN) results of cervical cytopathology during routine examinations. Methods: this is a case-control study in which the study group included 100 cytopathologic smears with FN results detected during systematic internal quality control consisting of 100% rapid review. For each FN result detected, two smears with a true-positive diagnosis were identified by the same cytotechnician and these constituted the control group, making a total sample size of 300 smears. The variables were established in accordance with the criteria defined for the analysis of sample adequacy, cell pattern and cytomorphological analyzed criteria. The results were evaluated using bivariate analysis and logistic regression with stepwise variable selection criteria expressed in OR (95%). Results: the number of atypical cells, the appearance of nuclear chromatin, and the distribution and presentation of atypical cells in the smear were the variables that showed the greatest risk for FN results with OR of 9.6, 4.2, 4.4, and 3.6, respectively. Inflammatory processes and the presence of blood in the smear were also identified as variables that influence the risk of FN results. Conclusions: the majority of the factors associated with FN results are dependent on the conditions and techniques of sample collection, since in the majority of cases, the lesion may not be adequately represented in the smear. Confounding factors such as blood and inflammatory processes may also impair analysis. With respect to cytomorphological alterations, thin chromatin strand was the variable that indicated the greatest risk of FN results.Verificar se, no escrutínio de rotina, fatores relacionados com a adequabilidade da amostra, padrão celular e critérios citomorfológicos estão associados a resultados falso-negativos (FN) dos exames citopatológicos. Métodos: trata-se de um estudo caso-controle, no qual o grupo de casos incluiu 100 esfregaços citopatológicos com um resultado FN que foi detectado pela sistemática de controle interno da qualidade com revisão rápida de 100%. Para cada resultado FN detectado foram identifi cados,pelo mesmo citotécnico, dois esfregaços com um diagnóstico verdadeiro-positivo e este grupo foi considerado controle, totalizando uma casuística de 300 esfregaços. As variáveis analisadas foram estabelecidas de acordo com os critérios defi nidos para a análise da adequabilidade da amostra, padrão celular e critérios citomorfológicos. Os resultados foram avaliados por análise bivariada e regressão logística com critério de seleção de variáveis stepwise e expressos em OR (95%). Resultados: o número de células atípicas, aspecto da cromatina nuclear, distribuição e apresentação de células atípicas no esfregaço apresentaram risco maior para resultados FN, com OR de 9,6; 4,2; 4,4 e 3,6, respectivamente. Processo infl amatório e presença de sangue no esfregaço mostraram também risco para os resultados FN. Conclusões: a maioria dos fatores associados à liberação de um resultadoFN é dependente das condições e técnicas de coleta de material, pois, em grande parte, a lesão pode não estar adequadamente representada no esfregaço, e também fatores obscurecedores como sangue e processo infl amatório podem prejudicar a análise. Quanto às alterações citomorfológicas, cromatina fi na foi a característica que apresentou maior risco para resultados FN288479485To evaluate whether factors related to the adequacy of the sample, cell pattern and cytomorphological criteria are associated with false-negative (FN) results of cervical cytopathology during routine examinations. Methods: this is a case-control study in which the study group included 100 cytopathologic smears with FN results detected during systematic internal quality control consisting of 100% rapid review. For each FN result detected, two smears with a true-positive diagnosis were identified by the same cytotechnician and these constituted the control group, making a total sample size of 300 smears. The variables were established in accordance with the criteria defined for the analysis of sample adequacy, cell pattern and cytomorphological analyzed criteria. The results were evaluated using bivariate analysis and logistic regression with stepwise variable selection criteria expressed in OR (95%). Results: the number of atypical cells, the appearance of nuclear chromatin, and the distribution and presentation of atypical cells in the smear were the variables that showed the greatest risk for FN results with OR of 9.6, 4.2, 4.4, and 3.6, respectively. Inflammatory processes and the presence of blood in the smear were also identified as variables that influence the risk of FN results. Conclusions: the majority of the factors associated with FN results are dependent on the conditions and techniques of sample collection, since in the majority of cases, the lesion may not be adequately represented in the smear. Confounding factors such as blood and inflammatory processes may also impair analysis. With respect to cytomorphological alterations, thin chromatin strand was the variable that indicated the greatest risk of FN result

Intoxicação por monofluoroacetato em animais

O monofluoroacetato (MF) ou ácido monofluoroacético é utilizado na Austrália e Nova Zelândia no controle populacional de mamíferos nativos ou exóticos. O uso desse composto é proibido no Brasil, devido ao risco de intoxicação de seres humanos e de animais, uma vez que a substância permanece estável por décadas. No Brasil casos recentes de intoxicação criminosa ou acidental têm sido registrados. MF foi identificado em diversas plantas tóxicas, cuja ingestão determina "morte súbita"; de bovinos na África do Sul, Austrália e no Brasil. O modo de ação dessa substância baseia-se na formação do fluorocitrato, seu metabólito ativo, que bloqueia competitivamente a aconitase e o ciclo de Krebs, o que reduz produção de ATP. As espécies animais têm sido classificadas nas quatro Categorias em função do efeito provocado por MF: (I) no coração, (II) no sistema nervoso central (III) sobre o coração e sistema nervoso central ou (IV) com sintomatologia atípica. Neste trabalho, apresenta-se uma revisão crítica atualizada sobre essa substância. O diagnóstico da intoxicação por MF é realizado pelo histórico de ingestão do tóxico, pelos achados clínicos e confirmado por exame toxicológico. Uma forma peculiar de degeneração hidrópico-vacuolar das células epiteliais dos túbulos uriníferos contorcidos distais tem sido considerada como característica dessa intoxicação em algumas espécies. O tratamento da intoxicação por MF é um desafio, pois ainda não se conhece um agente capaz de reverte-la de maneira eficaz; o desfecho geralmente é fata

Why Does The Prevalence Of Cytopathological Results Of Cervical Cancer Screening Can Vary Significantly Between Two Regions Of Brazil? [por Que A Prevalência De Resultados Citopatológicos Do Rastreamento Do Câncer Do Colo Do útero Pode Variar Significativamente Entre Duas Regiões Do Brasil?]

PURPOSE: To analyze the prevalence of cervical cytopathological results for the screening of cervical cancer with regard to women's age and time since the last examination in Maceió and Rio de Janeiro, Brazil, among those assisted by the Brazilian Unified Health System. METHODS: Cervical cytopathological results available in the Information System of Cervical Cancer Screening for the year 2011 were analyzed, corresponding to 206,550 for Rio de Janeiro and 45,243 for Maceió. RESULTS: In Rio de Janeiro, examination at one and two year intervals predominated, while in Maceió examination at one and three year intervals had a higher predominance. Women who underwent cervical smear screening in Maceió were older than those in Rio de Janeiro. The prevalence of invasive squamous cell carcinoma was similar for the two cities, but all the other results presented a higher prevalence in Rio de Janeiro: ASCUS (PR=5.32; 95%CI 4.66-6.07); ASCH (PR=4.27; 95%CI 3.15-5.78); atypical glandular cells (PR=10.02; 95%CI 5.66-17.76); low-grade squamous intraepithelial lesions (PR=6.10; 95%CI 5.27-7.07); high-grade squamous intraepithelial lesions (PR=8.90; 95%CI 6.50-12.18) and adenocarcinoma (PR=3.00; 95%CI 1.21-7.44). The rate of unsatisfactory cervical samples was two times higher in Maceió and that of rejected samples for analysis was five times higher in Maceió when compared to Rio de Janeiro. CONCLUSIONS: The prevalence rates of altered cervical cytopathological results was significantly higher in Rio de Janeiro than in Maceió. There is no objective information that may justify this difference. One hypothesis is that there may be a difference in the diagnostic performance of the cervical cancer screening, which could be related to the quality of the Pap smear. Thus, these findings suggest that it would be necessary to perform this evaluation at national level, with emphasis on the performance of cervical cancer screening in order to improve the effectiveness of cervical cancer control.365192197International Agency For Research On Cancer, , http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx, World Health Organization [Internet], GLOBOCAN 2012: estimated cancer incidence, and mortality and prevalence worldwide in 2012: cancer fact sheets. Lyon: IARC2013 [cited 2014 Apr 22]. Available fromAkinyemiju, T.F., Socio-economic and health access determinants of breast and cervical cancer screening in low-income countries: Analysis of the world health survey (2012) PLoS One, 7 (11), pp. e48834Coordenação De Prevenção E Vigilância [Internet], , http://portal.saude.sp.gov.br/resources/ses/perfil/gestor/homepage/estimativas-de-incidencia-de-cancer-2012/estimativas_incidencia_cancer_2012.pdf, Coordenação Geral De Ações Estratégicas Ministério Da Saúde. Instituto Nacional De Câncer José Alencar Gomes Da Silva. Brasil, Estimativa 2012: incidência de câncer no Brasil. Rio de Janeiro: INCA2011 [citado 2013 Ago 12]. Disponível emMathew, A., George, P.S., Trends in incidence and mortality rates of squamous cell carcinoma and adenocarcinoma of cervix--worldwide (2009) Asian Pac J Cancer Prev, 10 (4), pp. 645-650DATASUS [Internet], , http://www2.datasus.gov.br/DATASUS/index.php?area=06, Ministério Da Saúde Brasil, Sistemas e aplicativos [citado 2013 Set 20]. Disponível emInstituto Brasileiro De Geografia E Estatística [Internet], , http://www.ibge.gov.br/home/download/estatistica.shtm, Download: estatísticas [citado 2013 Set 20]. Disponível emInstituto Brasileiro De Geografia E Estatística [Internet], , http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/indicadoresminimos/default_minimos.shtm, Indicadores sociais mínimos [citado 2013 Ago 12]. Disponível emDATASUS [Internet], , http://w3.datasus.gov.br/siscam/index.php?area=0403, Ministério Da Saúde Brasil, SISCOLO/SISMAMA: sistema de informação do câncer de colo do útero e sistema de informação do câncer de mama: informações estatísticas: Siscolo 4.00 ou superior [citado 2013 Set 20]. Disponível emInstituto Nacional De Câncer [Internet], , http://mortalidade.inca.gov.br/Mortalidade/prepararModelo04.action, Ministério Da Saúde Brasil, Atlas de mortalidade por câncer [citado 2013 Set 20]. Disponível em(2006) Instituto Nacional De Câncer José Alencar Gomes Da Silva, , Ministério Da Saúde Brasil, Coordenação de Prevenção e Vigilância. Nomenclatura brasileira para laudos cervicais e condutas preconizadas: recomendações para profissionais de saúde. 2a ed. Rio de Janeiro: INCAInstituto Nacional De Câncer José Alencar Gomes Da Silva [Internet], , http://www2.inca.gov.br/wps/wcm/connect/agencianoticias/site/home/noticias/2010/escola_secao_integrada_citopatologia_inca, Ministério Da Saúde Brasil, Novos equipamentos da SITEC vão melhorar qualidade de exames citológicos. 2010 [citado 2013 Maio 9]. Disponível em(2012) Instituto Nacional De Câncer José Alencar Gomes Da Silva, 3 (1). , http://www1.inca.gov.br/inca/Arquivos/informativo_detecprecoce_1.2_2012.pdf, Ministério Da Saúde Brasil, Monitoramento das ações de controle dos cânceres do colo do útero e de mama. Bol Inf Detecção Precoce [Internet], [citado 2013 Maio 9]. Disponível emVale, D.B., Westin, M.C., Zeferino, L.C., High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion (2013) Cancer Cytopathol, 121 (10), pp. 576-581Fahey, M.T., Irwig, L., Macaskill, P., Meta-analysis of Pap test accuracy (1995) Am J Epidemiol, 141 (7), pp. 680-689Nanda, K., McCrory, D.C., Myers, E.R., Bastian, L.A., Hasselblad, V., Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review (2000) Ann Intern Med, 132 (10), pp. 810-819Tavares, S.B., de Alves, S.N.L., Manrique, E.J., de Pinheiro, A.Z.B., Zeferino, L.C., Amaral, R.G., Improvement in the routine screening of cervical smears: A study using rapid prescreening and 100% rapid review as internal quality control methods (2011) Cancer Cytopathol, 119 (6), pp. 367-376Azara, C.Z., Manrique, E.J., de Alves, S.N.L., Rodrigues, A.R., Tavares, S.B., Amaral, R.G., External quality control of cervical cytopathology: Interlaboratory variability (2013) Acta Cytol, 57 (6), pp. 585-590Amaral, R.G., Manrique, J.C., Guimarães, J.V., Sousa, P.J., Mignoli, J.R.Q., Influence of adequacy of the sample on detection of the precursor lesions of the cervical cancer] (2008) Rev Bras Ginecol Obstet, 30 (11), pp. 556-560Franco, F., Amaral, R.G., Montemor, E.B.L., Montis, D.M., Morais, S.S., Zeferino, L.C., Factors associated with false-negative cervical cytopathological results (2006) Rev Bras Ginecol Obstet, 28 (8), pp. 479-485Monitoramento Das Ações Do Controle Do Câncer Do Colo Do Útero E De Mama [Internet], , http://www1.inca.gov.br/inca/Arquivos/inform.deteccaoprecoce.pdf, Ministério Da Saúde. Instituto Nacional De Câncer Brasil, Bol Inf Detecção Precoce. 2010;1 [citado2012 Jul 13]. Disponível e