Download analysis of the results of cytopathological tests of uterine cervix

DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201502
ISSN: 1981-8963
Moraes MN, Jerônimo CGF.
Analysis of the results of cytopathological...
ORIGINAL ARTICLE
ANALYSIS OF THE RESULTS OF CYTOPATHOLOGICAL TESTS OF UTERINE
CERVIX
ANÁLISE DOS RESULTADOS DE EXAMES CITOPATOLÓGICOS DO COLO UTERINO
ANÁLISIS DE LOS RESULTADOS DE EXAMENES CITOPATOLOGICOS DEL CUELLO UTERINO
Marina do Nascimento Moraes1, Camila Gondim da Fonseca Jerônimo2
ABSTRACT
Objective: describing the results of cytopathology of the uterine cervix in women aged 25-64 in the
Municipality of João Pessoa, from 2009 to 2013. Method: a retrospective study based on the results of 118.795
examinations in Family Health Units of the Municipality of João Pessoa, State of Paraiba. Data were obtained
through research in the System Database Information about cervical cancer - SISCOLO. Results: 44.327
examinations were performed in 2009, 43.909 in 2010, 33.008 in 2011, 41.272 in 2012 and 26.279 in 2013. The
samples were analyzed for coverage of prevention of cervical cancer in women 25 to 64 years old, adequacy
of samples, microbiology changes, and benign cervical changes, atypical in squamous and glandular cells.
Conclusion: from data found in this study highlights the lower results of intraepithelial lesion high-grade
squamous, which fell from 110 in 2009 to 49 in 2013. This decrease suggests an improvement in the early
detection of precursor changes, effectivating the main purpose of the examination. Descriptors: Women's
Health; Cervix of Uterus; Thesis Papanicolau.
RESUMO
Objetivo: descrever os resultados dos exames citopatológicos do colo uterino nas mulheres de 25 a 64 anos no
Município de João Pessoa, no período de 2009 a 2013. Método: estudo retrospectivo, baseado nos resultados
de 118.795 exames realizados em Unidades de Saúde da Família do Município de João Pessoa, Estado da
Paraíba. Os dados foram obtidos por meio de pesquisa no banco de dados do Sistema de Informação do câncer
de colo de útero – SISCOLO. Resultados: foram realizados 44.327 exames em 2009, 43.909 em 2010, 33.008
em 2011, 41.272 em 2012 e 26.279 em 2013. As amostras foram analisadas quanto à cobertura da prevenção
do câncer cervico-uterino nas mulheres de 25 a 64 anos, adequação das amostras, alterações da
microbiologia, alterações cervicais benignas, atipias em células escamosas e glandulares. Conclusão: a partir
dos dados encontrados nesse estudo destaca-se a diminuição dos resultados de lesão intraepitelial escamosa
de alto grau, que caiu de 110, em 2009, para 49 em 2013. Essa diminuição sugere uma melhora na detecção
precoce de alterações precursoras, efetivando o principal objetivo da realização do exame. Descritores:
Saúde da Mulher; Colo de Útero; Tese de Papanicolau.
RESUMEN
Objetivo: describir los resultados de la citopatología de cuello uterino en mujeres de 25-64 años en João
Pessoa entre 2009 y 2013. Método: es un estudio retrospectivo basado en los resultados de 118.795 exámenes
de las Unidades de Salud Familiar del Condado João Pessoa, Estado de Paraíba. Los datos fueron obtenidos a
través de la investigación en la base de datos del Sistema de Información acerca de cáncer de cuello uterino Siscolo. Resultados: 44.327 exámenes fueron realizados en 2009, 43.909 en 2010, 33.008 en 2011, 41.272 en
2012 y 26.279 en 2013. Las muestras fueron analizadas para la cobertura de la prevención del cáncer de
cuello uterino en mujeres de 25 a 64 años, la adecuación de las muestras, cambios de microbiología, cambios
cervicales benignos, células escamosas y glandulares atípicas. Conclusión: a partir de los datos encontrados
en este estudio destacan los resultados más bajos de escamosas de alto grado de lesión entra-epitelial, que
pasó de 110 en 2009 a 49 en 2013. Este descenso sugiere una mejora en la detección temprana de los cambios
precursoras, efectuando el objetivo principal del examen. Descriptores: Salud de la Mujer; Cuello Úterino;
Tesis de Papanicolaou.
1
Nurse, Master of Nursing, Federal University of Paraiba/UFPB. João Pessoa (PB), Brazil. Email: [email protected]; 2Physical
Therapist, Specialist in Women's Health. João Pessoa (PB), Brazil. Email: [email protected]
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J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
7510
ISSN: 1981-8963
Moraes MN, Jerônimo CGF.
INTRODUCTION
DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201502
Analysis of the results of cytopathological...
national coverage of this test still lies below
the recommended WHO.5
In Brazil, the high number of incidence and
mortality from cervical cancer justify the
implementation of prevention and cancer
control (promotion, prevention, diagnosis,
treatment, rehabilitation and palliative care),
based on the guidelines of the National
Policy.1
The Ministry of Health sets the frequency
the preventive examination of the cervix once
a year and, after two consecutive negative
annual examinations every three years in
women 25-60 years of age, according to the
recommendations the main international
programs.2
Cervical cancer is a slow and silent growth
disease initially presents a pre-clinical stage,
asymptomatic, and important progressive
intraepithelial changes. These changes
progress slowly for years, until the attacker
stage of the disease, often was not possible to
cure.2
The determination of the age group for
carrying out the screening is justified by the
low incidence of cervical cancer in women
under 24, where most cases are diagnosed in
stage I and tracking is less efficient to detect
them.6
The estimate of the National Cancer
Institute for the year 2014 and 2015 shows the
occurrence of approximately 576.000 new
cases of cancer in Brazil, including nonmelanoma skin cases, reinforcing the
magnitude of the cancer problem in the
country. Among women, excluding cases of
non-melanoma skin, breast cancer, 57.000,
will be the most prevalent, followed by
cervical cancer, with an estimated 15.000 new
cases.3
Also according to the INCA (2014), Paraiba
is estimated for the current year the
occurrence of 290 new cases of cervical
cancer, of which 70 are expected in the city
of João Pessoa, smaller numbers compared to
the estimated 2012 which was 320 new cases
for the State and 80 to João Pessoa.
The incidence of cervical cancer is
manifested from the range of 30 years old,
increasing their risk quickly up to the age
peak between 50 and 60. In 2012 this cancer
was responsible for the death of 265,000
women, of these 87% were in developing
countries. Thus, for cancer of the cervix, the
already mentioned INCA study showed an
approximate survival of 70%.3
According to research the early detection
of cervical cancer should be performed from
the early screening of lesions and appropriate
treatment to prevent the onset of disease.
Among the detection techniques, the Pap
smear of the cervix is considered as the most
effective and efficient for screening. The
World
Health
Organization
(WHO)
recommends the exam every three years for
women 25 to 64 years old, after two negative
tests with annual range.4
Regular Pap smear testing continuous being
the most widely adopted strategy for
screening of cervical cancer. However,
although the cervical cytology examination
was introduced in Brazil in the 1950s, the
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J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
The squamous cell carcinoma is the most
common histological type of cervical cancer,
about 85% to 90% of cases, followed by
adenocarcinoma. The main risk factor for the
development of high-grade intraepithelial
lesions and cervical cancer is infection with
human papilloma virus. However the presence
of the virus by itself, is not sufficient to cause
the development of cancer, it is necessary
persistence.3
Thus this article aims to describe the
results of cytopathology of the uterine cervix
in women 25-64 years in João Pessoa County
from 2009 to 2013.
METHOD
Article prepared for completion Course
presented to the Specialization Course in
Basic Care Management and Health MicroRegional Networks, of the Department of
Health Promotion of the Federal University of
Paraiba/UFPB. João Pessoa, PB, Brazil. 2014
This study analyzed the results of cervical
screening cervical women aged 25-64 years
old conducted in health centers of the city of
João Pessoa Family, State of Paraiba.
The study was retrospective, based on the
results of 118.795 examinations performed
between January 2009 and November 2013.
Data were obtained by searching the System
Database Information on cervical cancer SISCOLO.
The results were presented descriptively,
on presentation and analyses of the results
and discussion, cervical changes followed the
Brazilian Nomenclature for Cervical Reports
and have been described in subgroups:
Coverage of prevention of cervical cancer in
women 25 to 64 years old, adequacy of
samples, microbiology changes, and benign
cervical changes, atypical squamous and
glandular cells.
The data were entered into a database,
processed and analyzed using the statistical
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DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201502
ISSN: 1981-8963
Moraes MN, Jerônimo CGF.
Analysis of the results of cytopathological...
program using the Statistical Package for
Social Sciences SPSS, version 18. The
statistical analysis was realized in a
descriptive way with the use of relative
frequency (%) and absolute (N).
RESULTS
Figure 1 shows the total amount of the
procedures performed each year among
women 25 to 64 years old.
Figure 1. Coverage of cervico-uterine cancer prevention in women 25 to 64 years old.
Concerning the adequacy of the material
found little variation during the study period,
with predominant presence of satisfactory
material.
Table 1. Adequacy of the samples
2009
2010
2011
2012
2013
Satisfactory
44.185
43.817
32.775
41.217
26.249
%
99,68
99,80
99,30
99,87
99.89
Table
2
shows
the
results
with
microbiological findings, among them include
changes related to sexually transmitted
diseases such as Trichonomas vaginalis which
Unsatisfactory
142
92
233
55
30
%
0,32
0,20
0,70
0,13
0,11
showed a considerable decrease (83,3%)
during the period. The values found for
Chlamydia sp and Actinomyces were much
prevalent.
Table 2. Changes in Microbiology.
2009
2010
2011
2012
2013
Actinomyces
16
3
1
0
2
Chlamydia
0
3
2
3
0
Coccobacilos
19.632
21.745
16.167
17.793
10.847
Lactobacilli
14.956
14.829
10.958
14.378
9.766
Supra-Cythoplasmatic /
Gardnerella Vaginalis
Trichonomas
7.523
6.427
4.139
4.454
2.512
2.101
1.662
863
785
351
There are considered benign cervical
changes the changes of epithelial cells, and
may appear as atrophy, inflammation,
metaplasia, radiation and repair. Generally
these changes are determined by the action of
English/Portuguese
J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
physical agents, which may be radioactive,
mechanical or thermal, chemical, or caustic
as abrasives drugs, chemotherapeutic and
vaginal acidity on glandular epithelium.2
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DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201502
ISSN: 1981-8963
Moraes MN, Jerônimo CGF.
Table 3. Benign cervical changes.
2009
Atrophy
2.945
Inflammation
27.131
Metaplasia
2.337
Radiation
7
Reparation
1.323
Other
90
Analysis of the results of cytopathological...
2010
2.747
25.448
2.330
13
935
107
The findings of intra-epithelial lesion of
low grade are chance of 15% to 30% of biopsy
compatible with CIN II and CIN III. Already in
about 70% to 75% of reports of intraepithelial
Table 4. Atypical squamous cells.
Year
Low grade
High grade
squamous
squamous
intraepithelial
intraepithelial
lesion
lesion
2009
165
110
2010
112
110
2011
85
81
2012
182
123
2013
104
49
Table 5. Atypical glandular cells.
Adenocarcinoma
in situ
2009
0
2010
1
2011
0
2012
1
2013
0
DISCUSSION
● Coverage of prevention of cervical
cancer in women aged 25 to 64
This study revealed that the assessed
municipality,
conducting
cytological
examination of the cervix in women 25-64
years old hit the proposed target by the
Ministry of Health, which ranged over the
period, with 44.327 made in 2009, 43.909 in
2010, 33.008 in 2011, 41.272 in 2012 and
26.279 in 2013.
The coverage rate in 2009 (21,44%) was
lower than that in the state of Pernambuco in
a survey conducted in the same year, where
the results point to a coverage of more than
60% among women 25-64 years old. These
stands out a significant concentration of
women without children, but reproductive
aged that are discovered by the screening test
and there is the presence of social inequality
in the exam, although not too prominent by
the limits of the sample.7
Following the trend study that evaluated
the coverage of examinations in Amparo,
State of Sao Paulo8, and the population
coverage on the basis of examinations
performed between varied and tended to
decrease. Whereas the Ministry of Health
standards recommend every three years, that
is, the coverage that interests the government
is the percentage of women who had at least
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J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
2011
2.205
19.139
1.709
6
798
68
2012
3.070
26.855
3.801
11
482
52
2013
2.167
16.916
2.095
7
130
47
lesion severity present histopathological
diagnosis confirmation and 1% to 2% will have
a histopathologic diagnosis of carcinome.6
Squamous
intraepithelial
lesion micro-invasor
Epidermoid
carcinoma invasor
13
7
11
42
16
1
0
4
3
4
Adenocarcinoma
invasor
0
1
0
1
4
one test in the last three years. Thus, despite
the observed decrease in annual coverage, the
three-year coverage was favored by the
increase in the percentage of women who
underwent controls at intervals of two to
three years.
● Adequacy of the samples
According to the Brazilian guidelines for
the screening of cervical cancer are classified
as satisfactory, samples presenting cells in a
representative amount, well distributed, fixed
and stained, allowing their observation and
diagnostic conclusion. May be present in these
samples representative cells of the epithelium
of the cervix, as squamous cells, glandular
and/or metaplastic.6
The suitability of results during the period
in the study, over 99% were similar to those
found in the analysis of 395 tests carried out
in Canoas, Rio Grande do Sul, where 100% of
the collected material was considered
satisfactory.9
● Changes of Microbiology
The microbiological changes are found
present in all the tests previously examined,
that are expected the presence of microorganisms that are part of the vaginal flora
characterized infections and not require
treatment. Among them we can mention the
Lactobacillus sp, coccus and other bacilli.5
The result found was markedly lower than
that found in a survey conducted in Natal/Rio
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Grande do Norte, between 2005 and 201010,
where for the same age group prevailed
Gardnerella vaginalis (47,2%), Candida sp.
(73,0%) and Chlamydia sp. (60,2%), all agents
associated with the development of cervical
cancer, especially Chlamydia sp. and
Trichonomas vaginalis.
● Benign cervical changes
According to the Brazilian guidelines for
the screening of útero6 cervical cancer,
benign changes are considered the presence
of inflammation, repair, atrophy, metaplasia
or radiation as a result of cervical
examination.
This study found benign cervical lesions,
which highlights the presence of inflammation
as the most recurrent. In a study conducted in
Bandeirantes, State of Paraná11, 52,37% were
found benign cellular changes, especially
inflammation, metaplasia and atrophy.
● Atypical squamous cells and glandular
Cervical intraepithelial neoplasia (CIN) is a
pre-invasive disease preceding cervical cancer
and is characterized in degrees according to
the thickness of the epithelium showing
mature and differentiated cells in CIN I, II and
III. The CIN I, the slightest degree, for the
most part does not progress and is not
considered precursor lesion. Already the most
severe levels (II and III), is likely to progress to
cervical cancer if not treated properly.6
It has been found to lower results
suggestive of atypical squamous cells,
especially
of
high-grade
squamous
intraepithelial lesion, which fell from 110 in
2009 to 49 in 2013. This decrease can suggest
an improvement in the early detection of
precursor changes, not allowing the evolution
of more severe changes as CIN II and III.
In a study conducted in Belem, State of
Para, analyzing the results of 363 cytological
examinations of cervical intraepithelial
cervical neoplasia was much prevalent,
accounting for 0.82% of the cases.12
A survey conducted by the National Cancer
Institute based on the results of all tests
performed in 2009 showed that about 48% to
69% of women with suggestive cytological
report of adenocarcinoma in situ had
confirmation of injury to histopathology and,
of these, 38 % had invasive adenocarcinoma
report. Therefore, the orientation of this
Institute is that all patients with cytology
adenocarcinoma in situ, found in the Basic
Health Unit, should be directed to the
Average Reference Unit Complexity for
immediate colposcopy, as well as the carriers
of suggestive cytological report invasive
adenocarcinoma.5
English/Portuguese
J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
DOI: 10.5205/reuol.7049-61452-1-ED.0903supl201502
Analysis of the results of cytopathological...
A systematic review of articles that
evaluated the relation between glandular cell
atypia with the presence of benign, preneoplastic and neoplastic revealed that
invasive lesions have a variation in invasive
squamous cell carcinoma of the percentage of
0,89% to 4,44% and cervical adenocarcinoma
from 1,4% to 18%. Of the studies reviewed
only one report found no association with
malignancy.13
Thus, the approach recommended for
women
with
histopathological
lesions
suggestive
and
examination
of
adenocarcinoma in situ (about 48-69%), or
invasive adenocarcinoma (38%), in tests
performed in the Family Health Units, should
have the clinical management referral for
immediate colposcopy, as well as the carriers
suggestive
examination
of
invasive
adenocarcinoma.5
FINAL NOTES
The Pap smear testing is an essential tool
in the early detection of changes that may
lead to the development of cervical cancer. It
is a simple, fast, effective and low cost, which
must every day be more stimulated both by
management but also by professionals of the
Family Health Teams.
Reflective study based on literature14
review shows that if carried out diagnostic
tests and early treatment risks of injury
progress to neoplasia are rare and the quality
of life of users improves markedly.
From the data found in this study highlights
the lower results of intraepithelial lesion highgrade squamous, which fell from 110 in 2009
to 49 in 2013. This decrease suggests an
improvement in the early detection of
precursor changes effectivating the main
purpose of the examination.
The knowledge of the health status of a
population is crucial to decision-making
concerning not only for the treatment of
pathologies, but primarily for the planning of
actions for prevention of diseases and health
promotion, always seeking the effectivity and
efficaciousness of health services.
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English/Portuguese
J Nurs UFPE on line., Recife, 9(Suppl. 3):7510-5, Apr., 2015
Submission: 2014/04/13
Accepted: 2015/03/13
Publishing: 2015/04/15
Corresponding Address
Camila Gondim da Fonseca Jerônimo
Rua Severino Nicolau de Melo, 268
Bairro Jardim Oceania
CEP 58037-700  João Pessoa (PB) Brazil
7515