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AbstractIntroduction: This paper aims to develop a data warehouse (AD-SISCOLO) in order to support the management of the cervical cancer screening program in the municipality of Rio de Janeiro/Brazil. As a part of the management process, the program managers of the municipality perform tedious manual work in order to calculate a series of performance indicators and then take decisions based on them. Methods AD-SISCOLO was implemented using the Pentaho BI Suite Business Intelligence Platform and the MySQL database management system. The indicators to be calculated and visualized in the tool were based on the municipal data of the cytopathology and histopathology tests from January 2012 until December 2014, which was obtained from the Information System of Cervical Cancer (SISCOLO) after a record linkage process. The follow-up indicators were based on a simplified version of the Brazilian guidelines for the cervical cancer screening. Results AD-SISCOLO allows the visualization of a set of test-based and follow-up indicators from different views and dimensions, which enable managers to monitor all the phases of the screening process and to identify the process' failures. Conclusions Compared with the current available environments in Brazil, AD-SISCOLO is unique in its visualization of the follow-up indicators of groups of women, according to their test results and age. Thereby it provides presentation flexibility to suit the program manager's needs.

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Introdução: Estudos mostraram que a presença de elementos celulares representativos da zona de transformação do colo do útero na lâmina coletada para o exame citopatológico favorece a detecção das atipias celulares. Objetivo: Analisara associação entre a presença dos elementos celulares representativos da zona de transformação e a detecção de atipias celulares utilizando dados do Sistema de Informação do Câncer do Colo do Útero do Estado do Rio de Janeiro no período de junho de 2006 a dezembro de 2009. Método: Neste estudo retrospectivo, foi utilizada a variável “epitélios representados na amostra” para gerar um indicador da presença de elementos celulares representativos da zona detransformação. Esse indicador foi analisado quanto à sua associação com a variável “atipias celulares” (maior e menor gravidade). Resultados: Verificou-se que a chance de se encontrar atipias na presença de elementos celulares da zona de transformação foi 5,19 (5,10 - 5,28) vezes maior que na ausência. Considerando-se as atipias de maior gravidade, a chance de detecção na presença de elementos celulares da zona de transformação foi maior do que a observada em toda a amostra, sendo de 5,85 (5,62-6,08). Nos municípios, observou-se heterogeneidade nos percentuais de lâminas com representatividade da zona de transformação e de atipias. Conclusão: Evidenciou-se o potencial da base de dados para avaliar a diferença na detecção de atipias entre os grupos analisados, apontando a necessidade de esforços na elhoria da capacidade de obtenção de amostras com qualidade

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OBJECTIVE: To analyze the performance of cytologic examinations for the diagnosis of adenocarcinoma in situ (AIS) through the correlation between the cytologic and histologic findings. STUDY DESIGN: This study included 60 patients followed at the Brazilian National Cancer Institute from November 1998 to December 2007, with the cytopathologic diagnosis of AIS. The percentage of agreement between cytologic and histologic findings was evaluated. RESULTS: Histologic study confirmed AIS in 28.3% (17/60) and invasive endocervical adenocarcinoma in 38.3% (23/60) of the cases. In 21.7% (13/60) of the patients, the histologic examination revealed cervical intraepithelial neoplasia (CIN) 2/3 and in 5.0% (3/60) squamous invasive carcinoma; in the remaining 5.0% (3/60) the diagnosis pointed to other neoplasms, and 1.7% (1/60) showed exclusively benign squamous cell lesions. Cytology identified lesions in 98.3% of the patients; 51% was intraepithelial. CONCLUSION: Although cytomorphologic criteria for diagnosis of AIS have been published, there was significant difficulty in interpreting glandular lesions. However, despite the fact that cytology has shown a poor performance in identifying glandular lesions, in almost all cases (98.3%) the presence of a clinically significant injury was detected. As knowledge of this diagnosis increases, better performance is expected.

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Context and objective: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. Design and setting: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. Methods: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest...

Contexto e objetivo: A última atualização do Sistema Bethesda dividiu a categoria de células escamosas atípicas de significado indeterminado (ASCUS) em ASC-US (de significado indeterminado) e ASC-H (quando não se pode excluir lesão intra-epitelial de alto grau). Os objetivos deste estudo foram medir a prevalência da lesão pré-invasiva (Neoplasia Intra-epitelial Cervical, NIC II/III) e câncer cervical, de pacientes que foram encaminhadas ao Instituto Fernandes Figueira (IFF), com citologia ASC-H e compará-la com os casos ASC-US. Tipo de estudo e local: Estudo transversal com coleta de dados retrospectiva, que ocorreu no ambulatório de Patologia Cervical do IFF. Métodos: Casos com diagnóstico de ASCUS recebidos no IFF entre novembro de 1997 a setembro de 2007, foram revisados de acordo com o Sistema Bethesda 2001 até um diagnóstico de consenso. Os casos ASC-H e ASC-US resultantes desta revisão, e os casos novos, foram analisados em relação ao desfecho de interesse...

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CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

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Introdução: O adenocarcinoma de endocérvice é uma lesão rara e de mau prognóstico. Sua incidência vem aumentando, principalmente em mulheres jovens, enquanto se observa uma diminuição do carcinoma escamoso. Em seu estágio inicial, habitualmente, não tem expressão clínica ou colposcópica, o que dificulta sua detecção. O exame citopatológico é, na maioria das vezes, a única oportunidade de identificação destas lesões antes que evoluam para o adenocarcinoma invasor. Entretanto, os critérios utilizados para o diagnóstico são de baixa reprodutibilidade e, freqüentemente, o adenocarcinoma in situ é confundido com lesão intra-epitelial de alto grau e adenocarcinoma invasor. Objetivo: Identificar critérios morfológicos presentes no exame citopatológico, preditivos de adenocarcinoma in situ de endocérvice. Material e métodos: Foram analisados 54 critérios citomorfológicos em 26 casos com diagnóstico histopatológico de adenocarcinoma in situ, comparando-os com 63 casos de neoplasia intra-epitelial graus 2 ou 3 e 49 de adenocarcinoma invasor, identificados na Seção Integrada de Tecnologia em Citopatologia, na Divisão de Patologia, do Instituto Nacional de Câncer. Foi realizada revisão das lâminas, por dois citopatologistas, às cegas, dos exames citopatológicos que antecederam o diagnóstico. Foram construídos dois modelos de regressão logística. Resultados: Na comparação entre adenocarcinoma in situ e adenocarcinoma invasor revelaram-se preditores o fundo não necrótico (OR = 6,3; IC 95% 1,3-30,3; p = 0,024) e a ausência de nucléolo (OR = 4,3; IC 95% 1,3-13,9; p = 0,014). No modelo que comparou adenocarcinoma in situ a neoplasias intra-epiteliais cervicais graus 2 ou 3, os resultados indicaram plumagem (OR = 71,4; IC 95% 4,0-1266,2; p = 0,004), ausência de disceratose e o aumento da RNC apenas leve a moderado, (OR = 12,3 e 12,0; IC 95% 1,2-130,3 e 1,2-124,7; p = 0,037). Conclusão: O incremento da eficiência do diagnóstico precoce do adenocarcinoma in situ, cuja incidência tem aumentado nas últimas décadas, independentemente dos programas de rastreamento, reforça o papel do exame citopatológico na prevenção e controle deste câncer.

Introduction: Endocervical adenocarcinoma is a rare lesion of difficult prognosis. Its incidence is increasing, mainly among young woman, while a decrease in the squamous carcinoma is being observed. In its initial stage, it usually has no clinical or colposcopic expression, what makes its detection difficult. The cytological exam, in the majority of cases, is the only way to identify these lesions before they evolve into invasive adenocarcinoma. Meanwhile, the criteria used for diagnosis are of low reproducibility, and are often confused with high grade intraepitelial lesion and invasive endocervical adenocarcinoma. Objective: Identify morphologic criteria present in the cytological exam that can predict cervical adenocarcinoma in situ. Material and methods: 54 cytomorphological criteria of 26 cases with histopathological diagnosis of adenocarcinoma in situ were analyzed. Comparing them with 63 cases of cervical intraepithelial neoplasia grade 2 or 3 and 49 of invasive adenocarcinomas, identified in Section for Integrated Technology in Cytopathology, in the Pathology Division of National Cancer Institute. Two cytopathologists made a blind review of the slides of the cytopathological examinations that preceded the diagnosis. Two models of logistic regression were constructed. Results: In the comparison between adenocarcinoma in situ and invasive adenocarcinoma, predictors revealed were non necrotic background (OR = 6.3; IC 95% 1.3-30.3; p = 0.024) and the absence of nucleolus (OR = 4.3; IC 95% 1.3-13.9; p = 0.014). In the model that compared adenocarcinoma in situ to cervical intraepithelial neoplasia grade 2 or 3, the results indicated feathering (OR = 71.4; IC 95% 4.0-1266.2; p = 0.004), absence of dyskeratosis and the increase of NCR, only mild to moderate, (OR = 12.3 e 12.0; IC 95% 1.2-130.3 e 1.2-124.7; p = 0.037). Conclusion: The increase in the efficiency of early diagnosis of adenocarcinoma in situ, the incidence of which has increased over the last decades, regardless of tracking programs, strengthens the role of the cytopathological examination in the prevention and control of this cancer.

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