RESUMO
BACKGROUND: Some studies reported that differential gene expression could be used as a biomarker for high-grade cervical lesion identification. The aim was to evaluate the gene expression profile of cervical intraepithelial neoplasia (CIN) to identify a gene expression signature of CIN2+ in liquid-based cytology (LBC) samples. METHODS: LBC samples (n = 85) obtained from women who underwent colposcopy were included with benign (n = 13), CIN1 (n = 26), CIN2 (n = 16), and CIN3 (n = 30) diagnoses. After RNA isolation, gene expression profiling was performed using the nCounter PanCancer Pathways, which consists of 730 cancer-related genes. The genes identified were in silico expression evaluated using the UALCAN database. An accurate prediction model to discriminate CIN2+ from Assuntos
Infecções por Papillomavirus
, Displasia do Colo do Útero
, Neoplasias do Colo do Útero
, Gravidez
, Humanos
, Feminino
, Neoplasias do Colo do Útero/diagnóstico
, Neoplasias do Colo do Útero/genética
, Neoplasias do Colo do Útero/metabolismo
, Citologia
, Colo do Útero/patologia
, Displasia do Colo do Útero/diagnóstico
, Citodiagnóstico
, Colposcopia
, Infecções por Papillomavirus/diagnóstico
, Papillomaviridae/genética
, Proteína Morfogenética Óssea 7
, Proteínas de Membrana
, Proteínas Tirosina Quinases
, Proteínas Serina-Treonina Quinases
RESUMO
Objective: Squamous cell carcinoma of the anus (SCCA) is associated with human papillomavirus (HPV) infection in almost 90% of the cases. Its incidence is alarmingly high among men who have sex with men (MSM) and continues to increase at an average rate of 2% per year. The objective of the present study is to evaluate the usefulness and performance of liquid-based anal cytology as a screening tool for prevention and early detection of SCCA in a cohort of at-risk men. Method: We conducted a retrospective study including 111 MSM, aged between 22 and 62 years old, who underwent anal cytological screening with a liquid-based Pap test at our sexually transmitted diseases (STDs) clinic from January 2015 to March 2017. Results: Out of 111 anal smears, 57 (51,4%) resulted negative, 42 (37,8%) abnormal, and 12 (10,8%) unsatisfactory for the cytological evaluation. Only patients with an abnormal cytology underwent anoscopy and subsequent biopsy. The histological results were as follows: negative for squamous intraepithelial lesion (SIL) in 5 cases, low-grade SIL (L-SIL) in 21, high-grade SIL (H-SIL) in 5, SCCA in 1. Five patients had a normal anoscopy and biopsy was not taken. Conclusion: Liquid-based cytology, reducing the "darkening factors" typical for the conventional smears, has a higher positive predictive value than the traditional technique. Moreover, a cytological diagnosis of atypical squamous cells of undetermined significance (ASC-US) or L-SILmay hide a severe dysplasia or even a carcinoma. Thus, all patients with an abnormal anal cytology at any grade should be considered for anoscopy. (AU)
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias do Ânus/prevenção & controle , Citodiagnóstico/métodos , Minorias Sexuais e de Gênero , HIV , Infecções por Papillomavirus/diagnósticoRESUMO
INTRODUCTION: Cervical cancer screening is an important tool in public health. Liquid-based cytology (LBC) has been performed at the studied hospital for 7 years. The present study compares the performance of 2 LBC techniques with conventional cytology. OBJECTIVE: Our objective is to verify the sensitivity for the detection of neoplastic and preneoplastic epithelial atypia, as well as the positive predictive value of the 3 methodologies. METHODS: We analyzed retrospectively 24,529 cases and evaluated the conventional cytology, ThinPrep®, and BD SurePath® performance categorizing the results according to the Bethesda system. We also compared the level of unsatisfactory samples, the presence of elements from the squamocolumnar junction, and the detection of pathogenic microorganisms. RESULTS: ThinPrep® (1.43%) showed superior sensitivity over BD SurePath® (0.91%) and conventional cytology (0.71%) in terms of the detection of high-grade lesions; however, in terms of squamous atypia as a whole (ASC-US+), BD SurePath® (6.44%) proved to be more sensitive than conventional cytology (5.28%) and ThinPrep® (3.73%). CONCLUSIONS: The results show the advantage of implementing LBC in routine screening for cervical lesions. In this study, BD SurePath® achieved the overall best performance considering the studied variables.
Assuntos
Displasia do Colo do Útero/mortalidade , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adulto , Brasil , Citodiagnóstico/métodos , Detecção Precoce de Câncer/métodos , Feminino , Hospitais Militares/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária/estatística & dados numéricos , Estados Unidos , Esfregaço Vaginal/métodosRESUMO
BACKGROUND: The goal of this study was to determine whether the detection of histologically confirmed cases of cervical high-grade squamous intraepithelial lesions or worse (HSIL+) can be increased by having each liquid-based cytology (LBC) slide read by 2 cytotechnologists as part of routine screening. METHODS: Over 36,212 women aged 30 to 64 years participated in the Forwarding Research for Improved Detection and Access for Cervical Cancer Screening and Triage (FRIDA) Study in Mexico between 2013 and 2016. For each participant, 2 cervical samples were collected at the same clinic visit, one to test for high-risk human papillomavirus (hrHPV) and the other for LBC, which was used to triage those with a hrHPV positive result. LBC slides were evaluated by 7 cytotechnologists, with each slide read independently by 2 blinded cytotechnologists. All women with atypical cells of undetermined significance or a worse result were referred to colposcopy for further evaluation and diagnosis. Three pathologists evaluated the biopsy specimens to confirm the final HSIL+ diagnosis. The HSIL+ detection rates for the single versus double reading were estimated and compared. RESULTS: A total of 3,914 women with a positive hrHPV result were triaged with LBC. The first and second cytology readings resulted in 43 HSIL+ cases detected; the double-reading strategy detected 9 additional HSIL+ cases, resulting in a total of 52 HSIL+ cases. The HSIL+ detection rate increased from 10.99/1000 with a single reading to 13.29/1000 with the double-reading strategy (P = .004). CONCLUSION: A 20.9% increase in HSIL+ cases detected was achieved with a double reading of the LBC slides in this sample of hrHPV-positive women.
Assuntos
Citodiagnóstico/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/complicações , Triagem/normas , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Adulto , Colposcopia , Citodiagnóstico/métodos , DNA Viral/análise , DNA Viral/genética , Feminino , Seguimentos , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Papillomaviridae/genética , Infecções por Papillomavirus/virologia , Prognóstico , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologiaRESUMO
Screening for cervical cancer by cytology has been effective in reducing the worldwide incidence and mortality rates of this disease. However, a number of studies have demonstrated that the sensitivity of conventional cervical cytology may be too low for detection of cervical intraepithelial neoplasias (CIN). Therefore, it is important to incorporate more sensitive molecular diagnostic tests that could substantially improve the detection rates and accuracy for identifying CIN lesions. MicroRNAs (miRNAs) are a class of small non-coding RNAs with the potential to provide robust non-invasive cancer biomarkers for detecting CIN lesions in liquid-based cervical cytology (LBC) samples. At present, there is no consensus on which are the best housekeeping genes for miRNA normalization in LBC. The present study aimed to identify housekeeping genes with consistent and reproducible performance for normalization of reverse transcription-quantitative PCR (RT-qPCR) expression analysis of miRNA using LBC samples. The present study firstly selected six potential candidate housekeeping genes based on a systematic literature evaluation. Subsequently, the expression levels of microRNAs U6, RNU-44, RNU-47, RNU-48, RNU-49 and hsa-miR-16 were measured in 40 LBC samples using RT-qPCR. The stability of each potential housekeeping gene was assessed using the NormFinder algorithm. The results revealed that U6 and RNU-49 were the most stable genes among all candidates requiring fewer amplification cycles and smaller variation across the sample set. However, RNU-44, RNU-47, RNU-48 and hsa-miR-16 stability exceeded the recommended housekeeping value suitable for normalization. The findings revealed that U6 may be a reliable housekeeping gene for normalization of miRNA RT-qPCR expression analysis using LBC samples.
RESUMO
Liquid-based cytology (LBC) has been used as a diagnostic tool for cervical cancer for years and is now being adopted for other gynecological cancers. LBC represents an important challenge to ensure that the process yields representative biospecimens for quality control (QC) of diagnostic procedures. In this study, we compare QC parameters (integrity, yield and purity, and polymerase chain reaction [PCR] amplification) of DNA isolated from LBC (N = 296) using two different nucleic acid isolation methods, manual (n = 233) or automated (n = 63). We also evaluated two different types of cytological brushes for sampling from the cervix. Our results suggest that manual isolation (yield 22.81 ± 1.92 µg) resulted in increased DNA recovery when compared with automated isolation (yield 9.96 ± 1.11 µg) from LBC samples, with a p-value of <0.0003. We estimated that 98% (53/54) of the samples preserved the integrity of DNA and were suitable for standard molecular biology analyses. The ß-globin gene was amplified in 100% (296/296) of the DNA samples by endpoint PCR. We found no significant difference between the performance of the cytological brushes (p value of <0.6711) in a general overview. However, when looking at the results from using each brush individually, the manual isolation method was statistically superior to the automated method. Our work illustrates the impact of good QC of preanalytic conditions, which will be important for the application of LBC for developing early detection methods for gynecological cancers.
Assuntos
DNA de Neoplasias/isolamento & purificação , Manejo de Espécimes/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bancos de Espécimes Biológicos , Detecção Precoce de Câncer , Feminino , Humanos , Biópsia Líquida , Neoplasias do Colo do Útero/genética , Adulto JovemRESUMO
OBJECTIVES: The diagnostic performance of cytology in esophageal squamous cell carcinoma (ESCC) is meticulously described. METHODS: Cytological and biopsy specimens were prospectively taken during esophagogastroduodenoscopy of 123 individuals in 2013 and 2014. Cytology samples were maintained in preservative fluid until processing and biopsies were formalin-fixed and paraffin-embedded. RESULTS: Based on endoscopic biopsy results, 70 cases were positive for ESCC whilst 53 were negative for cancer. In addition, brush cytology showed high sensitivity and specificity (98.57 and 96.23%, respectively) in detecting the disease, and high accuracy (97.5%) comparable to that provided by histopathology which is the accepted gold standard. CONCLUSION: Brush cytology specimens preserved in liquid medium may be a good alternative for ESCC diagnosis.
Assuntos
Biópsia/métodos , Citodiagnóstico/métodos , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esôfago/patologia , Estudos Transversais , Técnicas Citológicas/métodos , Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Conservantes Farmacêuticos , Estudos Prospectivos , Sensibilidade e Especificidade , Preservação de Tecido/métodosRESUMO
Introduccion: El uso de Citología Convencional de Papanicoloau (CC) frente a Base Líquida (CBL), el profesional que realiza la extracción, primera lectura y diagnóstico de la muestra; el uso de la clasificación Bethesda, la detección de ADN del VPH y el seguimiento de hallazgos ASCUS son eslabones en el tamizaje del Cáncer del Cuello Uterino (CCU) poco estudiadas en nuestro medio. Objetivo: Determinar las características del tamizaje para cáncer CCU en 08 establecimientos de salud (EESS) de Lima Metropolitana sedes del Internado Médico de la FAMURP en el 2017.Métodos: Descriptivo, transversal. Muestreo por conveniencia. Se entrevistó a los Jefes de los Servicios de Patología. Resultados: Participaron 8 EESS de Nivel III del MINSA, EsSalud y FFAA. Todos realizaron la CC, ninguno CBL. Las muestras son extraídas por el Ginecólogo o la Obstetriz, y en 1 caso por enfermería, la primera lectura es realizada por el Tecnólogo Médico y en un caso por el Anátomo Patólogo; el diagnóstico, por el Anátomo Patólogo. Se usa el Sistema de Bethesda para el Reporte Final. No se usan pruebas de detección para ADN del VPH. En 8, se hace seguimiento para hallazgos ASCUS. Conclusión: La CBL, la lectura automatizada, y la identificación del ADN de VPH no están implementados. Se recomienda realizar estudios costo-efectivo para proponer su implementación futura, y realizar estudios respecto de las fases del proceso del Tamizaje
Introduction: Use of Papanicolaou's test versus Liquid Based Cytology; professional that executes the sample's extraction, first lecture and diagnosys; use of Bethesda clasification; VPH's DNA detection, and the follow up of ASCUS results, are important topics of the Cervical Cancer screening which are scarcely studied at Peru. Objective: To determinate characteristics from the screening of Cervical Cancer at 08 Health institutions (HI) from Metropolitan-Lima in 2017 which were Intership Medical Centers for FAMURP students. Methods: Observational, descriptive transversal study with convenience type sampling. Pathology's Chiefs from HI were interviewed. Results: 8 Third level HI from MINSA, ESsalud and FFAA were included. All HI use Papanicolaou Test, no LBC were used. Samples were taken by the Gynaecologist or the Obstetrician and in one case by the nurse; first lecture, by the Medical Tecnologyst and in one case by the anatomic pathology specialist; diagnosys, by the anatomic pathology specialist. The Bethesda System was used at the Final Report. No HPV- DNA detection test was used. 8 HI made ASCUS finding follow up. Conclusion: LBC, automatic lecture for screening and HPV-DNA detection are not implemented. It is recommended to desing cost-effective studies for their future implementation, and desing studies at the Cervicuterine cancer Screening stages.
RESUMO
The aim of this study was to explore the value of different combination schemes of liquid-based cytology (LBC) and high-risk human papilloma virus (HPV) test in the screening of high-grade (≥CIN 2) cervical lesions. From 5727 women who had undergone examinations with LBC and high-risk HPV test, 1884 patients with positive results of either or both LBC and HPV test were included in this study and underwent cervical biopsy. Based on the pathological examination results, comparisons of the assessment indicators of all diagnostic tests were made, and the application values of LBC and high-risk HPV test and different combination schemes of the two in the screening of high-grade (≥CIN II) cervical lesions were estimated. Compared with the single test method, the sensitivity and negative predictive value of the combination scheme of LBC+HPV (with one positive result) were increased significantly (98.7% and 99.7%), but the specificity (60.8%) and accuracy rate (65.4%) dropped significantly (P<0.05). The sensitivity of LBC+HPV (with two positive results) was the lowest (80.7%), but the specificity and accuracy rate were the highest (83.5% and 83.1%, P<0.05). Z test showed that differences in the screening efficiency of four schemes were not statistically significant (P>0.05). Both LBC and HPV test were effective methods in the screening of high-grade cervical lesions; combination of the two tests did not improve the screening efficiency, but the scheme of LBC+HPV (with two positive results) significantly increased the sensitivity and negative predictive value, which was of better cost-benefit value.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Lesões Pré-Cancerosas/patologia , Displasia do Colo do Útero/patologia , Infecções por Papillomavirus/patologia , Biópsia Líquida/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Infecções por Papillomavirus/complicações , Programas de Triagem DiagnósticaRESUMO
OBJECTIVE: To test the performance of a new fixative for pap smear collection for liquid-based cervical cytology, CellPreserv® and compare it with the commercially available, PreservCyt® used in the diagnosis and detection of human papillomavirus (HPV). METHODS: Seven hundred twenty five women participated in this study after signing an informed consent. The specimens were collected using a traditional device, agitated in PBS, and equally divided in both fixatives. The slides were prepared routinely, stained by Papanicolaou, examined blindly by 2 cytologists, and reviewed by one cytopathologist. To search for HPV, 1,000 µL from each fixative was taken and processed by polymerase chain reaction. RESULTS: Considering the adequacy of samples, both fixatives had similar results - 0.33 and 0.32% of the cases unsatisfactory for PreservCyt® and CellPreserv®, respectively. Considering the 701 satisfactory cases and comparing the new fixative to the traditional fixative, there was 99.3% concordance between both. The results regarding the HPV detection was 100% concordant between the 2 fixatives. CONCLUSION: The new methanol-based fixative, CellPreserv®, is cheaper and equally efficient for treating cervical cancer screening and for HPV detection, and can be safely used by the health system prevailing in low-income countries.
Assuntos
Citodiagnóstico/métodos , Fixadores , Testes de DNA para Papilomavírus Humano , Metanol , Infecções por Papillomavirus/patologia , Fixação de Tecidos/métodos , Neoplasias do Colo do Útero/patologia , Adolescente , Adulto , Idoso , Brasil , Redução de Custos , Análise Custo-Benefício , Citodiagnóstico/economia , Feminino , Fixadores/economia , Custos de Cuidados de Saúde , Testes de DNA para Papilomavírus Humano/economia , Humanos , Biópsia Líquida , Metanol/economia , Pessoa de Meia-Idade , Teste de Papanicolaou , Infecções por Papillomavirus/economia , Infecções por Papillomavirus/virologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fixação de Tecidos/economia , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal , Adulto JovemRESUMO
OBJECTIVE: Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells (AGC) reflect cellular abnormalities insufficient for clear diagnosis. We used cell pellets obtained from liquid-based cytology (LBC) to prepare cell blocks (CB) and clarify the initial diagnosis of ASCUS and AGC. STUDY DESIGN: A total of 393 CBs with initial diagnosis of ASCUS or AGC were processed. Of those, 305 of the ASCUS and 20 of the AGC had adequate specimens. We compared results of CBs prepared from ASCUS and AGC to determine which had higher frequencies of higher-grade lesions. RESULTS: A majority of specimens (83%) were adequate for evaluation. Compared with the initial diagnosis, 14% (42/305) of ASCUS were diagnosed with low-grade squamous intraepithelial lesion (LSIL) in CB, while 10% (2/20) of AGC were diagnosed with LSIL or adenocarcinoma. No statistical relationship between the initial diagnosis of ASCUS and AGC and results of higher-grade lesions in CB is evident as determined by p value greater than 0.05 (p = 0.228). CONCLUSIONS: CBs prepared from Liqui-PREP cell pellets are, in most cases, assessable and can be useful as an adjunctive test to help clarify the initial diagnosis of ASCUS and AGC. Diagn. Cytopathol. 2017;45:520-525. © 2017 Wiley Periodicals, Inc.
Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Células Epiteliais/patologia , Teste de Papanicolaou/métodos , Adulto , Feminino , Humanos , Teste de Papanicolaou/normasRESUMO
In the present study, we compared the performance of a ThinPrep cytological method with the conventional Papanicolaou test for diagnosis of cytopathological changes, with regard to unsatisfactory results achieved at the Central Public Health Laboratory of the State of Pernambuco. A population-based, cross-sectional study was performed with women aged 18 to 65 years, who spontaneously sought gynecological services in Public Health Units in the State of Pernambuco, Northeast Brazil, between April and November 2011. All patients in the study were given a standardized questionnaire on sociodemographics, sexual characteristics, reproductive practices, and habits. A total of 525 patients were assessed by the two methods (11.05% were under the age of 25 years, 30.86% were single, 4.4% had had more than 5 sexual partners, 44% were not using contraception, 38.85% were users of alcohol, 24.38% were smokers, 3.24% had consumed drugs previously, 42.01% had gynecological complaints, and 12.19% had an early history of sexually transmitted diseases). The two methods showed poor correlation (k=0.19; 95%CI=0.11–0.26; P<0.001). The ThinPrep method reduced the rate of unsatisfactory results from 4.38% to 1.71% (χ2=5.28; P=0.02), and the number of cytopathological changes diagnosed increased from 2.47% to 3.04%. This study confirmed that adopting the ThinPrep method for diagnosis of cervical cytological samples was an improvement over the conventional method. Furthermore, this method may reduce possible losses from cytological resampling and reduce obstacles to patient follow-up, improving the quality of the public health system in the State of Pernambuco, Northeast Brazil.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Teste de Papanicolaou/métodos , Doenças do Colo do Útero/diagnóstico , Brasil , Estudos Transversais , Método Duplo-Cego , Sensibilidade e Especificidade , Fatores SocioeconômicosRESUMO
UNLABELLED: Sensitivity of cervical cytology is suboptimal, especially in developing countries such as Mexico, despite available guidelines aimed at improving this. When obtaining cervical samples, whether the samples are taken from the transformation zone and whether abnormal cells are missing must be considered. Cervical secretions (CS) are always present in variable proportions, and when cleaning the cervix, better samples may be obtained. In this study, we analyzed samples obtained with or without cleaning the cervix, and compared their contents in order to determine the sensitivity and specificity of these two methods. METHODS: Of 500 patients who underwent cytology and colposcopy, 271 (54.2%) required a second opinion due to a diagnosis of cervical intraepithelial neoplasia (CIN). CS was removed and compared with the clean, second sample (SS) using in both liquid-based cytology. The quality of samples according to the Bethesda System, the presence of CIN, and inflammatory reactions were recorded. The sensitivity and specificity were calculated using biopsy as the gold standard. RESULTS: The SS resulted in a higher proportion of adequate samples being obtained (97.6% vs. 44.8%), and in increased sensitivity (88.2% vs. 58.8%). CIN was detected in the SS 26% more often than in the CS (34 vs. 27 samples), whereas inflammatory reactions were noted more often in the CS (91.4% vs. 74%). CONCLUSION: Cervical sampling including CS results in lower sensitivity and CIN detection rates, and in more inflammatory reactions. By excluding CS from cervical samples, the sensitivity could be improved and the false negative rate could be reduced.
Assuntos
Colo do Útero/patologia , Citodiagnóstico , Manejo de Espécimes/métodos , Displasia do Colo do Útero/patologia , Neoplasias do Colo do Útero/patologia , Adolescente , Adulto , Idoso , Biópsia , Colo do Útero/metabolismo , Colposcopia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Adulto JovemRESUMO
Este estudio se llevó a cabo para examinar el patrón de inmunoexpresión simultánea de p16INK4a/Ki-67y establecer su posible utilidad clínica para la detección precoz del cáncer de cuello uterino. Las muestras celulares de cuello uterino fueron seleccionadas de la pesquisa de rutina de cáncer cervical. La detección inmunocitoquímica de p16INK4a/Ki-67se realizó con el kit de trabajo CINtec® Plus. Todos los casos tenían una prueba de virus papiloma humano (VPH). Ciento quince muestras citológicas fueron incluidas: 11(9,6%) fueron negativas para lesión intraepitelial o malignidad (NILM), 32(27,8%) presentaron células escamosas con atipias de significado indeterminado (ASC-US), 62(53,9%) mostraron lesión intraepitelial escamosa de bajo grado (LSIL) y 10(8,7%) lesión intraepitelial escamosa de alto grado (HSIL). La prevalencia general de infección por VPH fue de 81,7% (94/115). En 42 casos (45,0%) se identificaron los siguientes genotipos específicos de VPH: VPH16 (26,2%), VPH51 (21,4%), VPH52 (14,3%) y el genotipo VPH66 (7,1%). De 115 muestras celulares, 42(36,5%) fueron positivas para la tinción dual de p16INK4a/Ki-67, siendo ésta muy frecuente en las muestras citológicas con HSIL (70,0%), disminuyendo en las LSIL (44,0%) y existiendo inmunopositividad en una minoría de ASC-US (25,0%). Ningún caso NILM mostró inmunopositividad para p1(6INK4a)/Ki-67 (p<0,001). En 40/115 casos (34,8%) hubo positividad tanto para infección por VPH oncogénico como para la tinción dual p16INK4a/Ki-67, incluyendo 6/32 (18,8%) con ASC-US, 26/62 (42,0%) con LSIL and 8/10 (80,0%) con HSIL. Esta metodología podría ser utilizada para detectar lesiones en cuello uterino que aún no han sido diagnosticadas o han pasado inadvertidas.
We aimed to explore the expression pattern of p16INK4a/Ki-67 immunocytochemical dual-staining and to establish the potential clinical utility for early detection of cervical lesions. Liquid-based cytologies of cervical specimens of cervical cancer screening were processed for p16INK4a/Ki-67 immunocytochemical dual-staining using the CINtec® Plus Kit. HPV testing was performed with the INNO-LiPA HPV genotyping Extra Reverse Hybridization Line Probe Assay kit. One hundred and fifteen cervical cytologies were analyzed with the following results: 11(9.6%) were negative for intraepithelial lesions or malignancy (NILM); 32(27.8%) presented atypical squamous cells of undetermined significance (ASC-US); 62(53.9%) exhibited low grade squamous intraepithelial lesions (LSIL) and 10(8.7%) showed high grade squamous intraepithelial lesions (HSIL). No cases of cervical cancer were detected. The overall prevalence of DNA HPV detection was 81.7% (94/115). The following specific HPV genotypes were identified in 42 (45.0%) cases: HPV16 (26.2%), HPV51 (21.4%), HPV52 (14.3%) and HPV66 (7.1%). Viral sequences of an unknown single HPV were detected in 23.8%of the cases. A total of 42/115 (36.5%) were p16INK4a/Ki-67 dual-staining-positive, being more frequent in HSIL (70.0%), decreasing in LSIL (44.0%), detected in a minority of ASC-US (25.0%) and negative in NILM cases (p<0.001). 40/115 cases (34.8%) were positive for both oncogenic HPV and p16INK4a/Ki-67 dual-staining, including 6/32 (18.8%) ASC-US, 26/62 (42.0%) LSIL and 8/10 (80.0%) HSIL, which represent a strong association between positivity for HPV, p16INK4a/Ki-67 staining and severe cytological abnormalities (p<0.001). This methodology could be used to detect unnoticed cervical lesions.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Infecções por Papillomavirus/patologia , Displasia do Colo do Útero/patologia , Displasia do Colo do Útero/virologia , /análise , /biossíntese , Genótipo , Imuno-Histoquímica , /análise , /biossíntese , Papillomaviridae , Coloração e Rotulagem , Displasia do Colo do Útero/química , Displasia do Colo do Útero/metabolismoRESUMO
Anal intraepithelial neoplasia (AIN) is associated with HPV infection and can be detected by cytological screening. While conventional exfoliative cytology (CC) is a low-cost and nonaggressive method, liquid-based cytology (LBC) tends to give clearer readings. Although studies of the efficacy of anal cancer screening methods would be of great importance for groups at high risk for AIN, few such studies have been conducted. The aim of the present study was to assess the concordance of CC and LBC in diagnosing anal pre-neoplastic lesions, and to compare cytological results with anoscopy, histopathological, and molecular biology findings. Comparative study involving 33 HIV-positive patients, who underwent anoscopy and biopsy of suspected lesions. Concordance between the two cytology methods was calculated, as were the associations between cytology results and findings from other screening methods. A total of 54.5% of cases were considered AIN-negative by CC and LBC, and concordance between the two methods was statistically significant (P < 0.05). Anoscopy was negative in 15 of the 18 CC- and LBC-negative cases. CC identified 75% of patients with positive biopsy, while LBC identified 85.71% of these patients. Molecular biology results showed that patients with LSIL tested positive for the highest number of HPV subtypes. The associations between positive biopsy and high grade HPV, HPV 16, and multiple HPV infections were not statistically significant. Conventional and liquid-based cytology are equally effective in screening for anal preneoplastic lesions.
Assuntos
Neoplasias do Ânus/diagnóstico , Carcinoma in Situ/diagnóstico , Soropositividade para HIV/complicações , Teste de Papanicolaou/métodos , Adolescente , Adulto , Neoplasias do Ânus/complicações , Neoplasias do Ânus/patologia , Carcinoma in Situ/complicações , Carcinoma in Situ/patologia , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Breast cancer is the second cause of death in women worldwide. The spontaneous breast nipple discharge may contain cells that can be analyzed for malignancy. Halo® Mamo Cyto Test (HMCT) was recently developed as an automated system indicated to aspirate cells from the breast ducts. The objective of this study was to standardize the methodology of sampling and sample preparation of nipple discharge obtained by the automated method Halo breast test and perform cytological evaluation in samples preserved in liquid medium (SurePath™). METHODS: We analyzed 564 nipple fluid samples, from women between 20 and 85 years old, without history of breast disease and neoplasia, no pregnancy, and without gynecologic medical history, collected by HMCT method and preserved in two different vials with solutions for transport. RESULTS: From 306 nipple fluid samples from method 1, 199 (65%) were classified as unsatisfactory (class 0), 104 (34%) samples were classified as benign findings (class II), and three (1%) were classified as undetermined to neoplastic cells (class III). From 258 samples analyzed in method 2, 127 (49%) were classified as class 0, 124 (48%) were classified as class II, and seven (2%) were classified as class III. CONCLUSION: Our study suggests an improvement in the quality and quantity of cellular samples when the association of the two methodologies is performed, Halo breast test and the method in liquid medium.
RESUMO
OBJECTIVE: To establish a definitive diagnosis of oral hairy leukoplakia (OHL) by in situ hybridization for Epstein-Barr virus (EBV) detection with liquid-based cytology (LBC), using the ThinPrep® Pap Test, and to compare its efficacy with the traditional method of performing biopsy. METHODS: Thirty-three individuals divided into three groups were included in this study. Group 1 consisted of 15 human immunodeficiency virus (HIV)-positive patients with a clinical and histopathological diagnosis of OHL on the lateral border of the tongue. Group 2 consisted of 10 HIV-positive individuals with neither OHL nor other oral lesions. Group 3 consisted of 10 immunocompetent HIV-negative individuals with neither OHL nor other oral lesions. For each patient from the three groups, exfoliative LBC was performed on the lateral border of the tongue using ThinPrep. For the patients from group 1, a 6-mm-diameter punch biopsy was obtained from the same anatomic site as the brush collection to confirm the diagnosis of OHL by histopathology with in situ hybridization. Slides were prepared for morphological cellular analysis using Papanicolaou (Pap) staining, and for EBV detection using in situ hybridization. RESULTS: Thirteen of the 15 patients from group 1 were confirmed on punch biopsy as OHL, providing the gold standard for the study. The sensitivity of LBC followed by a Pap-stained smear was 62% and the specificity was 90%. The sensitivity of LBC followed by in situ hybridization was 100% and the specificity was 100%. CONCLUSIONS: Exfoliative LBC associated with EBV in situ hybridization is a simple, effective and non-invasive diagnostic tool for OHL.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Soropositividade para HIV/complicações , Leucoplasia Pilosa/diagnóstico , Adulto , Biópsia , Feminino , Soropositividade para HIV/virologia , Humanos , Hibridização In Situ/instrumentação , Hibridização In Situ/métodos , Leucoplasia Pilosa/virologia , Masculino , Pessoa de Meia-IdadeRESUMO
Objetivando avaliar a concordância, sensibilidade e especificidade diagnóstica dos métodos citológicos:convencional e em meio líquido, foi realizado um estudo de caso-controle, no Ambulatório deCabeça e Pescoço do Hospital de Câncer de Pernambuco, sendo selecionados 182 indivíduos doentese 179 sãos, no período de setembro de 2002 a janeiro de 2004, os quais, permitiram através de assinatura de termo de consentimento livre e esclarecido a realização de exames (clínico/ citológicoesfoliativo - cytobrush) na área carcinomatosa e em área sã, constituindo, respectivamente, o grupo de casos e controles. Os dados obtidos foram analisados através dos softwares estatísticos SPSS(Statistical Package for Social Science) e Epi-Info versão 6.4. Os resultados evidenciaram que os métodosdiagnósticos citológicos apresentaram entre os casos: sensibilidade= 96,9% (IC= 95%: 92,5% a98,8%); especificidade= 75,0% (IC= 95%: 21,9% a 98,7%) e acurácia= 96,3% (IC=95%: 92,5% a 98,5%);e entre os controles: sensibilidade= 91,0% (IC=95%: 84,1% a 95,2%); especificidade = 57,5% (IC=95%:41,0% a 72,6%) e acurácia= 82,7% (IC=95%: 76,3% a 88,0%). A citologia convencional e em base--líquida apresentaram concordância com o diagnóstico histopatológico em mais de 90%. Conclui-se, portanto, que, se bem indicado e executado, o exame citológico pode ser utilizado rotineiramente como exame complementar, pois ambos apresentaram alta sensibilidade e razoável especificidade,cabendo à citologia convencional maior especificidade para o diagnóstico das lesões orais.
The purpose of this study was to evaluate the sensitivity, specificity, and concordance between conventionalcytology and liquid-based cytology. A case-control study was developed at the Head andNeck ambulatory service of Hospital do Cancer de Pernambuco. A hundred and eighty-two patientswith primary Oral Squamous Cellular Carcinoma (OSCC) (case group) and 179 individuals with normalbuccal mucosa (control group) were selected, from September 2002 to January 2004. They agreed tobe submitted to clinical examination and exfoliative cytology of the oral cavity, by signing a documentof consent. The data were analysed by Statistical Package for Social Science (SPSS) and Epi-Info 6.4 program.Among the cases, the cytologic methods demontrated a sensitivity= 96.9% (IC= 95%: 92.5% to98.8%), specificity= 75.0% (IC=95%: 21.9% to 98.7%), and accuracy= 96.3% (IC=95%: 92.5% to 98.5%).Among the controls the results were: sensitivity= 91.0% (IC=95%: 84.1% to 95.2%);, specificity= 57.5%(IC=95%: 41.0% to 72.6%), and accuracy= 82.7% (IC=95%: 76.3% to 88.0%). Conventional cytologyand liquid-based cytology demonstrated a diagnostic concordance with histopathology of more than90%. In conclusion if properly indicated and executed, they can be routinely used as complementarydiagnostic methods. When compared to each other, conventional cytology and liquid-based cytologyshowed a high sensitivity and reasonable specificity, conventional cytology having higher specificity.
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Biologia Celular , Carcinoma/prevenção & controle , Técnicas e Procedimentos DiagnósticosRESUMO
Introdução: o câncer do colo uterino é a neoplasia mais frequente em mulheres de países em desenvolvimento. Doença causada pela infecção persistente com diferentes tipos de papilomavírus humano (HPV) classificados em baixo e alto risco, de acordo com o potencial oncogênico. Objetivo: em mulheres com diagnóstico citopatológico anormal por ocasião de exame de rastreamento do câncer cervical, encaminhadas por diferentes postos de atendimento do Sistema Único de Saúde para serviço universitário de referência e com diagnóstico definitivo de lesão intraepitelial de alto grau ou câncer cervical, avaliara eficácia diagnóstica de métodos morfológicos e biomoleculares utilizados de maneira isolada ou em associação; e a prevalência, estratificada em duasfaixas etárias, abaixo de 30 e igual ou superior a 30 anos, do HPV tipos 16, 18 e 45. Métodos: estudaram-se 167 mulheres encaminhadas ao Ambulatório de Patologia Cervical e Colposcopia do Hospital Universitário da Universidade Federal de Juiz de Fora, no período de novembro de 2002 e dezembro de 2003,com colo uterino íntegro, não grávidas e sem história de câncer no trato genital inferior. Coletaram-se, de todas as mulheres, amostras para estudo citológico,convencional e em meio líquido, e para os testes de DNA-HPV. Considerou-se como diagnóstico histopatológico final a avaliação mais grave dentre ospossíveis espécimes, biópsia, conização ou peça cirúrgica, que a paciente pudesse ter. Resultados: não há qualquer diferença no tocante à sensibilidade,ao valor preditivo positivo e negativo e à acurácia dentre os métodos diagnósticos estudados, porém a associação da citologia com o teste DNA-HPV tem menor especificidade que o exame citológico isolado, quer convencional ou em meio líquido. A prevalência do HPV 16, 18 e 45 cai de 88,9% para 50,0%nas mulheres com 30 anos ou mais (p = 0,02). Conclusão: nas mulheres encaminhadas ao ambulatório de PTGIC do HU-UFJF com colpocitologia alteradanão se justifica a realização de qualquer exame confirmatório, devendo realizar-se imediatamente a colposcopia para se ter o desfecho diagnóstico.
Introduction: cervical cancer is the most frequent neoplasia among the women of countries in development. Great part of these cases is caused by persistent infection with different types of human papilomavirus (HPV) classified as low and high risk, according to the risk of cervical cancer development. Objectives:based on women with abnormal cytology when screening for cervical cancer who were led from different units of the Public Health System to the reference university service and with a definite diagnosis of high cervical intraepithelial neoplasia or cancer, was to evaluate the diagnostic efficacy of morphologicand molecular methods used alone or together and the prevalence of HPV types 16, 18, 45, stratified into two age brackets. Methods: 167 women went to the Cervical Pathology and colposcopy clinic of the University Hospital of the Universidade Federal de Juiz de Fora, during the period from November 2002 to December 2003, with intact uterine cervix, not pregnant and without previous chemical and/or radiotherapy treatment for the inferior genital tract.Samples for cytology study were collected from all women, with conventional and liquid-based preparations, for CH2 for high risk virus, for DNA PAP andfor Probe Pack test. The worst histologic diagnosis among the possible histologic studies through biopsy, conization or cirurgic pieces was considered as "gold standard". Results: there is no difference regarding sensibility, positive predict value and negative predict value for all methods studied, However, the DNA PAP method has less specificities than the citology exam, either with conventional or based-liquid preparation. The prevalence of HPV 16, 18, 45 decreases from 88,9% to 50% in women of 30 years old or more, being this decrease statistically significant. Conclusion: in those women led to the PTGIC of the HUUFJF with abnormal cytology it is not necessary to repeat any tests, just colposcopy in order to reach the final diagnosis.
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Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções por Papillomavirus/diagnóstico , Estudos Prospectivos , Técnicas Citológicas , Hospitais UniversitáriosRESUMO
INTRODUÇÃO: Quando comparada à técnica da citopatologia convencional (CC), a citologia em meio líquido (LBC) tem sido referida como método de desempenho superior em esfregaços cervicouterinos. OBJETIVO: Comparar (quantitativa e qualitativamente) esfregaços orais preparados por meio da citopatologia convencional e da LBC. Material e métodos: Foram realizados raspados em borda lateral da língua de seis indivíduos com mucosa oral de aspecto clínico normal, e testados três instrumentos de coleta: escova endocervical (cytobrush), espátula plástica e escova contida no kit da citologia em meio líquido utilizado no estudo, sendo os esfregaços submetidos à citopatologia convencional e à LBC. RESULTADOS: A escova endocervical mostrou-se mais adequada para coleta e quanto ao método, a LBC forneceu lâminas com distribuição celular mais regular e homogênea do que a citopatologia convencional. Notou-se ainda redução da quantidade de células inflamatórias e de colônias de bactérias. DISCUSSÃO: Mesmo em menor quantidade, a sobreposição celular não foi totalmente eliminada na LBC como a literatura relata, pois estava presente em algumas lâminas. Embora em amostras cervicouterinas a redução de células inflamatórias, de hemácias e de muco seja considerada uma vantagem da LBC, nos raspados orais muitas vezes esses elementos compõem aspectos significativos de determinada doença. CONCLUSÕES: A citologia em meio líquido pode ser uma nova técnica a ser somada aos exames auxiliares de diagnóstico oral, mas, apesar de apresentar alguns resultados favoráveis, ainda são necessárias adaptações ao utilizá-la no diagnóstico oral.
INTRODUCTION: When compared to conventional cytopathology (CC), liquid-based cytology (LBC) has been referred to as a method of superior performance in cervical smears. OBJECTIVE: To quantitatively and qualitatively compare oral smears obtained through conventional cytopathology and liquid medium cytology. MATERIAL AND METHODS: Six individuals with normal oral mucosa had the lateral border of their tongues scraped. Three collecting instruments were tested in this process: endocervical brush (cytobrush), a plastic spatula, and the LBC kit brush. Both methods, CC and LBC, were applied. Results: The endocervical brush was the most appropriate collecting instrument; as far as method is concerned, liquid medium cytology provided slides with more regular and homogeneous cellular distribution in comparison to conventional cytopathology. There was also a reduction in the number of inflammatory cells and bacteria colonies. DISCUSSION: Cellular overlapping was not totally eliminated in the liquid medium cytology as reported in medical literature, inasmuch as it was present in some slides, though in a smaller amount. Although in cervical samples the reduction of inflammatory cells, erythrocytes and mucus is considered an advantage of LBC, in oral smears these elements may represent significant aspects of some oral diseases. CONCLUSIONS: Liquid-based cytology may be an additional technique to be used with complementary exams in oral diagnosis, but despite the fact it presents some favorable results some adaptations are still necessary for its use in oral diagnosis.