ASPECTE CITOLOGICE ALE SCREENINGULUI CANCERULUI DE COL UTERIN

INTRODUCTION: Romania ranks first in Europe in terms of cervical cancer mortality (10.77%), over 6 times more than the average of European Union countries. Of all cancers in women, occupies 4th place in terms of mortality rate after breast, colorectal and lung cancer. Cervical cancer is caused by persistent and common infections of the female genital tract by human papilloma virus (HPV).  Currently there is no treatment for HPV, reducing the incidence of cervical cancer can be achieved through organized screening programs and anti-HPV vaccination of female patients at young age. European Union Council recommends early detection of cervical cancer through programs organized for the population, providing quality services at all levels. THE AIM of the study was the identification of determinants for squamous intraepithelial lesions and assess the importance of classical cytology in detecting cervical cancer at an early stage. MATERIAL AND METHODS: We selected a group of 405 patients with positive Babeş-Papanicolaou test results from the total number of women tested during 2015 by the screening program organized at the Emergency County Hospital in Tg-Mureș. We performed a retrospective study on the previously mentioned group of women, demographic, obstetric and medical history data were collected from FS1 screening forms belonging to the Centre Region Management Technical Assistance Unit of the active screening program for early cervical cancer. The study group included women aged 25-64, asymptomatic and without known disease in the genital area. RESULTS: The accessibility of women to Babeş-Pap testing has become more visible since the implementation of organized screening program. The accessibility of women to Babeş-Pap testing has become more visible since the implementation of organized screening program. In the studied group, 52.25% of  the women had regular menstrual cycle and 32.5% of them were at menopause. Batch analysis of the studied group of patients showed that in case of 47.75% of the women the presence of lesions at macroscopic examination of the cervix has been identified. In 12% of the patients the presence of leucorrhea was noted and bleeding of the cervix has been described in 2% of the women. Only 0.75% of the women included in the study benefited from hormonal treatment and a percentage of 1.25% were pregnant at the time of the Babeş-Pap test. Analysis of the group of women from the point of view of microbiological examination showed infection with Gardnerella vaginalis in 44% and Trichomonas co-infection in 42%. Of patients selected by interpreting the results using the Bethesda cytology method, the majority (42.25%) were classified in the cytodiagnostic ASCUS class, and a percentage of 26.75 were included in the ASC-H class. Management of intraepiteliale lesions presented in 5 cases showed investigations applying differentiated therapies and the importance of  follow-up screening. CONCLUSIONS: Implementing screening of cervical cancer remains a challenge as it involves complex coordination of medical services. Urban women benefit from easier access to specialized medical services, but still a large percentage of women included in the Regional Units’ screening underwent Pap test for the first time in life.Our study identified a small percentage of high-grade squamous intraepithelial lesions, but for these women case management is essential for investigation and early treatment to stop the development of dysplasia. The major benefit of screening for cervical cancer is especially identifying these cases of high-grade dysplasia, treatment applied in time decreasing the incidence of cervical cancer   Keywords: cervix, screening, cytology, dysplasiaINTRODUCERE: România se situează pe primul loc din Europa în ceea ce priveşte mortalitatea cauzată de cancerul de col uterin, de peste 6 ori mai mult decât media ţărilor din Uniunea Europeană. Din totalul cancerelor la sexul feminin, cancerul de col ocupă locul 4 în ceea ce priveşte rata de mortalitate, după cancerul de sân, colorectal şi cel pulmonar. Cancerul de col uterin este cauzat de infecţiile persistente şi comune ale tractului genital uterin cu virusul papilloma uman (HPV-human papilloma virus). La momentul actual nu există tratament împotriva HPV, reducerea incidenţei cancerului de col uterin se poate realiza prin programe organizate de screening şi prin vaccinarea sexului feminin anti-HPV la vârste tinere. SCOPUL STUDIULUI a fost identificarea factorilor determinanţi ai leziunilor scuamoase intraepiteliale şi evaluarea importanţei citologiei clasice în detecţia precoce a cancerului de col uterin. MATERIAL ŞI METODĂ: A fost efectuat un studiu retrospectiv asupra unui lot de 405 paciente cu rezultate pozitive ale testului Babeş-Papanicolaou, selectate din cazuistica Reţelei de Screening organizate în cadrul Spitalului Clinic Judeţean de Urgenţă Tg-Mureş, din numărul total de femei testate în cursul anului 2015. Datele demografice, antecedentele obstetricale şi medicale le-am cules din formularele de screening FS1. Lotul studiat a inclus femei cu vârsta între 25-64 de ani, asimptomatice şi fără afecţiuni cunoscute în sfera genitală. REZULTATE: Accesibilitatea femeilor la testarea Babeş-Papanicolaou a devenit mai vizibilă odată cu implementarea programului de screening organizat. Din lotul total studiat, 52,25% de femei au avut ciclul regulat, iar 32,5 % erau la menopauză. Analiza lotului de paciente a evidenţiat că la examenul macroscopic al colului s-a identificat  prezenţa leziunilor evidente la un procent 47,75 % de femei. La 12% dintre femei s-a notat prezenţa leucoreei, iar sângerări ale colului uterin s-au descris doar la 2% dintre femei. Doar 0,75 % din femeile incluse în studiu beneficiau de tratament hormonal, iar 1,25 % erau însărcinate la momentul efectuării testului Babeş-Papanicolaou. Analiza lotului studiat din punct de vedere al examenului microbiologic a evidenţiat un procent de 44 % a infecţiei cu Gardnerella vaginalis şi 42% coinfecţii cu Trichomonas.Prin interpretarea rezultatelor citologice, prin metoda Bethesda 2001, majoritatea pacientelor (42,25 %) s-au încadrat în clasa citodiagnostică ASCUS şi un procent de 26,75  au avut ASC-H. Managementul leziunilor intraepiteliale prezente la 5 cazuri a demonstrat aplicarea diferenţiată a investigaţiilor şi a terapiilor şi importanţa follow-up-ului în screening. CONCLUZII: Studiile efectuate pe loturi de femei care au participat la programele de screening organizat au demonstrat că testarea Papanicolaou previne cancerul cervical. Studiul nostru a identificat un procent mic al leziunilor scuamoase intraepiteliale de grad înalt, dar pentru aceste femei este esenţial managementul cazului pentru investigaţii şi tratament precoce de stopare a evoluţiei displaziilor. Beneficiul major al screeningului cancerului de col uterin este identificarea tocmai a acestor displazii de grad înalt, tratamentul aplicat la timp cu scăderea incidenţei cancerului de col uterin.   Cuvinte-cheie: col uterin, screening, citologie, displazie