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Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

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ABSTRACT Objective: This study aimed to evaluate whether severity changes with colposcopic lesion size, regardless of age. Methods: This retrospective comparative study reviewed the records of 428 women with altered cytopathology reports who were directed by primary health care. Only those women with colposcopic alterations were evaluated (n=411). Histopathological analyses were restricted to patients who underwent excisional treatment (n=345). According to their age, they were grouped into the following: <21, 21-24, 25-35, and >35 years, and also, ≤24 and ≥25 years. The cytopathological, colposcopic, and histopathological findings were grouped according to severity. Lesion size was subjectively assessed from the colposcopic drawing recorded in the chart and according to the number of quadrants of the total cervical surface affected by colposcopic alterations in the transformation zone. Statistical significance was set at p<0.05. Results: The evaluations suggested that the lesion size was directly related to the severity of the cytopathology, colposcopy, and histopathology reports for the age groups ≤24 or ≥25 years. We observed associations between lesion size and severity of the cytopathology (≤24 years, p=0.037) and histopathology (≥25 years, p=0.003) findings. Conclusion: The size of the lesion was directly related to the severity of the histopathological lesion in patients aged ≥25 years and cytopathological in patients aged ≤24 years.

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Abstract Objective The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age. Methods Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019. Results A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group. Conclusion The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.

Resumo Objetivo Estabelecer um perfil de risco de lesões intraepiteliais de alto grau e câncer do colo do útero (NIC2 + ) em mulheres submetidas a colposcopia considerando-se a infecção pelo papilomavírus humano (HPV), citologia cervical e idade. Métodos Estudo retrospectivo transversal em banco de dados informatizado de mulheres com idade ≥ 18 anos que realizaram colposcopia no departamento de Prevenção de Câncer no Hospital do Câncer de Barretos/SP no período de 2017 a 2019. Resultados Foram incluídas 3.411 mulheres, sendo 58,0% positivas para HPV de alto risco, e maior prevalência de NIC2+ para HPV16 (30,3%) e outros HPV (45,0%). Resultados citológicos sugestivos de lesões invasivas (epidermoide ou adenocarcinoma), independente do teste de HPV, apresentaram 100% de diagnóstico NIC2 + , enquanto atipias sugestivas de lesões de alto grau, HSIL e ASC-H, associados a HPV positivo, apresentaram 86 e 55,2%, respectivamente. Resultados citológicos de ASC-H entre mulheres > 40 anos e HPV negativo foram associados principalmente a achados benignos. Observamos que ≤ NIC1 apresenta uma maior prevalência entre mulheres mais velhas com HPV negativo, enquanto para lesões de alto grau, há um aumento entre mulheres mais jovens positivas para HPV16/18. Para diagnóstico de câncer, observamos que há um predomínio de HPV16/18 independente da faixa etária. Conclusão Foi identificado maior risco de lesões precursoras e câncer entre mulheres com HPV 16/18 positivo e atipias citológicas graves em testes de rastreio populacional. Além disso, resultados citológicos de ASC-H quando associados a HPV negativo com idade > 40 anos habitualmente representam achados benignos em investigação histológica.

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ABSTRACT Objective: To assess the feasibility of incorporating technology as a new alternative for treating topics on cervical lesions. Method: This is a randomized, double-blind, controlled clinical trial with a prospective design. During the realization of this study, 43 women were included and divided between groups A (ointment without silver nanoparticles n = 23) and B (ointment with silver nanoparticles n = 20) clinically healthy and who used the unified health system. Results: There were no significant differences when comparing before and after the use of ointment for IVA test (p = 0.15), Schiller test (p = 0.15), cellular changes (p = 0.47) and microbiological analysis (p = 0.89) through cytology. After use, no adverse reaction was observed in the sample studied. Conclusion: Based on the results identified in this study, identified that the product is safe and does not promote adverse events. Regarding the effectiveness of the product in uterine cervical lesions, it is necessary to continue the study in phase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMO Objetivo: Avaliar a viabilidade da incorporação da tecnologia como uma nova alternativa para o tratamento de lesões cervicais. Método: Trata-se de um ensaio clínico randomizado, duplo-cego e controlado com um desenho prospectivo. Durante a realização deste estudo, foram incluídas 43 mulheres, divididas entre os grupos A (pomada sem nanopartículas de prata n = 23) e B (pomada com nanopartículas de prata n = 20), clinicamente saudáveis e usuárias do sistema único de saúde. Resultados: Não houve diferenças significativas na comparação entre antes e depois do uso da pomada para o teste IVA (p = 0,15), teste de Schiller (p = 0,15), alterações celulares (p = 0,47) e análise microbiológica (p = 0,89) por meio de citologia. Após o uso, não foi observada nenhuma reação adversa na amostra estudada. Conclusões: Com base nos resultados identificados neste estudo, identificou-se que o produto é seguro e não promove eventos adversos. Com relação à eficácia do produto em lesões cervicais uterinas, é necessária a continuidade do estudo na fase II. Registro de Ensaios Clínicos Brasileiros: UTN: U1111-1218-2820.

RESUMEN Objetivo: evaluar la viabilidad de la incorporación de la tecnología como una nueva alternativa para el tratamiento de temas sobre lesiones cervicales. Método: Se trata de un ensayo clínico aleatorizado, doble ciego, controlado y con un diseño prospectivo. Durante la realización de este estudio se incluyeron 43 mujeres divididas entre los grupos A (pomada sin nanopartículas de plata n = 23) y B (pomada con nanopartículas de plata n = 20) clínicamente sanas y usuarias del sistema unificado de salud. Resultados: No hubo diferencias significativas al comparar antes y después del uso de la pomada para la prueba de IVA (p = 0,15), la prueba de Schiller (p = 0,15), los cambios celulares (p = 0,47) y el análisis microbiológico (p = 0,89) mediante citología. Tras el uso, no se observó ninguna reacción adversa en la muestra estudiada. Conclusiones: Con base en los resultados identificados en este estudio, se identificó que el producto es seguro y no promueve eventos adversos. Con relación a la eficacia del producto en lesiones cervicales uterinas, es necesario continuar el estudio en fase II. Registro de Estudios Clínicos Brasileños: UTN: U1111-1218-2820.

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Resumen Objetivo: Analizar las características relacionadas con el diagnóstico de cáncer de las pacientes que consultan una IPS de la ciudad de Medellín. Metodología: Estudio observacional analítico. La población fueron todas las mujeres atendidas en la IPS Unidad Video Diagnóstica de la Mujer, institución que se dedica a realizar confirmación diagnóstica de mujeres con citologías alteradas. Se analizaron todos los registros de la base de datos de la institución correspondientes a las mujeres que consultaron durante el período 2012- 2017, un total de 55655 mujeres. Resultados: Se analizaron los registros de 55655 usuarias, la mediana de edad fue de 40 años (RIQ 19) y el 66.1% (36812) pertenecen al régimen subsidiado. La principal indicación para la realización de la colposcopia fueron las alteraciones citológicas con un 89.8% (49984) y más frecuente fue el LIEBG 35.3% (19649). El principal cáncer diagnosticado fue el escamocelular con 0.5% (284) y los factores asociados fueron residir en el Valle de Aburrá (OR 0.60 IC 0.42-0.84) y el resultado de citología LIEAG (OR 3.31 IC 2.22-4.94). Conclusiones: Se encontró una prevalencia de cáncer de cérvix de 7.8 por cada 1000 pacientes que consultan en la IPS.

Abstract Objective: To analyze the characteristics related to the diagnosis of cancer of the patients who consult an IPS in the city of Medellín. Methodology: Analytical observational study. The population consisted of all the women treated at the IPS Unidad Video Diagnóstica de la Mujer, an institution dedicated to performing diagnostic confirmation of women with altered cytologies. All the records of the institution's database corresponding to the women who consulted during the period 2012-2017 were analyzed, a total of 55,655 women. Results: The records of 55,655 users were analyzed, the median age was 40 years (RIQ 19) and 66.1% (36,812) belonged to the subsidized regime. The main indication for performing colposcopy was cytological alterations with 89.8% (49984) and the most frequent was LIEBG 35.3% (19649). The main cancer diagnosed was squamous cells with 0.5% (284) and the associated factors were residing in the Valle de Aburrá (OR 0.60 IC 0.42-0.84) and the LIEAG cytology result (OR 3.31 IC 2.22-4.94). Conclusions: A cervical cancer prevalence of 7.8 was found for every 1000 patients who consulted the IPS.

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Objetivo: Com o presente estudo, buscou-se verificar a quantidade de exames de colpocitologia oncótica coletados em Unidade Básica de Saúde (UBS) escolhida, determinar quantas e quais são as alterações encontradas nesses exames e quais foram as condutas e acompanhamentos realizados em pacientes com exames alterados. Métodos: Foram analisados 446 exames de colpocitologia oncótica realizados em uma UBS do centro-oeste do Paraná. As pacientes com exame alterado foram selecionadas e foi feita uma análise desses prontuários a fim de verificar a conduta e o acompanhamento dessas pacientes. Resultados: Foram encontrados 32 exames com alterações, sendo três de uma mesma paciente. Dessas 30 pacientes, a grande maioria correspondia a células escamosas atípicas de significado indeterminado (ASC-US), possivelmente não neoplásicas, e 28 pacientes retornaram para receber uma conduta inicial, sendo principalmente o encaminhamento para a coleta de novo preventivo em seis meses ao serviço de oncologia clínica. Conclusão: O presente estudo concluiu que a hipótese principal foi verdadeira, a qual foi descrita como prevalência significativa de lesões intraepiteliais de alto grau, embora não seja a mais frequente, e descontinuidade por parte das pacientes que obtiveram esse resultado. Além disso, notou-se grande encaminhamento à atenção terciária, o que não é indicado pelo Ministério da Saúde.(AU)

Objective: With the present study, we sought to verify the amount of cytopathological tests collected in the chosen basic health unit, to determine how many and what are the alterations found in these tests and what were the conducts and follow-ups performed in patients with altered exams. Methods: We analyzed 446 preventive tests performed in a basic health unit in the Midwest of Paraná, and patients with altered examination were selected and an analysis of these medical records was made in order to verify the conduct and follow-up of the patients. Results: Thirty-two tests with alterations were performed, 3 of which were the same patient. Of these 30 patients, the vast majority corresponded to atypical cells of squamous meaning ­ possibly non-neoplastic (ASC-US), and 28 patients returned to receive an initial approach, mainly being referred to the collection of preventive new in 6 months and to the clinical oncology service. Conclusion: The present study concluded that the main hypothesis was true, which was described as a significant prevalence of high-grade intraepithelial lesions (HSIL), although not the most frequent, and discontinuity on the part of the patients who obtained this result. In addition, there was a large referral to tertiary care, which is not indicated by the Ministry of Health.(AU)

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INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública, siendo una de las principales causas de morbilidad y mortalidad en países en vía de desarrollo. Para el screening y diagnóstico de las lesiones del cuello uterino se realiza citología cervical (Papanicolaou). Ante un reporte de citología sospechosa, la colposcopia es un procedimiento imprescindible en la evaluación del tracto genital inferior para detectar lesiones tempranas y cáncer. El objetivo de la presente investigación fue caracterizar los procedimientos colposcópicos realizados, como método diagnóstico y terapéutico, en las pacientes con resultados anormales del Papanicolaou. MATERIALES Y MÉTODOS: El presente es un estudio observacional, descriptivo de corte transversal, cuyo universo lo conformaron todas las pacientes con diagnóstico citológico anormal en Papanicolaou, que se realizaron un procedimiento colposcópico entre el año 2015 hasta el año 2019 en el Hospital José Carrasco Arteaga, con un total de 1 628 pacientes. RESULTADOS: Se incluyen 1 628 procedimientos colposcópicos. El 55.46% de la población estuvieron entre los 27 a 46 años de edad. El estado civil predominante fue casada (75%). El 63.45% de las mujeres iniciaron vida sexual entre los 21 a 30 años. El 95.20% de las pacientes tuvieron entre 1 y 3 parejas sexuales. Los resultados de Papanicolaou anormales representan; el 37.28% a LIE-BG, seguido de 35.81% con ASC-US y 14.18% como LIE-AG. El 67.32% de colposcopías fueron satisfactorias. Se realizó biopsia en el 71% de las pacientes, seguido de la toma de muestra de cono con ASA-LEEP (13.69%), legrado endocervical en el 11.05%. Los resultados de anatomía patológica reportaron LIE-AG en 46.56% de los casos, seguido de 22.23 % como LIE-BG y cervicitis crónica en el 16.27%, 12.28% de los resultados fueron negativos. CONCLUSIÓN: Tres cuartas partes de las colposcopias se realizaron en mujeres entre los 27 y 56 años de edad. Los resultados anormales más frecuentemente encontrados en el Papanicolaou fueron: LIE-BG, seguido de ASC-US. 67% de las colposcopias realizadas fueron satisfactorias. Tras la colposcopia, en la mayoría de pacientes se realizó biopsia, en un menor porcentaje y en orden de frecuencia: conización electro quirúrgica con asa (ASA-LEEP), legrado endocervical e histerectomía diagnóstica. Los resultados de anatomía patológica reportaron LIE-AG en el 46.56%, LIE-BG en el 22.23 % como y cervicitis crónica en el 16.27%; 12.28% de estudios fueron negativos.(au)

BACKGROUND: Cervical cancer is a public health issue, being one of the main causes of morbidity and mortality in developing countries. Cervical cytology (Papanicolaou) is performed for screening and diagnosis of cervical lesions. In case of a suspicious cytology report, colposcopy is an essential procedure for evaluation of the lower genital tract, to detect early lesions and cancer. The aim of this study was to characterize the colposcopy procedures performed, as a diagnostic and therapeutic method, in patients with abnormal Papanicolaou results. METHODS: This is an observational, descriptive cross-sectional study, whose universe were all the patients with abnormal cytological diagnosis in pap smear, who underwent a colposcopy procedure between 2015 and 2019 at Hospital José Carrasco Arteaga, with a total of 1 628 patients. RESULTS: 1 628 colposcopic procedures were included. 55.46% of the population were between 27 to 46 years of age. The predominant marital status was married status (75%). 63.45% of women had their first sexual experience between 21 and 30 years of age. 95.20% of the patients had between 1 and 3 sexual partners. Abnormal pap smear results represent; 37.28% to LSIL, followed by ASC-US (35.81%), and HSIL (14.18%). 67.32% of colposcopies were classified as satisfactory. Biopsy was performed in 71% of the patients, followed by loop electrosurgical excision procedure (LEEP) (13.69%), endocervical curettage in 11.05%. The pathology results reported HSIL in 46.56% of the cases, followed by 22.23% as LSIL and chronic cervicitis in 16.27%, 12.28% of the results were negative. CONCLUSION: Three-quarters of all colposcopies were performed on women between 27 and 56 years of age. The most frequently abnormal Pap smear results were: LSIL, followed ASC-US. 67% of the colposcopies were satisfactory. After colposcopy, biopsy was performed in most of the patients, in lower percentage: loop electrosurgical excision procedure (LEEP), endocervical curettage and diagnostic hysterectomy. Pathology results reported HSIL in 46.56%, LSIL IN 22.23% and chronic cervicitis in 16.27%; 12.28% of studies were negative.(au)

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Avaliar a estrogenização tópica vaginal no seguimento de citologia oncótica de significado indeterminado, tipo ASC-H, na pós-menopausa. Estudo, tipo caso-controle, que avaliou mulheres menopausadas com diagnóstico de ASC-H, divididas em dois grupos, com e sem uso de estrogênio tópico vaginal (GE e GNE). Foi calculada razão de chance a partir de tabelas de contingência construídas com variação robusta. Foram analisados 128 prontuários, sendo 27% de pacientes do GNE e 72% do GE. Houve aumento de diagnósticos ASC-H no GNE. No GE, aproximadamente 68 vezes menos colposcopias inadequadas e diminuição do número de colposcopias e Cirurgia de Alta Frequência (CAF), com evidência na redução em 21 e 12,5 vezes, respectivamente. Diminuição do número de colposcopias com melhor adequação ao exame, número de biópsias inalterado e diminuição do número de cirurgias de alta frequência, no grupo com uso de estrogênio tópico vaginal durante o seguimento.

Current paper evaluates topic vaginal estrogenization following oncotic cytology of undetermined significance, type ASC-H, in postmenopausal women. A case-control study evaluated menopausal women diagnosed with ASC-H, divided into two groups, with and without the use of topic vaginal estrogen (GE and GNE). Odds ratios were calculated from contingency tables built with robust variation. 128 medical records were analyzed, 27% of which were from the GNE and 72% from the GE. There was an increase in ASC-H diagnoses in GNE. In GE, approximately 68 times less inappropriate colposcopies and a decrease in the number of colposcopies and High Frequency Surgery (HFS), with a reduction of 21 and 12.5 times, respectively. Decrease in the number of colposcopies with better adaptation to the exam, unchanged number of biopsies and decrease in the number of high-frequency surgeries, in the group using topic vaginal estrogen during the follow-up.

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Resumen Introducción: Actualmente, el cáncer de cérvix sigue siendo una enfermedad importante por su incidencia y mortalidad. Aunque se conoce su etiología generada por la infección del virus del Papiloma Humano (PVH) y sus métodos de tamizaje como la citología convencional y el test de ADN-PVH, aún es necesario reconocer diversas características que se relacionan con la aparición de este tipo de cáncer. Objetivo: Describir las características citológicas previas al diagnóstico de cáncer cervical en mujeres de una institución de salud de la ciudad de Medellín. Materiales y métodos: Estudio descriptivo. Se tomaron los registros clínicos correspondientes a mujeres con diagnóstico confirmado de cáncer de cérvix entre 2012 y 2017 y se revisaron los resultados de citología previos al diagnóstico. Se realizó análisis univariado para describir las variables de estudio. Resultados: La muestra de mujeres con cáncer fue de 714, la mediana de edad fue 51 años (rango intercuartílico: 42-60), la alteración citológica más frecuente fue lesión intraepitelial de alto grado (33,8%), el principal cáncer diagnosticado fue carcinoma escamocelular (70,6%). Conclusiones: Los resultados de citología alteradas son un indicador para riesgo de cáncer de cérvix, de ahí la importancia de continuar con el protocolo de tamizaje establecido.

Abstract Introduction: Currently, cervical cancer continues to be an important disease because of its high incidence and mortality. Even though its etiology (Human Papilloma Virus infection) and screening methods (conventional cytology and HPV-DNA test) are well known, understanding the various characteristics associated with the appearance of cervical cancer is fundamental. Objective: To describe the cytological characteristics that precede the diagnosis of cervical cancer in women diagnosed in a health care institution from the city of Medellín. Materials and methods: A descriptive study. The clinical records corresponding to women with a confirmed diagnosis of cervical cancer between 2012 and 2017 were used. Also, the citology results obtained before the diagnosis were reviewed. An univariate analysis was carried out in oder to describe the study variables. Results: The sample size of women with cervical cancer was 714, the age median was 51 years old (interquartile range: 42-60), the most frequent cytological alteration was high-grade intraepithelial lesion (33.8%), and the main diagnosed cancer type was squamous cell carcinoma (70.6%). Conclusions: Results showing an altered cytology are indicators of cervical cancer risk. Therefore, it is important to continue with the stablished screening protocol.

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Introducción: La citología cervicouterina es la prueba de tamización utilizada para identificar cambios celulares de forma temprana Objetivo: Describir las características sociodemográficas y clínicas de las mujeres con alteraciones citológicas tipo Ascus. Métodos: Estudio observacional. Se analizaron reportes citológicos de Ascus durante el período 2012-2017. Se realizó análisis univariado para describir las variables de estudio. Resultados: La mediana de edad fue 42 años (RIQ 18), el 58,8 % pertenecía al régimen subsidiado de salud. El resultado de la colposcopia fue negativo con un 84,9 %. De las 21180 usuarias se les realizó biopsia al 38,7 % y se encontró resultado negativo al 80 %. La alteración histológica más frecuente en las mujeres entre 40 y 59 años fue el adenocarcinoma en un 66,7 %. Conclusión: Las alteraciones citológicas tipo Ascus siguen siendo frecuentes, por lo que es importante continuar con un adecuado cumplimiento de los programas para detección temprana de cáncer de cuello uterino, especialmente en mujeres a partir de los 40 años.

Introduction: Cervical cytology is the screening test used to identify early cellular changes. Objective: To describe the sociodemographic and clinical characteristics of women with ASCUS-type cytological alterations. Method: Observational study. Cytological reports of AS-CUS were analyzed during the period 2012-2017. Univariate analysis was performed to describe the study variables. Results: The median age was 42 years (IQR 18), 58.8% belonged to the subsidized health regime. The colposcopy result was negative with 84.9%. Of the 21,180 users, a biopsy was performed in 38.7%, finding a negative result in 80%, the most frequent histological alteration in women between 40 and 59 years was adenocarcinoma in 66.7%. Conclusion: ASCUS-type cytological alterations are still frequent, so it is important to continue with adequate compliance with programs for early detection of cervical cancer, especially in women over 40 years old.

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Objetivos del trabajo: Se determinaron los porcentajes de las lesiones precancerosas de cuello uterino en un grupo de mujeres diagnosticadas positivas por la prueba ADN-VPH. Materiales y métodos: El presente estudio es un análisis exploratorio descriptivo transversal de una base de datos con resultados de las pruebas de ADN-VPH (genotipo y tipo de infección), citología y colposcopia, realizadas en 58 mujeres de 30 años o más, para el periodo de octubre del 2018 a febrero del 2019. Resultados: De las 58 mujeres positivas para la prueba ADN-VPH, el 57% (n=33) fueron positivas para la prueba citológica cervical. De este grupo de mujeres fueron diagnosticadas negativas para LEI el 21% (n=7); para LEI-BG el 33% (n=11); y para LEI-AG el 45% (n=15) mediante la prueba de colposcopia. El VPH-16 mostró la mayor frecuencia relativa de detección en las LEI-AG con un 46,7% (n=7). Igualmente, los genotipos que cubre la vacuna Gardasil_4 fueron identificados en mayor porcentaje en las LEI-AG en comparación con los otros tipos histopatológicos diagnosticados, siendo esta asociación estadísticamente significativa, valor de p = 0,033. Conclusiones: La implementación de la nueva guía de práctica clínica para la detección y manejo de lesiones precancerosas de cuello uterino muestra resultados satisfactorios, siendo concordante la detección de ADN-VPH, con la identificación de anormalidades citológicas e histopatológicas, permitiendo la identificación precoz de mujeres en riesgo de desarrollar cáncer cervical.

Objectives of the study: To determine the percentages of precancerous lesions in the cervix in a group of women with positive diagnostic to the DNA-HPV test. Materials and methods: The present study is a cross-sectional exploratory analysis of a database with information on the results of DNA-HPV tests (genotype and type of infection), cytology and colposcopy, carried out on 58 women aged 30 or older, for the period from October 2018 to February 2019. Results: Of the 58 women positive for the DNA-HPV test, 57% (n=33) were positive for the cervical cytology test. Of this group of women, 21% (n=7) were diagnosed LEI-negative; for LEI-BG 33% (n=11); and for LEI-AG, 45% (n=15) using the colposcopy test. HPV-16 has a higher detection frequency in the LEI-AG with 46.7% (n=7). Likewise, the genotypes that cover the Gardasil_4 vaccine were members in a greater percentage in the LEI-AG in comparison with other diagnosed histopathological types, this association being statistically significant, value of p = 0.033. Conclusions: The implementation of the new clinical practice guideline for the detection and management of precancerous lesions of the cervix shows satisfactory results, the DNA-HPV detection being consistent, with the identification of cytological and histopathological abnormalities, allowing the early identification of women at risk to develop cervical cancer.

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RESUMEN Fundamento: los factores de riesgo de las lesiones intraepiteliales se comportan similares a los del cáncer cervicouterino. Objetivo: identificar la influencia de distintos factores de riesgo relacionados con la aparición de lesiones intraepiteliales de cuello uterino. Método: se realizó un estudio observacional de casos y controles en el Policlínico Docente Gustavo Aldereguía de la provincia Granma en el período comprendido desde el 1ro de enero del 2016 hasta el 30 de junio del 2017. Se definieron como casos a las 105 pacientes con neoplasia intraepitelial cervical confirmadas histopatológicamente y como controles a las mujeres que se les realizó la prueba citológica, seleccionadas por muestreo simple aleatorio. A cada paciente se le realizó: interrogatorio, examen físico y medios de diagnóstico. Para el análisis de los factores de riesgo se utilizó una estrategia univariada y multivariada. Se delimitaron como variables explicativas aquellos factores considerados como hipotéticamente de riesgo y que serían sometidos a evaluación. Como variable respuesta se consideró la aparición de la neoplasia intraepitelial. Se obtuvieron estimaciones puntuales y por intervalo de confianza del 95 %. Resultados: la sepsis vaginal y menarquía precoz fueron significativas, no así el no uso del condón, infección por virus del papiloma humano, anticoncepción oral, edad, dispositivo intrauterino y tabaquismo como factores indiferentes. La erosión y sepsis vaginal fueron los más significativos por el modelo de regresión logística. Hubo interacciones entre cervicitis, múltiples parejas sexuales y tabaquismo; moderadamente significativo se comportaron la edad y la menarquía precoz; cervicitis y erosión, infección por el virus del papiloma humano y múltiples parejas sexuales. Conclusiones: se determinó que la sepsis vaginal y la erosión cervical presentaron una asociación estadísticamente significativa e importante con la probabilidad de aparición de las lesiones intraepiteliales propias del cuello uterino.

ABSTRACT Foundation: the risk factors of intraepithelial lesions behave similar to those of cervical cancer. Objective: to identify the influence of different risk factors related to the appearance of intraepithelial lesions of the cervix. Method: an observational case-control study was carried out in the Gustavo Aldereguía Teaching Polyclinic of the Granma province in the period from January 1, 2016 to June 30, 2017. The 105 patients with cervical intraepithelial neoplasia were defined as cases histopathologically confirmed and as controls to women who underwent the cytological test, selected by simple random sampling. Each patient was performed: interview, physical examination and diagnostic means. For the analysis of risk factors, a univariate and multivariate strategy was used. Explanatory variables were defined as factors considered as hypothetically risky which would be subject to evaluation. The appearance of intraepithelial neoplasia was considered as a response variable. Punctual and 95 % confidence interval estimates were obtained. Results: vaginal sepsis and early menarche were noticeable, however not the use of condoms, human papillomavirus infection, oral contraception, age, intrauterine device and smoking as indifferent factors. Erosion and vaginal sepsis were the most significant due to the logistic regression model. There were interactions between cervicitis, multiple sexual partners and smoking; moderately significant were age and early menarche; cervicitis and erosion, human papillomavirus infection and multiple sexual partners. Conclusions: it was determined that vaginal sepsis and cervical erosion presented a statistically significant and important association with the probability of the appearance of intraepithelial lesions of the cervix.

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INTRODUCCIÓN. El cáncer cérvico-uterino tiene una fase precursora de larga duración, pues debe pasar por varios estados previos al cáncer invasivo, denominados lesiones intraepiteliales, de bajo y de alto grado, que pueden transformarse en lesiones malignas. La importancia de un diagnóstico oportuno y certero de las lesiones intraepiteliales escamosas de alto grado radica en que, si son tratadas de manera oportuna, son ciento por ciento curables. OBJETIVO. Proporcionar información actualizada sobre el diagnóstico y tratamiento de las lesiones precursoras de cáncer de cérvix y ayudar a los profesionales en la toma de decisiones médicas. MATERIALES Y MÉTODOS. Estudio de revisión de 45 artículos científicos la gran mayoría de la última década y, unos pocos, con datos históricos vigentes sobre lesiones intraepiteliales escamosas de alto grado del cuello uterino. La búsqueda se realizó en MedLine, PLoS y Scielo utilizando los términos tamizaje, neoplasias uterinas, lesiones intraepiteliales escamosas de cuello uterino y tratamiento. RESULTADOS. Los artículos científicos fueron seleccionados por niveles de evidencia 1 y 2, con recomendaciones A y B. Las recomendaciones de inicio de tamizaje han cambiado y el manejo toma en cuenta el riesgo acumulado por tipo de lesión. El tratamiento, en la mayoría de casos, es la escisión y resulta definitivo. CONCLUSIÓN. El diagnóstico sigue siendo cito-colpo-histológico y el tratamiento depende de la edad de la paciente, pudiendo las posibilidades ir de la observación hasta la escisión quirúrgica y, en casos específicos, la histerectomía.

INTRODUCTION. Cervical-uterine cancer has a long-term precursor phase, as it must go through several states prior to invasive cancer, called intraepithelial lesions, low and high grade, which can become malignant lesions. The importance of a timely and accurate diagnosis of high-grade squamous intraepithelial lesions is that, if treated in a timely manner, they are one hundred percent curable. OBJECTIVE. Provide updated information on the diagnosis and treatment of precursor lesions of cervical cancer and assist professionals in medical decision making. MATERIALS AND METHODS. Review study of 45 scientific articles the vast majority of the last decade and, a few, with current historical data on high-grade squamous intraepithelial lesions of the cervix. The search was conducted in MedLine, PLoS and Scielo using the terms screening, uterine neoplasms, squamous intraepithelial lesions of the cervix and treatment. RESULTS. The scientific articles were selected by levels of evidence 1 and 2, with recommendations A and B. The recommendations for starting screening have changed and management takes into account the accumulated risk by type of injury. The treatment, in most cases, is excision and is definitive. CONCLUSION. The diagnosis is still cyto-histological and the treatment depends on the age of the patient, and the possibilities may range from observation to surgical excision and, in specific cases, hysterectomy.

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Abstract Objective To estimate the cytological and colposcopic performances for the diagnosis of cervical neoplasias. Methods Cross-sectional retrospective study with data from patients' charts. The participants underwent colposcopy, guided biopsies, and excision when needed. The cytological and colposcopic categorization followed the Bethesda System and the international colposcopic terminologies. The cytology and colposcopy performances were evaluated by sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) analyses with 95% confidence interval (95% CI). Results From 1,571 participants, a total of 1,154 (73.4%) were diagnosed with cervical squamous intraepithelial neoplasia grade 2 or worse (CIN 2+), 114 (7.2%) with adenocarcinoma in situ or worse (AIS+), 615 (39.2%) presented atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or worse (ASC-H+) cytology, and 934 (59.4%) presented major or suspicious for invasion colposcopic abnormalities. The SE, SP, PPV, and NPV of ASC-H+ for diagnoses of CIN 2+ and AIS+ were, respectively: 44% (95% CI: 41-47) and 72% (95% CI: 67-76), 79% (95% CI: 77-81) and 79% (95% CI: 75-83), 88% (95% CI: 87-90) and 55% (95% CI: 50-60), and 28% (95% CI: 26-31) and 88% (95% CI: 85-91). The SE, SP, PPV, and NPV of major or suspicious for invasion colposcopic abnormalities for diagnoses of CIN 2+ and AIS+were, respectively: 62% (95% CI: 60-65) and 86% (95% CI: 83-89), 59% (95% CI: 57-62) and 59% (95% CI: 55-64), 85% (95% CI: 83-87) and 44% (95% CI: 40-49), and 29% (95% CI: 27-32) and 92% (95% CI: 89-94). Conclusion The SE analyses results of ASC-H+ and major or suspicious for invasion colposcopic abnormalities were higher for diagnoses of glandular neoplasias. These results confirm the role of cytology in identifying women at risk who will have their final diagnoses settled by colposcopy and histology.

Resumo Objetivo Estimar o desempenho da citologia e colposcopia no diagnóstico das neoplasias cervicais. Métodos Estudo retrospectivo de corte transversal com dados coletados em prontuários. Foram incluídas participantes que foram submetidas a colposcopia, biópsia e excisão quando necessário. A categorização da citologia e da colposcopia seguiram a terminologia de Bethesda e a classificação colposcópica internacional. Os desempenhos da citologia e colposcopia foram avaliados por análises de sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com intervalos de confiança de 95% (IC 95%). Resultados Das 1.571 participantes, um total de 1.154 (73,4%) foram diagnosticadas com neoplasia intraepitelial escamosa cervical de grau 2 ou mais grave (NIC 2+), 114 (7,2%) com adenocarcinoma in situ ou mais grave (AIS+), 615 (39,2%) apresentaram células escamosas atípicas de significado indeterminado, quando não se pode excluir lesão intraepitelial de alto grau ou mais grave (ASC-H+) e 934 (59,4%) tiveram achados colposcópicos maiores ou suspeitos de invasão. Os valores de S, E, VPP e VPN das ASCH + para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 44% (IC 95%: 41-47) e 72% (IC 95%: 67-76), 79% (IC 95%: 77-81) e 79% (IC 95%: 75-83), 88% (IC 95%: 87-90) e 55% (IC 95%: 50-60) e 28% (IC 95%: 26-31) e 88% (IC 95%: 85-91). Os valores de S, E, VPP e VPN dos achados colposcópicos maiores ou suspeitos de invasão para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 62% (IC 95%: 60-65) e 86% (IC 95%: 83-89), 59% (IC 95%: 57-62) e 59% (IC 95%: 55-64), 85% (IC 95%: 83-87) e 44% (IC 95%: 40-49) e 29% (IC 95%: 27-32) e 92% (IC 95%: 89-94). Conclusão Os resultados das análises de S de ASC-H+ e achados colposcópicos maiores ou suspeitos de invasão foram mais elevados para o diagnóstico das neoplasias glandulares. Esses resultados confirmam o papel da citologia na identificação de mulheres em risco que terão seus diagnósticos definidos por colposcopia e histologia.

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Introdução: O câncer de colo do útero ainda é um sério problema de saúde pública em nosso país. Aparece em terceiro lugar entre os tipos de câncer mais comum entre as mulheres. Vários são os fatores envolvidos na etiologia desse câncer e suas lesões precursoras. Objetivo: Verificar os principais cofatores associados às alterações cervicouterinas. Casuística e Métodos: Trata-se de um estudo analítico e documental, realizado em um laboratório do município de Surubim-PE, incluindo resultados de exames citopatológicos do período de janeiro de 2014 a dezembro de 2015. Os dados foram avaliados pelo programa PRISM versão 7.0, por meio do teste Qui-quadrado, com intervalo de confiança 95% e razão de prevalência (RP). Resultados: Foram incluídos 1.200 resultados de exames de mulheres na faixa etária entre 14 e 78 anos. Quarenta e três por cento das mulheres pertenciam à faixa etária entre 31 e 47 anos e 86,6% haviam realizado seu último exame citopatológico a menos de três anos. A faixa etária entre 14 e 30 anos esteve associada a um maior risco para o desenvolvimento das anormalidades cervicais (p< 0,001 e OR 2,9). Mulheres que realizaram o exame citopatológico a menos de três anos apresentaram uma maior associação com a presença de lesões intraepiteliais escamosas de baixo grau (LSIL) e atipias escamosas (p < 0,0001 e OR 11,3). A lesão intraepitelial escamosa de baixo grau foi a anormalidade cervical de maior frequência, correspondendo a 46,3%. Mulheres com presença de Gardnerella vaginalis e/ou Mobiluncus spp. apresentaram associação com a presença de anormalidades cervicais (p< 0,0001). Conclusão: Mulheres abaixo de 30 anos, que realizaram exame citopatológico a menos de três anos ou apresentam Gardnerella vaginalis e/ou Mobiluncus spp.devem ser acompanhadas quanto aos possíveis riscos associados ao desenvolvimentode alterações cervicouterinas.

Introduction: Cervical cancer is still a serious public health problem in our country. It appears third among the most common types of cancer among women. Several are the factors involved in the etiology of this cancer and its precursor lesions. Objective: Verify the main cofactors associated with the changes in the cervix of the uterus. Patients and Methods:This is an analytical and documentary study, carried out in a laboratory in the municipality of Surubim-PE, including results of cytopathological exams from January 2014 to December 2015. Data were evaluated using the software PRISM version 7.0, by the Chi-square test, with 95% confidence interval and prevalence ratio (PR). Results: We included 1,200 tests results of women in the age between 14 and 78 years. Forty-three percent of the women were in the age group from 31 to 47 years and 86.6% had performed their last cytopathological examination less than three years. The age group ranging from 14 to 30 years was associated with a higher risk for the development of cervical abnormalities (p< 0.001 and OR 2.9). Women who underwent cytopathological examination less than three years presented a greater association with the presence of low squamous intraepithelial lesions (LSIL) and squamous atypia (p< 0.0001 and OR 11.3). The low-grade squamous intraepithelial lesion was the most frequent cervical abnormality, corresponding to 46.3%. Conclusion: Women under 30 years, who performed cytopathological examination at less than three years or present Gardnerella vaginalis and / or Mobiluncus spp. should be accompanied for the possible risks associated with the development of the changes in the cervix of uterus.

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OBJECTIVE: Our goal was to develop a tele-colposcopy platform for primary-care clinics to improve screening sensitivity and access. Specifically, we developed a low-cost, portable Pocket colposcope and evaluated its performance in a tertiary healthcare centre in Peru. DESIGN AND SETTING: Images of the cervix were captured with a standard-of-care and Pocket colposcope at la Liga Contra el Cáncer in Lima, Peru. POPULATION: Two hundred Peruvian women with abnormal cytology and/or human papillomavirus positivity were enrolled. METHODS: Images were collected using acetic acid and Lugol's iodine as contrast agents. Biopsies were taken as per standard-of-care procedures. MAIN OUTCOME MEASURES: After passing quality review, images from 129 women were sent to four physicians who provided a diagnosis for each image. RESULTS: Physician interpretation of images from the two colposcopes agreed 83.1% of the time. The average sensitivity and specificity of physician interpretation compared with pathology was similar for the Pocket (sensitivity = 71.2%, specificity = 57.5%) and standard-of-care (sensitivity = 79.8%, specificity = 56.6%) colposcopes. When compared with a previous study where only acetic acid was applied to the cervix, results indicated that adding Lugol's iodine as a secondary contrast agent improved the percent agreement between colposcopes for all pathological categories by up to 8.9% and the sensitivity and specificity of physician interpretation compared with pathology by over 6.0 and 9.0%, respectively. CONCLUSIONS: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when used to identify precancerous and cancerous lesions using acetic acid and Lugol's iodine during colposcopy examinations in Peru. TWEETABLE ABSTRACT: The Pocket colposcope performance was similar to that of a standard-of-care colposcope when identifying cervical lesions.

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El proceso investigativo tuvo un enfoque cuantitativo, de tipo observacional, descriptivo, transversal; con el propósito de caracterizar las lesiones intraepiteliales en 100 pacientes del cantón Penipe, con edades comprendidas entre 20 a 65 años, que asistieron a consulta gineco-lógica del Centro de Erradicación del Bocio y Capacitación a Minusválidos (CEBYCAM), durante el mes de noviembre de 2014. Los datos fueron obtenidos empleando la técnica de la medición, a través del empleo del Sistema Internacional de Reporte de Bethesda. El prome-dio de la edad fue 41.44 años (± 13.60); la media aritmética de la edad de inicio de las relacio-nes sexuales fue de 16,37 (± 4.49); predominaron las mujeres con dos hijos, aquellas cuyo test resultó negativo (88 %) y las que no utilizaban algún método anticonceptivo, así como para la presencia de microorganismos con potencial patológico. La prueba de correlación de Pearson arrojó la existencia de una relación fuerte y positiva entre las variables paridad y edad.

The researching process had a quantitative, observational, descriptive, cross-sectional approach. It aimed to characterize the intraepithelial lesions in 100 patients from Penipe town, aged between 20 and 65 years, who are treated at the gynecological consultation of Centro de Erradicación del Bocio y Capacitación a Minusválidos during the month of November 2014. The data were obtained through the use of the Bethesda International Reporting System measurement technique. The age was on average 41.44 (± 13.60); the arithmetic mean of the age of onset of sexual intercourse was 16.37 (± 4.49); women with two children predominated, those whose test was negative (88%) and those who did not use any contraceptive method, as well as the presence of microorganisms with pathological potential. The Pearson correlation test showed the existence of a strong and positive relationship between parity and age variables.

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ResumenObjetivo:conocer la incidencia y comportamiento del carcinoma epidermoide de cérvix, tanto in situ/neoplasia intraepitelial cervical grado tres, como invasor, en las mujeres diagnosticadas en el Servicio de Patología del Hospital "Dr. Escalante Pradilla" en el periodo 2007 - 2015.Métodos:se realizó un estudio retrospectivo con los datos de los archivos del Servicio de Patología. Se incluyeron todas las mujeres diagnosticadas con cáncer epidermoide de cérvix (in situ/NIC3 e invasor), para 461 mujeres en el periodo de nueve años. Las variables por estudiar fueron: tipo de cáncer, edad y año al diagnóstico, cantón de procedencia y resultados citológicos dos años previos al diagnóstico de cáncer. Para los cálculos de incidencia, se utilizaron tasas ajustadas por 10.000 habitantes en las tasas por cantón y por 100.000 habitantes en las tasas de la región Brunca.Resultados:se documentó un aumento en la incidencia de cáncer de cérvix, desde 2012. El grupo de edad más afectado de manera global fue el de 26-30 años, pero en carcinoma invasor fue de 46-50 años. A nivel cantonal se observa una diferencia marcada en cuanto a toma de citología, siendo el cantón de Corredores el de menor cobertura citológica y, a su vez, mayor tasa de carcinoma invasor.Conclusión:la región Brunca presentó un aumento en la incidencia de cáncer de cérvix en el periodo estudiado, y se documentó que regiones con menor cobertura tuvieron mayores tasas de carcinomas invasores. Es fundamental fortalecer las regiones vulnerables.

AbstractObjective:Evaluate the incidence and behavior of squamous cervical cancer, both in situ/cervical intraepithelial neoplasia grade 3 and invasive carcinomas in women diagnosed in the "Dr. Escalante Pradilla" Hospital Pathology Service between the years 2007 to 2015.Methods:A retrospective study was carried out with the data obtained from the files of the Pathology Service. We included all women diagnosed in this service with epidermoid cervical cancer (in situ/NIC3 and invasive) for a total of 461 women in the nine-year period. The variables to be studied were cancer type, age and year at diagnosis, residence and cytological results two years prior to tthe cancer diagnosis. For the incidence calculations, adjusted rates per 10,000 inhabitants were used in the rates per place of residence and per 100,000 inhabitants in the Brunca region rates.Results:It was documented an increase in the incidence of cervical cancer since 2012. The age group most affected globally is 26-30 years, but in invasive carcinoma it's the group of 46-50 years.At cantonal level, there is a marked difference in cytology, with the canton of Corredores having the lowest cytological coverage and, at the same time, a higher rate of invasive carcinoma.Conclusion:The Brunca region is showing an increase in the incidence of cervical cancer and it was documented that regions with lower coverage, had higher rates of invasive carcinomas. The cervical cytology screening program is an effective prevention method if used appropriately. It is essential to strengthen the program in vulnerable regions, since screening coverage is inversely proportional to the incidence of cervical cancer.

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RESUMEN OBJETIVO: estimar la prevalencia de cambios y alteraciones cervicales en mujeres pertenecientes al Programa de Prevención y Detección Precoz de Cáncer de Cuello del Útero de Castilla y León, e identificar la coexistencia y genotipo más frecuente del VPH. MATERIALES Y MÉTODOS: estudio cuantitativo, observacional, descriptivo, transversal, retrospectivo, efectuado en mujeres de 25 a 64 años de edad que participaron en las pruebas de cribado de 2012 a 2014. Los resultados de la citología cervical convencional se interpretaron de acuerdo con la clasificación Bethesda 2001. La detección y genotipificación del VPH se realizó con PCR. Las variables cualitativas se describen mediante frecuencias absolutas y relativas (porcentajes) de sus categorías, con IC95% . Para estudiar la asociación entre variables cualitativas se utilizó la prueba de χ2. Se consideró estadísticamente significativo el valor de p≤0.05. RESULTADOS: se analizaron 190,203 muestras de frotis de cuello uterino. El 66.4% de las muestras citológicas no mostró lesiones ni alteraciones morfológicas. De las muestras citológicas con alteraciones se identificaron 7,083 con metaplasia, 2,844 con células escamosas atípicas (1.5%), 855 con lesiones de bajo grado (0.4%), 255 con lesiones de alto grado (0.13%) y 198 con lesiones cancerosas (0.1%). Las lesiones intraepiteliales de bajo y alto grado, además de los carcinomas, fueron más frecuentes en las muestras positivas a VPH (p<0.001). En relación con la atrofia vaginal de mujeres perimenopáusicas, los genotipos más frecuentes fueron el VPH-53 (0.7%), VPH-31 (0.6%) y VPH-58 (0.5%). En pacientes con lesiones intraepiteliales el genotipo más frecuente fue el VPH-16. CONCLUSIONES: la prevalencia del VPH suele ser más alta conforme aumenta la severidad de la lesión citológica detectada. El genotipo aislado con mayor frecuencia en lesiones intraepiteliales de alto o bajo grado es el VPH-16.

ABSTRACT OBJECTIVE: To estimate the prevalence of cervical changes and alterations in women belonging to the Program for the Prevention and Early Detection of Cervical Cancer of Castilla y León, and to identify the most frequent presence and genotype of Human Papilloma Virus (HVP). MATERIAL AND METHODS: A quantitative, observational, descriptive, cross-sectional, retrospective study of women aged 25-64 years who participated in screening tests during 2012 and 2014. The results of conventional cervical cytology were interpreted according with the Bethesda 2001 classification. The detection and genotyping of HPV was performed across PCR. Qualitative variables are described by absolute and relative frequencies (percentages) of their categories, with a 95% confidence interval (CI 95%). To study the association between qualitative variables, the χ2 test was used. The value of p≤0.05 was considered statistically significant. RESULTS: 190,203 samples of cervical smears were analyzed during the period. 66.4% of the cytological samples showed no lesions or morphological alterations. Of the cytological samples with alterations we identified 7,083 with metaplasia, 2,844 with atypical squamous cells (1.5%), 855 with low grade lesions (0.4%), 255 with high grade lesions (0.13%) and 198 with cancerous lesions%). Low- and high-grade intraepithelial lesions, in addition to carcinomas, were more frequent in HPV positive samples (p <0.001). To the vaginal atrophy of perimenopausal women we detected HPV-53 (0.7%), HPV-31 (0.6%) and HPV-58 (0.5%) genotypes. In patients with intraepithelial lesions the most frequent genotype was HPV-16. CONCLUSIONS: the prevalence of HPV is usually higher according to the severity of the cytological lesion detected. The most frequently isolated genotype in high-grade low-grade intraepithelial lesions is HPV-16.

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ABSTRACT Objective To assess cervical cancer prevalence and associated mortality in Grenada, West Indies during 2000–2010. Methods Records of visits to hospital and clinical facilities were obtained from the histopathology laboratory of the Grenada General Hospital. Records were de-identified and electronically compiled. Cervical cancer prevalence was assessed via cross-sectional analysis of this secondary data. Of a total 12 012 records, 2 527 were selected for analysis using sampling without replacement. Cases were matched to corresponding patient data from death registries, where possible, and used to calculate associated mortality rates. Results The observed prevalence of cervical cancer was 52.4 per 100 000 women (ages 15 and above). The highest rates of cervical cancer occurred in the 35–44 age group, with the second highest among 45–64-year-olds. A total of 65 deaths were attributable to cervical cancer during 2000–2010, more than 50% of which were among women > 65 years old. The observed mortality rate was 16.7 per 100 000, almost twice the rate estimated by WHO for the region. Conclusions This study demonstrates the need for a comprehensive cervical cancer-screening program in Grenada. Results should contribute to informing future studies on how to appropriately generate and execute public health policy for education, screening, prevention, and control of cervical cancer in Grenada.

RESUMEN Objetivo Evaluar la prevalencia del cáncer cervicouterino y la mortalidad asociada en Granada, Antillas Menores, entre el 2000 y el 2010. Métodos Se obtuvieron los registros de las visitas al hospital y a consultorios clínicos a partir del laboratorio de histopatología del Hospital General de Granada. Se borraron los datos personales de los registros y se los compiló electrónicamente. La prevalencia de cáncer cervicouterino se evaluó por medio del análisis transversal de estos datos secundarios. De un total de 12 012 registros, fueron seleccionados para el análisis 2 527 mediante un método de muestreo sin reemplazo. Los casos se compararon con los datos correspondientes de pacientes en los registros de defunciones, cuando fue posible, y se usaron para calcular las tasas de mortalidad asociadas. Resultados La prevalencia observada de cáncer cervicouterino fue 52,4 por 100 000 mujeres (de 15 años o más). Las tasas más elevadas de cáncer cervicouterino se observaron en el grupo de edad de 35 a 44 años, seguido por el grupo de 45 a 64 años. Del 2000 al 2010, 65 defunciones fueron atribuibles al cáncer cervicouterino, más del 50% en mujeres mayores de 65 años. La tasa de mortalidad observada fue 16,7 por 100 000, casi el doble de la calculada por la Organización Mundial de la Salud para la región. Conclusiones Este estudio indica la necesidad de establecer un programa integral de detección del cáncer cervicouterino en Granada. Los resultados deben servir como base para estudios futuros sobre cómo generar y ejecutar apropiadamente políticas de salud pública para la educación en la materia, la detección, la prevención y el control del cáncer cervicouterino en Granada.

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